Clinical practice guidelines provide a practical approach in health care. Critically ill adult may experience, pain, confusion anxiety and stress, which require sedatives to reduce the level of discomfort. Neuromuscular program may be used for extreme cases of pain. Thus, care providers must understand clinical practice guidelines for efficient health care delivery. Health care providers must discontinue sustained use of sedatives and analgesics to avoid complications (Nasraway, Jacobi, Murray, & Lumb, 2002). Using clinical practice guidelines and pathways, care providers must distinguish between familiar situations and the last resort. The use of sedatives must be observed to avoid complications. Considering the review of clinical practice guidelines in 2002, we can develop a plan of care for a mechanically ventilated patient.
Managing mechanically ventilated patients requires a multidisciplinary plan. It is necessary to accommodate clinical procedure that reduces pain and complications. Mechanically ventilated procedures require clinical and technical skill to achieve invasive assessment of the patient. The plan will address the patient’s safety, comfort, position, mouth care, eye care, hygiene, and sleep disorders. Care for a mechanically ventilated patient requiring sedation will include primary and secondary assessment. The patient’s body examination will be documented using clinical practice guidelines.
Fig 1: Primary assessment
|Airway||Check air flow,|
|Examine chest movements|
|Confirm the safety and length of air tubes|
|Breathing||Observe the breathing pattern|
|Examine the heart rate|
|Examine patient pallid|
|Circulation||Provide adequate ventilation|
|Observe patient’s pulse|
|Determine the strength of pulse|
|Examine patient color|
|Disability||Is the patient conscious?|
|Determine the level of stimulation|
|Exposure||Is the patient exposed?|
|Accessing the patient’s environment.|
|Can patient’s safety be guaranteed?|
Fig 2: Secondary assessment
|Neurological||Observe with coma scale|
|Use sedation scale|
|Examine the level of blockade|
|Determine the BIS score|
|Access communication ability|
|Cardiovascular||Examine blood pressure|
|Determine pulse rhythm|
|Monitor cardiac output|
|Respiratory||Check airway tube|
|Monitor cuff pressure|
|Observe secretion blockade|
|Examine tube position|
|Observe breathing pattern|
|Conduct blood analysis|
|Conduct chest X ray|
|Gastrointestinal||Observe bowel sound|
|Conduct liver test|
|Check body weight and strength|
|Determine the level of serum phosphate|
|Check abdominal pain|
|Metabolic||Observe body temperature|
|Estimate glucose level|
|Skin integrity||Conduct ulcer test|
|Determine ulcer pressure|
|Check body weight and sugar level|
|Conduct urine test|
|Observe renal test|
|Determine creatinine level|
Emergency care equipment
A critically ill patient will require essential bedside equipment to avoid complications.
- Resuscitation face mask.
- Suction unit and Yakeur sucker.
- Intubation and oxygen equipment.
- Manual suction unit.
Clinical practice guidelines require the following safety checks
- Provide essential equipment and test its efficiency.
- Check ventilation tubes for blockades.
- Provide uninterrupted power.
- Administer infusions carefully.
- Test the alarm speed of all equipment.
- Reexamine all equipment and alarm limit.
The role of clinical pathways in health care delivery
A clinical pathway is described as a concept and a tool for accessing and guiding clinicians to discharge adequate care. Clinical pathways involve a multidisciplinary plan used by health care professionals. The role of clinical pathways as a multidisciplinary plan for documentation can influence the patient’s recovery timeline. Other benefits include patient care, clinical processes and management. Thus, clinical pathway documentation will reduce mistakes, correct errors, reduce length of stay, facilitate communication with patients, and improve safety.
Nasraway, S., Jacobi, J., Murray, M., & Lumb, P. (2002). Sedation, analgesia, and neuromuscular blockade of the critically ill adult: Revised clinical practice guidelines for 2002. Crit. Care Med, 30(1), 1-19.