Sedative and Analgesic Use on Night and Day Shifts in a Pediatric Cardiovascular Intensive Care Unit

Staveski, Sandra L.; Tesoro, Tiffany M.; Cisco, Michael J.; Roth, Stephen J.; Shin, Andrew Y.

doi:10.4037/NCI.0000000000000023

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Features| April 01 2014

Sedative and Analgesic Use on Night and Day Shifts in a Pediatric Cardiovascular Intensive Care Unit

Sandra L. Staveski, RN, MS, CPNP-AC;

Sandra L. Staveski, RN, MS, CPNP-AC

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 ([email protected]). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

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Tiffany M. Tesoro, PharmD;

Tiffany M. Tesoro, PharmD

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 ([email protected]). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

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Michael J. Cisco, MD;

Michael J. Cisco, MD

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 ([email protected]). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

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Stephen J. Roth, MD, MPH;

Stephen J. Roth, MD, MPH

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 ([email protected]). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

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Andrew Y. Shin, MD

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 ([email protected]). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

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AACN Adv Crit Care (2014) 25 (2): 114–118.

https://doi.org/10.4037/NCI.0000000000000023

Introduction:

The use of sedative and analgesic medications is directly linked to patient outcomes. The practice of administering as-needed sedative or analgesic medications deserves further exploration. We hypothesized that important variations exist in the practice of administering as-needed medications in the intensive care unit (ICU). We aimed to determine the influence of time of day on the practice of administering as-needed sedative or analgesic medications to children in the ICU.

Methods:

Medication administration records of patients admitted to our pediatric cardiovascular ICU during a 4-month period were reviewed to determine the frequency and timing of as-needed medication usage by shift.

Results:

A total of 152 ICU admissions (1854 patient days) were reviewed. A significantly greater number of as-needed doses were administered during the night shift (fentanyl, P = .005; lorazepam, P = .03; midazolam, P = .0003; diphenhydramine, P = .0003; and chloral hydrate, P = .0006). These differences remained statistically significant after excluding doses given during the first 6 hours after cardiovascular surgery. Morphine administration was similar between shifts (P = .08).

Conclusions:

We identified a pattern of increased administration of as-needed sedative or analgesic medications during nights. Further research is needed to identify the underlying causes of this practice variation.

2014

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Sedative and Analgesic Use on Night and Day Shifts in a Pediatric Cardiovascular Intensive Care Unit

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