Authors (including presenting author) :
Chan, HT (1), Tang CT (1), Lee MM (1), Cheung CY (1)
Affiliation :
(1) Accident and Emergency Department, Tin Shui Wai Hospital
Introduction :
Performing Rapid-sequence intubation (RSI) is a core competency in the Accident and Emergency department (AED). Conventionally, in Hong Kong AEDs, trainings and practices for nurses have been heavily focused on the pre-intubation and intubation phase. Yet, in the post-intubation phase, a valid sedation assessment tool and a structured post-RSI sedation management workflow were absent. Without these tools, suboptimal sedation (either over or under) was commonly reported, leading to various lethal impacts including awake paralysis, increased ventilator days, delirium and mortality. In this light, an interventional program is crucial to enhance the sedation status of sedated-intubated-adult patients.
Objectives :
The objectives of this project are (1) to optimise the sedation status of intubated adult patients who underwent RSI and (2) to enhance nursing staff’s confidence and competence in assessing the sedation status of intubated patients.
Methodology :
A post-RSI sedation assessment workflow was designed and implemented in TSWH AED, for which the Richmond Agitation Sedation Scale (RASS) was adopted as the sedation assessment tool. To enhance nurses’ competence in assessing and managing the sedation status of intubated patients, an enhancement workshop on managing post-RSI patients was designed and held prior to the implementation of the workflow. The workflow was evaluated and reviewed after 3 months of pilot.
Result & Outcome :
The training workshop showed promising results in empowering ED nurses to perform RASS. Nurses demonstrated high accuracy (100%) on performing the RASS assessment with knowledge enrichment (post-test mean score = 4.83/6) in managing post-RSI sedated patients. An increasing trend was also observed on the compliance rate of performing post-RSI sedation assessment timely since the implementation of the workflow, with a mean of 54.17% (n=8). No adverse event has been reported after the implementation of this project. Such positive outcomes have demonstrated the feasibility and effectiveness of employing a post-RSI sedation assessment workflow along with adequate training to optimise the sedation status of patients underwent RSI in the AED. By providing nurses a structural framework to assess and manage intubated patient’s sedation status, the likelihood of suboptimal sedation would be minimized. With support from the current studies, it is legitimate to sustain the measures introduced by this project to improve patient safety and the quality of care being delivered in the AED.
