Interprofessional Team Develops New Management Tools for Analgesia and Sedation

Submitted By:

Early in the course of treating critically-ill COVID-19 patients, many practitioners realized that their usual approaches to analgesia and sedation were insufficient. Unable to adequately ventilate patients using standard analgesics and sedating agents at typical doses, clinicians quickly recognized that non-traditional analgesia and sedation would be required, as well as adjunct medications not typically needed for patients receiving mechanical ventilation. In order to address these substantial changes in the approach to analgesia and sedation, a team of critical care pharmacists at Northwestern Medicine, including ACCP members Kasey Greathouse and Dan Dickson, PGY-2 resident Tori Adams (also an ACCP member), and Abeer Ammar, worked with advanced practice nurses (APNs) and physicians from pulmonary critical care, neurocritical care, and psychiatry to develop a new COVID-19 analgesia and sedation guidance document, flowsheet, and order set.

These tools now help guide physicians and nurses by informing them of currently available agents, their appropriateness for a given patient’s course, methods of titration, and necessary monitoring. Although they’ve not sought formal feedback, the clinical pharmacists’ collaborative development of these tools has been praised by nurses, residents, and attending physicians. Kasey notes, “We have many nurses and APNs who have moved from other specialized ICUs, or from the operating room, to help in the COVID ICUs. They are often unfamiliar with many of the medications we’re using and find our guidance document and flowsheet vital in helping to titrate and monitor analgesia and sedation.”  The clinical pharmacy team is also in the process of carrying out a research project to formally evaluate the effects of the new tools.