Authors (including presenting author) :
Yeung MF (1), Chan KH (1), Leung CK (1), Lau KL (1), Yim TT (1), Shi YT (1), Kwok MK (2), Hui CM (1)
Affiliation :
(1) Kowloon East Cluster, Department of Intensive Care
(2) Department of Medical Specialties Services of Tseung Kwan O Hospital (TKOH)
Introduction :
Sedation is commonly used for bedside invasive procedures and promote patient comfort for ventilated patients in intensive care unit (ICU), and inappropriate sedation adequacy were found to have adverse effects on patient outcomes such as delirium and safety issues (Jackson et al., 2010). Therefore, the sedation assessment tool provides an objective way to monitor the level of sedation to optimize patient’s sedation level by titration is crucial. TKOH ICU is using Richmond Agitation Sedation Scale (RASS) for sedation titration, and nurses’ compliance rate by using RASS for sedation titration was around 57% due to various reasons during September to November 2023. TKOH ICU would like to implement an enhancement program by integration of RASS with using Bispectral Index (BIS) is an evidenced technology which can provide a continuous bedside monitoring to provide objective data on patient’s response to sedative drug to facilitate ICU nurses to implement sedation titration.
Objectives :
- To enhance ICU nurses’ competency on sedation titration to monitor patient’s optimal sedation level for critically ill ventilated patient
Methodology :
All ventilated patients were recruited, inclusion criteria were those are given sedation or paralyzing agent, RASS with BIS monitoring was applied within 24 to 48 hours of ICU admission, for BIS values < 60 and RASS score <-3 which may indicate moderate or deep-sedation. The exclusion criteria were those patients with neurological deficits, such as stroke and epilepsy. Outcomes measured patients’ BIS and RASS data, and their subsequent sedation titration.
Result & Outcome :
Data collection started from November 2023 to October 2024, total 46 patients were recruited, consisting of 30 males and 16 females. During the first hour of RASS with BIS application, there were 95.6% of patients were found RASS < -3 with BIS < 60, and 4.4% patients’ BIS ranged > 60 to 80 and RASS -2 to 0. Subsequently, 67% of the patients with BIS < 60 and RASS <-3 were proceeded to sedation titration enhancement program. There are 75% ICU nurses reported that BIS can provide continuous and accurate sedation level monitoring which can enhance their competency in sedation titration.
