Traci Shortt
Published: 2013
Total Pages: 0
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"Waveform capnography has been successfully used as a standard of care in the operating room setting for decades. Sedation related respiratory depression is a patient safety risk costing the health care system millions. Only recently has the technology begun to breach the sterile corridor and become a standard of care in areas outside the operating room theater. After one hospital identified an increasing patient safety concern for emergency department patients receiving intravenous sedation and analgesia, a literature review was conducted to identify technological advances to increase clinician recognition for respiratory depression. After an intensive literature review significant, congruent evidence supported a pilot policy change to utilize waveform capnography in conjunction with pulse oximetry to monitor both oxygenation and ventilation of the at-risk patient population. Utilizing the Problem-Evaluation- (PET) portion of John Hopkins Nursing Evidence Based Practice Model, a project plan was formulated incorporating best practices elicited from the literature review. Volunteer participants were recruited to participate in an educational offering on the use, interpretation, and application of waveform capnography. In conjunction with the anesthesiology department, the intensive education program was developed. Pre and post test scores were assessed in areas of written and scenario based applications. Competency demonstration was required before participants could utilize the technology on patients. After education was provided and competency assessed, participants incorporated waveform capnography use on patients 18-65 years of age receiving intravenous sedation and analgesia in the emergency department. Educational effectiveness was determined using a pre and post test model with a paired t-test analysis for statistical significance. Evaluation of adherence to use, respiratory depression occurrence rates, and adverse respiratory events were conducted. Pre-implementation rates were compared to post implementation rates to determine if waveform capnography affected patient care and improved patient safety with an intended outcome of a 93% reduction in occurrences. An eight week evaluation period was used to determine if the intervention was effective in improving recognition of respiratory depression and allowing intervention time to reduce incidence of medication reversals and advanced airway interventions. Outcomes for the project were deemed successful in both the education and utilization phases. Every participant had a score of 90% or higher on the educational post-test. Application of the knowledge was evident with the reduction in adverse respiratory events and medication reversals related sedative and narcotic medications in the emergency department resulting in a zero occurrence rate. In an effort to share the patient safety gains with other similar organizations, next steps for the project administrator and facility include a more longitudinal evaluation and dissemination of outcomes and implications from the project implementation. Translating the change to a larger platform locally and nationally with educational offerings, manuscripts, and conferences will be a top priority. With the success of this project future evidence-based practice change projects will follow a similar format." -- Abstract.