Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient

Background: Reliability of clinical scales and haemodynamic variables for assessing sedation depth in critically children is limited, particularly for those receiving neuromuscular blocking agents (NMBAs). Objective: To introduce and integrate the use of Bispectral Index (BIS) monitoring as adjunct to sedation scale assessment in intubated mechanically ventilated Paediatric Intensive Care Unit (PICU) patients. Methods: Quality improvement intervention including: BIS education for all PICU nurses; 8-week implementation of BIS monitoring guided by Paediatric BIS Sedation Protocol; evaluation by convenience sample of nurses (n=17). Measurements: 15-Item survey assessing perceptions of BIS attributes was given to nurses after first 4 BIS encounters; nurse comments and project coordinator observations were recorded. Findings: Survey data (intermediate reliability and nurse attitude ratings and low ratings on other attributes; little change over time) revealed nurses' reservations about the usefulness' of BIS as an adjunct to sedation scales, but qualitative data indicated that they valued BIS for assessing sedation depth in children receiving NMBAs. Conclusions: Post-intervention, BIS monitoring was adopted in PICU for children receiving NMBAs. One year later; this practice is sustained, and the percentage of BIS-monitored patients has increased. Guidelines addressing the use of BIS in patients not receiving paralytics are needed. (C) 2012 Elsevier Ltd. All rights reserved.