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- Title
Implementing a Stepwise Shivering Protocol During Targeted Temperature Management.
- Authors
Bock, Czarina A.; Medford, Whitney G.; Coughlin, Emily; Mhaskar, Rahul; Sunjic, Katlynd M.
- Abstract
Background: Shivering is often encountered in patients undergoing targeted temperature management (TTM) after cardiac arrest. The most efficient, safe way to prevent shivering during TTM is not clearly defined. Objective: The purpose of this study was to evaluate the impact of shivering management using a stepwise shivering protocol on time to target temperature (TT), medication utilization and nursing confidence. Methods: Single-center, retrospective chart review of all post-cardiac arrest patients who underwent TTM between 2016 and 2021. The primary outcome is a comparison of time to TT pre- and post-protocol implementation. Secondary objectives compared nursing confidence and medication utilization pre- and post-shivering protocol implementation. Results: Fifty-seven patients were included in the pre-protocol group and thirty-seven were in the post-protocol group. The median (IQR) time to TT was 195 (250) minutes and 165 (170), respectively (p = 0.190). The average doses of acetaminophen was 285 mg pre- vs 1994 mg post- (p <0.001, buspirone 47 mg pre- vs 127 mg post- (p < 0.001), magnesium 0.9 g pre-vs 2.8 g post- (p < 0.001), and fentanyl 1564 mcg pre- vs 2286 mcg post- (p=0.023). No difference was seen for midazolam and cisatracurium. Nurses reported feeling confident with his/her ability to manage shivering during TTM 38.5% of the time pre-protocol compared to 60% post-protocol (p = 0.306). Conclusion: Implementation of a stepwise approach to prevent and treat shivering improved time to TT in our institution, although this finding was not statistically significant. The stepwise protocol supported a reduced amount of high-risk medication use and increased nursing confidence in shivering management.
- Subjects
MEDICAL protocols; HUMAN services programs; MAGNESIUM; BODY temperature regulation; INDUCED hypothermia; SHIVERING; HOSPITAL nursing staff; CONFIDENCE; RETROSPECTIVE studies; DESCRIPTIVE statistics; MIDAZOLAM; PRE-tests &; post-tests; MEDICAL records; ACQUISITION of data; CARDIAC arrest; DRUGS; COMPARATIVE studies; TIME; ACETAMINOPHEN; FENTANYL
- Publication
Journal of Pharmacy Practice, 2024, Vol 37, Issue 4, p871
- ISSN
0897-1900
- Publication type
Article
- DOI
10.1177/08971900231193533