I am a new nurse fresh out of college and landed a job on a prestigious nsicu floor. After 6 months of orientation and aacn's Ecco course, I am finally on my own!!! My first week off orientation has been complete hell and I already had two different patients self extubate while on propofol drip and bilaterally mitted with wrist restraints. Before each incident, I was in the room with the patient ensuring they werent restless or agitated and that the restraints were tight. 5 minutes after I walked out of the room, the patients were extubated.
At this point, I'm not sure what else I could have done to prevent this from happening. Titrating propofol is such a difficult dance, in a sense, because I feel you need to give them enough to be comfortably sedated but not too much that their blood pressure tanks.
I'm looking for advice on possibly other options that I could utilize to stop this from being a frequent problem. I know this is a common occurrence, especially in the icu, but I want to make sure all of my bases are covered so I can say, " I tried every option to prevent this from happening."