[Establishment of a nursing-driven sedation protocol: effect on the sedation level and accidental withdrawal of tubes and catheters]. / Implementación de un protocolo de sedación dirigido por enfermería: efecto sobre el nivel de sedación y la retirada accidental de tubos y catéteres.

INTRODUCTION: Mechanically ventilated patients require sedation during ventilatory support. Our study has aimed to determine if the effects on the sedation level of a nursing-driven sedation protocol has any influence in the accidental removal of tubes and catheters. MATERIAL AND METHODS: A quasi-experimental intervention study was performed in a medical-surgical intensive care unit. A 17-month pre-intervention observational period was followed by a 17-month intervention period where a nursing-driven sedation protocol based on the Glasgow Coma Score modified by Cook and Palma was implemented. In both periods, we registered the accidental removals of endotracheal tube, nasogastric tube, urinary catheter and intravascular catheters. RESULTS: A total of 176 patients (age: 65 +/- 17 years; SAPS II: 43 +/- 14) were included in the observation period and 189 patients (age: 65 +/- 15 years; SAPS II: 40 +/- 13) in the intervention period. In second period, the percentage of patients excessively sedated decreased (20% vs. 41%; p = 0.001) and the percentage of patients with optimal sedation increased (53% vs. 35%; p < 0.001). The rate of accidental removals of enteral tubes in the first period was 15.8 per 1,000 tube-days vs. 5.6 in the second period (p = 0.001). No accidental removal of intravascular catheters was found in the second period vs. a rate of 2.6 central venous catheters per 1,000 catheter-days and a rate of 3.4 intra-arterial catheters per 1,000 catheter-days during the first period. CONCLUSIONS: Implementation of a nursing-driven sedation protocol increases the percentage of patients with an optimal sedation and decreases the incidence of accidental removal of tubes and catheters.

Implementación de un protocolo de sedación dirigido por enfermería: efecto sobre el nivel de sedación y la retirada accidental de tubos y catéteres / Establishment of a nursingdriven sedation protocol: effect on the sedation level and accidental withdrawal of tubes and catheters

Introducción. Los pacientes con ventilaciónmecánica requieren sedación durante el soporteventilatorio. El objetivo de nuestro estudio esdeterminar los efectos, sobre el nivel sedación y laretirada accidental de tubos y catéteres, de laaplicación de un protocolo de sedación dirigido porenfermería.Material y métodos. Se trata de un estudio cuasiexperimentalrealizado en una Unidad de CuidadosIntensivos polivalente durante 2 períodos de 17meses: el primero observacional y el segundointervencionista. En el segundo, el personal deenfermería aplicó un protocolo de sedación basadoen la Glasgow Coma Score modificada por Cook yPalma. En ambos períodos fueron recogidas lasretiradas accidentales de tubo endotraqueal, sondasgástrica y vesical y catéteres vasculares.Resultados. Se incluyeron en el estudio 176 pacientes(edad: 65 ± 17 años; SAPS II: 43 ± 14) durante elprimer período y 189 (edad: 65 ± 15 años; SAPS II: 40± 13) durante el segundo. En este último disminuye elporcentaje de pacientes con sedación excesiva (20%frente a 41%; p < 0,001) y aumenta el porcentaje depacientes con sedación óptima (53% frente a 35%; p< 0,001). La tasa de retiradas accidentales de sondasenterales en el primer período fue de 15,8 por 1.000días de sonda frente a 5,6 del segundo período (p =0,001). No observamos ninguna retirada de catéteresvasculares en el segundo período, frente a tasas de2,6 catéteres venosos centrales por 1.000 días decatéter y 3,4 catéteres arteriales por 1.000 días decatéter del primer período. Las tasas de retiradaaccidental de los tubos endotraqueales en ambosperíodos son muy similares. No observamos ningunaretirada accidental de sondas vesicales.Conclusiones. La introducción en la práctica clínicade un protocolo de sedación dirigido por enfermeríaaumenta la cantidad de pacientes óptimamentesedados y disminuye la incidencia de retiradasaccidentales de sondas y catéteres

Introduction. Mechanically ventilated patients require sedation during ventilatory support. Our study has aimed to determine if the effects on the sedation level of a nursing-driven sedation protocol has any influence in the accidental removal of tubes and catheters. Material and methods. A quasi-experimental intervention study was performed in a medical-surgical intensive care unit. A 17-month pre-intervention observational period was followed by a 17-month intervention period where a nursing-driven sedation protocol based on the Glasgow Coma Score modified by Cook and Palma was implemented. In both periods, we registered the accidental removals of endotracheal tube, nasogastric tube, urinary catheter and intravascular catheters. Results. A total of 176 patients (age: 65 ± 17 years; SAPS II: 43 ± 14) were included in the observation period and 189 patients (age: 65 ± 15 years; SAPS II: 40 ± 13) in the intervention period. In second period, the percentage of patients excessively sedated decreased (20% vs. 41%; p = 0.001) and the percentage of patients with optimal sedation increased (53% vs. 35%; p < 0.001). The rate of accidental removals of enteral tubes in the first period was 15.8 per 1,000 tube-days vs. 5.6 in the second period (p = 0.001). No accidental removal of intravascular catheters was found in the second period vs. a rate of 2.6 central venous catheters per 1,000 catheter-days and a rate of 3.4 intra-arterial catheters per 1,000 catheter-days during the first period. Conclusions. Implementation of a nursing-driven sedation protocol increases the percentage of patients with an optimal sedation and decreases the incidence of accidental removal of tubes and catheters