hospital policy review and compare it with EBP articles

• The paper should discuss the hospital policy and compare it with EBP articles.
• The length of the paper is 2 pages (NO MORETHAN THAT)

The APA format is required:references (a minimum of two EBP references required. Must be published in the last 5 years)references: https://bmcpalliatcare.biomedcentral.com/articles/… https://onlinelibrary.wiley.com/doi/10.1111/acem.1…please follow the examples below Also, make power point regarding the topic

THERAPEUTIC HYPOTHERMIA PROTOCOL
1
Evaluation of Kaiser Hospital’s Therapeutic Hypothermia Protocol
To preserve neurological function in unconscious patients who have suffered cardiac
arrest, Kaiser Hospital has developed a therapeutic hypothermia protocol (Kaiser, 2018). Unless
the patient’s condition is unstable (active bleeding or life-threatening heart rhythms, for
example), the team uses a cooling system immediately, which lowers and maintain the patient’s
body temperature at 33 degrees Celsius for 24 hours (Kaiser, 2018). The team monitors and
intervenes to keep the pCO2 at a normal range (35 to 45 mmHg) and the mean arterial pressure
at an elevated level (above 90 mmHg) (Kaiser, 2018). The nurse monitors for bleeding,
potassium imbalance, and hyperglycemia, checking blood glucose every four hours (Kaiser,
2018). Because of the risk of temperature-induced or immobility-related damage, the nurse also
checks the skin every two hours (Kaiser, 2018). He or she also monitors for shivering and treats
it according to another protocol (Kaiser, 2018).
After 24 hours, the team warms the patient to near normal body temperature (36.5
degrees Celsius) for 14 hours and re-evaluates neurological status (Kaiser, 2018). The team
discontinues paralyzing agents when the body temperature reaches 36.5 degrees Celsius (Kaiser,
2018). Again, the team monitors for bleeding and for potassium imbalances (Kaiser, 2018). The
patient is then returned to the cooling phase, and the process begins again.
Recent evidence supports Kaiser’s hypothermia protocol. In one meta-analysis,
researchers examined 24 studies to determine outcomes for unconscious patients who had
suffered cardiac arrest (Schenone et al., 2016). The researchers found that the hypothermia
protocol increased both the odds of survival and the odds of preserved brain function (Schenone
et al., 2016).
Although there is good evidence for Kaiser’s hypothermia protocol, some of its details
are not fully supported. For example, the same meta-analysis found no significant change in
outcomes for a range of temperatures, from 32-34 degrees Celsius (Schenone et al., 2016).
Another study of about five hundred survivors of cardiac arrest found no significant difference
between neurological outcomes after treatment at 33 degrees versus 36 degrees Celsius
(Cronberg et al., 2015). In addition to the temperature requirement, the requirement for mean
arterial pressure is not fully supported. A recent study found no significant difference in
neurological outcomes between patients who were maintained at 80-90 mmHg versus above 65
mmHg (Young et al., 2015).
Considering this evidence, two small changes might be made to Kaiser’s therapeutic
hypothermia protocol. First, the temperature range for the cooling process might be made less
exact. Rather than specifying 33 degrees Celsius, a range from 32 to 34 or even up to 36 degrees
Celsius might be considered acceptable.
Second, rather than requiring that the mean arterial pressure be maintained above 90
mmHg during the cooling phase, the protocol might specify that it be kept above 65 mmHg,
which is approximately normal. In addition to being supported by evidence, this level of
perfusion to vital organs is likely sufficient, given that it is in the normal range. In addition,
lowering this requirement would prevent unnecessary use of vasoconstrictors, which could cause
complications such as hypertension, blood clots, or even cardiac arrest.
Overall, Kaiser’s therapeutic hypothermia protocol for unconscious patients after cardiac
arrest is well-founded. Recent evidence shows that cooling the body does improve chances of
survival and of neurological preservation. Although some details might be altered slightly, the
protocol should remain, promoting patient survival and neurological preservation.
References
Cronberg, T., Lilja, G., Horn, J., Kjaergaard, J., Wise, M., Pellis, T., . . . Nielsen, N. (2015).
Neurologic function and health-related quality of life in patients following targeted
temperature management at 33° C vs 36° C after out-of-hospital cardiac arrest. JAMA
Neurology, 72(6): 634-641. doi: 10.1001/jamaneurol.2015.0169
Kaiser Permanente Critical Care Leadership. (2018). Therapeutic hypothermia after cardiac
arrest: Use of the temperature management system. San Diego Service Area Policy and
