Quality Improvement: Outcomes of Huddle Education for Titratable Sedating Medications
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Background: Nurses have a profound responsibility to act in the best interest of their patients. One way they care for their patients responsibly in the critical care setting is by routinely assessing and administering medications according to the provider order. Simultaneously, nurse leaders have a commitment to educate bedside nurses on how to care for patients in with evidence-based practices. In order to reveal nurse behaviors in the critical care setting for the assessment, documentation, and administration of sedating medications, this study seeks to determine how to improve compliance among bedside nursing staff.
Purpose:The purpose of this study was to investigate how implementing education for Intensive Care Unit (ICU) nursing staff at a hospital in central Texas improved quality of patient care, as measured by the assessment, documentation, and administration of titratable sedating medications.
Methods: In a cohort study of hidden social patterns, the frequency of nurses administering and titrating medication according to the provider order, and the frequency of documentation of appropriate assessment was measured pre- and post- education intervention to all nurses in the coho1t. Titration of sedating medications was only documented in paper charting "flow sheets." After assessing the sedation score of the patient, nurses who deemed it appropriate to increase or decrease sedating medications were then to document the change in dosage administered, as well as the subsequent sedation score on paper.
Results: The population considered in this project included a total of72 male and female, ranging from age 21 to 56. The racial groups included were Caucasian, African America, Asian, and Hispanic. Prior to the educational intervention, dayshift compliance with sedation documentation was 62.69 percent and nightshift compliance was 63.04 percent. After the educational intervention, dayshift compliance with sedation documentation was 74.68 percent and nightshift compliance was 61.82 percent. Dayshift compliance with titration of medication according to provider order was 72.22 percent and nightshift compliance was 90.10 percent. Following the intervention, dayshift compliance with medication titration was 82.61 percent, and nightshift compliance was 70 percent. 100 percent compliance (defined as a nurse documenting sedation 100 percent of opportunities to chart) with sedation documentation was 41 percent and compliance with medication titration was 60 percent. After the educational intervention, 55 percent of nurses were 100 percent compliant with sedation documentation and nurses were 64 percent compliant with 100 percent medication titration.
Conclusions: The risks associated with implementing this educational intervention are lost time and money for hours paid to attend the education intervention. Increasing medication knowledge and documentation skills improved the quality of nurses' medication management. Ongoing monitoring of compliance might be measured with leadership unit rounding.