PICU: On Monday I introduced our new sedation scale and withdrawal assessment tool. Both forms can be found on the intranet --> order forms--> children's hospital--> PICU under Service Specific Orders. I have placed printed copies of each behind the charge nurse desk and will also have Donna put them on the PICU portal. I will continue to arrive early to go over these scales with nightshift, but in case I miss a few of you, I will explain the new scales here.
The State Behavioral Scale (SBS) will take the place of our current Sedation/Agitation assessment in McKesson. This scale is to be used on every patient receiving chemical sedation. Assessments are documented every 4 hour hours and are not to be confused with Pain assessments. The form is self-explanatory and objective- you score the patient based on occurrences of the actions described.
The Withdrawal Assessment Tool (WAT-1) will be used on any patient who has received opioid and/or benzos for at least 5 days. You will begin using this tool with the first sedation wean. The idea is to get a baseline immediately before weaning drips, so you can compare symptoms associated with withdrawal to symptoms present prior to the wean. This tool is also self-explanatory- the patient receives a "point" for each symptom they exhibit. Some assessments are performed prior to stimulating the patient, others noted during stimulation (turning, suctioning, etc), and the last assessment, "time to gain calm state" is assessed once you are finished stimulating the patient. This assessment is also performed every 4 hours.
The goal is to become familiar with these scales because we will be using them to determine infusion rates/PRN boluses in the near future when we roll out the nurse-driven sedation protocol. Please let me know if you have any questions. Thanks!
Erin
Quick question about the sedation score. Does it apply to any sedation given (PRNs for pts. not on cont. infusion, scheduled ativan, etc) or only to pts on continuous infusions who are needing to receive a PRN?? And if we are needing to give something more frequently than every 4hrs, are we just "fitting" that time and number into the empty boxes between the 4hr time slots? Thanks!
ReplyDeleteThanks Karen- this score is for ALL patients receiving chemical sedation, IV or enteral. We are going to get rid of the times so you can fill in what time you assessed your patient. We are also working on getting these scores into McKesson ASAP so you can document them as often as you like.
ReplyDelete-Erin