The Efficacy of Using Sedation Protocol on Medication Error of Proportion Drug Use and Incidence Rate of Unplanned Extubation in Intensive Care Unit

Abstract

Background: Prescribing errors and administration errors occurred with proportion use of fentanyl and midazolam injection for endotracheal intubated patients. Nurses caring of these patients experienced problems to interpret medication orders because there are no clear guidelines. It was found that these 2 drugs were mostly used in intensive care unit (ICU). It was also found that the incidence rate of unplanned extubation (UE) was higher than the target. Therefore, a sedation protocol has been developed. It is expected that these problems can be solved.

Objectives: The purpose of this study was to examine the effect of sedation protocol on medication error, UE rate, and determine physicians and nurses satisfaction of this sedation protocol.

Method: This is quasi-experimental study. Data of patients in ICU between November 15, 2022 - February 15, 2023 were collected. The results were analyzed using descriptive statistics, Fisher’s exact test and Chi-squared test.

Results: After the sedation protocol was implemented, prescribing error and administration error were significantly decreased from 2.68% (9/336) to 0% (0/527) (p-value < 0.001). The incidence rate of UE in ICU was significantly decreased from 13.19% (15.67 episodes per 1,000 device days) to 2.70% (2.43 episodes per 1,000 device days) (p-value < 0.016). There were 96% of physicians and nurses (n=50) who satisfied at level of ≥4 satisfaction scores with the use of the sedation protocol (mean=4.34/5, standard deviation=0.56).

Conclusion: The use of sedation protocol can help prevent medication errors of proportion drug use and reduce the incidence rate of UE in ICU. Physicians and nurses satisfied with the use of the sedation protocol.