Q Per The Joint Commission, we need clearer nursing titration/pausing guidelines to facilitate serial neurological assessments. How can we titrate or pause sedation/analgesia infusions to facilitate serial neurological assessments as well as “standard” wake-up assessments in a way that is compliant with regulatory agencies?
A Richard Arbour, MSN, RN, CCRN, CNRN, CCNS, CCTC, replies:
The Joint Commission (TJC) overview of sedation, analgesia, restraints, and other practices has added additional requirements to documentation, policies, and clinical review as a means to increase standardization of care and, most importantly, patient safety. In particular, TJC has closely evaluated sedation/analgesia dosing and titration.
Optimal, goal-directed sedation practices are well established and include 4 components. First, validated clinical assessment tools such as the Sedation-Agitation Scale and the Richmond Agitation-Sedation Scale (RASS) are used to determine therapeutic end points for patients who are not pharmacologically paralyzed.1–3 Second, targeted clinical end points for sedative/hypnotic...
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