Procedures.
Schenone, A., Cohen, A., Patarroyo, G., Harper, L., Wang, X., Shishehbor, M., . . . Duggal, A.
(2016). Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis
exploring the impact of expanded criteria and targeted temperature. Resuscitation, 108:
102-110. doi: 10.1016/j.resuscitation.2016.07.238
Young, M., Hollenbeck, R., Pollock, J., Giuseffi, J., Wang, L., Harrell, F., & McPherson, J.
(2015). Higher achieved mean arterial pressure during therapeutic hypothermia is not
associated with neurologically intact survival following cardiac arrest. Resuscitation, 88:
158-164. doi: 10.1016/j.resuscitation.2014.12.008
Due to the procedural sedation resulting in various adverse effects, Kaiser
Permanente sets a minimum requirement for the delivery of sedation during procedures for
all patients to ensure safe and appropriate care. This paper will review the policy’s content
and compare it to the most recent tested evidence based practices in order to determine its
validity. Overall, Kaiser Permanente’s policy is concurrent with most of today’s recent
studies on sedation management, however there is room for improvement.
The policy begins with defining different types of sedation. However, it focuses on
two aspects, moderate and deep, which are determined by the Procedure and Anesthesia
scoring system (PASS). Moderate has a pass score of one, while keep has a pass score of
two. Depending on the patient’s level of sedation, different requirements are required.
The policy then determines what competencies are required in regards to a
physician and for a registered nurse. Both physicians and nurses must complete their
certifications for Advance Cardiovascular Life Support (ACLS), and then the Pedatric
advance life support (PALS) and Neonatal Resuscitation program (NRP) as needed. Both
physicians and nurses also must take an annual module and test to confirm competency
every year. However, for deep sedation, physicians also must be competent in performing
endotracheal intubations. An article from the Association of Perioprative Nurses (AORN)
states that the ACLS and Basic Life Support (BLS) is needed in moderate sedation (White,
2014). Kaiser has exceeded this requirement by requiring its annual modules.
The policy continues to define the requirements in the immediate setting of patients
who are sedated. Items such as the crash cart, suction, resuscitation bags and mask, oxygen,
pulse oximetry, continuous end tidal capnography, are needed on the floor. All reverse
agents to the available agents must be present on the floor as well. Although capnography
was not endorsed by all professional entities, the American Society of Anesthesiologist
suggested that capnographys is a better assessment of ventilation, whereas in the case of
airway obstruction, oxygenation levels can remain normal for some time, which will be
observed later if using only pulse oximetry (White, 2014). Kaiser has taken measures to
ensure proper oxygenation in sedated patients.
There also must be an assessment done for the pre-procedure, intra-procedure, and
post-procedure. This policy defines what needs to be assessed in particular for every step
of sedation. One assessment Kaiser did not include in their policy is the Bispectral Index
Score (BIS). The Australian Critical Care Journal confirmed that using the BIS can be helpful
in reducing the amount of Propofol and narcotic medication (Olson, 2014). Perhaps Kaiser
can better monitor their patients and reduce the required amount of administered
narcotics if they implemented the use of this scoring system.
Finally the policy describes when to refer to the quality improvement committee in
order to evaluate the quality of care given. The quality improvement committee must be
notified under the event of cardiac arrest, use of reversal agents as well as other scenarios.
Kaiser Permanente has set out a thorough policy revising the minimal requirements
for the delivery of sedation. From the implementation of constant competency test to
setting up the requirements of proper equipment needed in the immediate environment,
the policy has been able to safely care for sedated patients. Although may be certain
adjustments made to the policy to improve monitoring of the patients, overall the evidence
behind this policy is sound.
References
Caperelli-White, L., & Urman, R. D. (2014). Developing a Moderate Sedation Policy:
Essential Elements and Evidence-Based Considerations. AORN Journal, 99(3), 416430. doi:10.1016/j.aorn.2013.09.015
Olson, D. M., Zomorodi, M. G., James, M. L., Cox, C. E., Moretti, E. W., Riemen, K. E., &
Graffagnino, C. (2014). Exploring the impact of augmenting sedation assessment
with physiologic monitors. Australian Critical Care, 27(3), 145-150.
doi:10.1016/j.aucc.2013.09.00