Abstract
Purpose: To evaluate the effect on benzodiazepine and dexmedetomidine administration in mechanically ventilated neonates after the implementation of the sedation subscale of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) in the neonatal intensive care units of Children’s Minnesota.|Background: Sedative therapy for mechanically ventilated neonates in the NICU is a frequent occurrence as neonatal care providers attempt to alleviate neonatal pain and distress. However, this practice varies widely and is often based on a nurse’s subjective assessment as to adequacy of sedation.|Methods: The N-PASS sedation subscale was integrated into the electronic medical record in conjunction with nursing and provider education on the tool. Infants admitted to the NICU, receiving mechanical ventilation and sedation, and not having received more than one dose of a muscle-relaxant were included. The primary outcome of interest was mean number of doses of sedatives per patient pre- and post-intervention. In addition, use of the N-PASS sedation subscale post-intervention, and completion rates of the nursing learning module, were evaluated.|Results: A total of 53 infants were included in the analysis (24 in the pre-intervention cohort, 29 in the post-intervention cohort). Only lorazepam doses provided enough data for meaningful analysis. Three variables (number of doses, days of sedation, and dose per day of sedation) were analyzed three different ways (range, median, and mean). Between the two cohorts, the range of doses decreased as did the median; however this median decrease was not statistically significant. The mean number of doses per patient pre- vs post-intervention was essentially unchanged. Range of days of sedation increased in the post-intervention cohort; however, the median decreased, though it was not statistically significant. The mean days of lorazepam was essentially unchanged. Dose of lorazepam (in mg) per days of sedation demonstrated a decrease in range, median and mean, although neither the median decrease, or the mean decrease, were statistically significant. In the post-intervention cohort the N-PASS was used in seven out of 29 patients (25%). At the completion of the study, 303 out of 414 nurses (73%) completed the education module.|Discussion: The sedation subscale of the N-PASS did not achieve a full integration into clinical practice as evidenced by the 25% use rate in the post-intervention cohort. This was not achieved even with a 73% completion rate of the educational module on the part of nursing staff. Although mean number of doses of lorazepam pre- and post-intervention did not change, the dose per days of sedation suggested a downward trend.|Keywords: N-PASS, neonatal sedation, sedation scale