ICU documentation post sedation

[AllAngelsRN]

Hello all,

I had an elderly patient at my care that had an order to turn off sedation an hour and a half prior to the end of my shift. Pt had an ativan drip for sedation running at 1mg/hr. At 6 o'clock I turned it off. After an hour an a half and after I have given report, the AM-shift RN came to inform me that the patient didn't wake up and is still in deep sleep (+gag, cough reflex, grimaces to stimuli, withdraw to painful stimuli, about 3 on the Ramsey sedation scale) which is exactly how I assessed the patient at the beginning of my shift. My last entry of documentation says that patient remains as assessed. I asked a senior RN if I should document more on this and she told me that this is normal in the elderly and that sedation hit them hard which I fully understand. My concern was documentation.

Should I have written something to the fact that the patient remains as if sedated even though the sedation was off?

Thanks in advance for all your help and Happy 2010 :)

[bill4745, RN]

I would have written a note. You need to document that the pt didn't become uncomfortable without the sedation.

[ghillbert, MSN, NP]

More than that, you need to document to show that you assessed the patient again because they remained unresponsive. Remember, if it isn't written down, it didn't happen... so always think, how would I justify in court if they said "So Miss xxxxxx, you turned off the sedation and the patient never awoke, why didn't you do anything about that?".

[sunnycalifRN]

Hello all,

I had an elderly patient at my care that had an order to turn off sedation an hour and a half prior to the end of my shift. Pt had an ativan drip for sedation running at 1mg/hr. At 6 o'clock I turned it off. After an hour an a half and after I have given report, the AM-shift RN came to inform me that the patient didn't wake up and is still in deep sleep (+gag, cough reflex, grimaces to stimuli, withdraw to painful stimuli, about 3 on the Ramsey sedation scale) which is exactly how I assessed the patient at the beginning of my shift. My last entry of documentation says that patient remains as assessed. I asked a senior RN if I should document more on this and she told me that this is normal in the elderly and that sedation hit them hard which I fully understand. My concern was documentation.

Should I have written something to the fact that the patient remains as if sedated even though the sedation was off?

Thanks in advance for all your help and Happy 2010 :)

ativan is very long-acting . . . and 90 minutes is not enough time for and elderly patient to metabolize the circulating drug. regarding your documentation . . . we just chart the RASS score every hour . . . there's nothing unusual about an elderly patient remaining sedated after just 90 minutes. BTW, why ativan?

[AllAngelsRN]

ativan is very long-acting . . . and 90 minutes is not enough time for and elderly patient to metabolize the circulating drug. regarding your documentation . . . we just chart the RASS score every hour . . . there's nothing unusual about an elderly patient remaining sedated after just 90 minutes. BTW, why ativan?

Ok that's sounds good. I think I am covered then. We have a shortage of Diprivan in my hospital so instead we are using Ativan drip. Who knew that MJ was going to cause us problems even after his death LOL (J/K)

[meandragonbrett]

BTW, why ativan?

Quite a few units use lorazepam for mechanical ventilation >72 hours. Many centers are anti-propofol r/t propofol infusion syndrome.

[PostOpPrincess, BSN, RN]

Do you do PARS scores?

Included that her airway was okay? pupillary reaction?

next time add how her comfort status is and focus on respiratory.

[AllAngelsRN]

Do you do PARS scores?

Included that her airway was okay? pupillary reaction?

next time add how her comfort status is and focus on respiratory.

I am not familiar with PARS scores. The patient was intubated and that was documented as part of my assessment. I included that there was no sign of distress or discomfort noted I add this as part of my final entries before I indicated that report was giving to the next shift RN. Would that be sufficient?