Emergency nurses practices in assessing and administering continuous intravenous sedation for critically ill adult patients: A retrospective record review'

• An initial profile of emergency nurses' practices in and factors influencing the assessment and administration of continuous intravenous analgesia and sedation for critically ill mechanically ventilated adult patients is reported.
• The safety and quality of sedation, pain-relief and well-being of mechanically ventilated critically ill patients in ED is reliant upon the knowledge, skills, expertise and awareness of emergency nurses.
• Titration of sedation and analgesia based upon patients' level of consciousness (i.e. GCS), vital signs or behaviour may lead to poor awareness of patient depth of sedation and/or quality of pain-relief.
• The use of validated pain assessment and sedation-scoring tools is warranted to avoid jeopardising patient safety.

AimTo generate an initial profile of emergency nurses' practices in and factors influencing the assessment and administration of continuous intravenous sedation and analgesia for critically ill mechanically ventilated adult patients.BackgroundEmergency nurses are relied upon to assess and manage critically ill patients, some of whom require continuous intravenous sedation. Balancing sedation is a highly complex activity. There is however little evidence relating to how emergency nurses manage continuous intravenous analgesia and sedation for the critically ill intubated patients.DesignDescriptive study.MethodA 12-month retrospective medical record review was undertaken from January to December 2009 of patients (>16 years) administered continuous intravenous sedation in ED.ResultsFifty-five patients received ongoing intravenous sedation within the ED during a median length of stay of 3.4 h. Assessment of patient depth/quality of sedation and pain-relief varied and were rarely documented. Adverse events were documented, majority (16%) drug administration related. Thematic analysis identified three themes: ‘Maintaining sedation’, ‘Directionless-directions’, and ‘Navigating the balance’.ConclusionEmergency nurses provide continuity of patient care and optimisation of analgesia and sedation for critically ill sedated patients. The safety and effectiveness of continuous intravenous sedation for the critically ill adult patient in ED are dependent on the expertise and decision-making abilities of the nurse.