Hi this is Breehan! Because my mom just had a knee replacement, I talked to her about her different medications. She is on Percocet and Tramadol. I was surprised that her doctor did not educate her about not mixing the Percocet and Tramadol too closely together until she actually asked him after I told her that she should not take the maximum amount of each medication all at once, especially because she enjoys a glass of wine in the evening when she tends to take her pain medications to help her sleep. I warned her not to mix the wine and medications and explained why it was a bad idea.

Once my mom was educated about that, she was then confused about whether she could mix Ibuprofen with the opiates and I had to educate her that Ibuprofen and Percocet or Tramadol are ok together but to make sure not to take too much Acetaminophen along with the Percocet if she takes the maximum amount every 4-6 hours as is recommended on the bottle. Once again, I was so dismayed and surprised that my mom’s surgeon did not take the time to give her this important pharmacological education.

The surgeon did succeed at least in telling my mom about the side effects of being on strong opiate pain medication post-op. He encouraged her to take stool softeners for the constipation and not to drive while under the influence of the medications.

I was glad I was present to assist my mom in educating her about her medications and rather appalled that she had not been told what I considered very basic information about them in the post-op period.

I actually have not seen sedation vacation performed in clinicals, but I know Cottage has their own policy and procedure for conducting it. In Cottage, the nurse and Respiratory Therapist collaborate to perform sedation vacation according to the optimal time based on the pt and family’s schedule. In order for the procedure to be performed, the pt must not meet any absolute or relative contraindications. Absolute contraindications includes increased ICP that is exacerbated with awakening or if pt is less than 18 yrs old. Relative contraindications include: PEEP greater than or equal to 10cm H20, PaO2/FiO2 less than or equal to 200, SpO2 less than 90% on FiO2 greater than or equal to 50%. If pt does not meet any contraindications, then all sedation infusions are turned off and pt is assessed according to the Richmond Agitation Sedation Score (RASS). Hospital protocols are then performed according to assessment thereafter.

Standard practice for sedation vacation is the same as Cottage Hospital. Many researchers encourage and promote sedation vacation because of its benefits to the pts (Dunn and Baker, 2011). These include less ICU stays, less chances of developing ICU delirium, and decrease need for ventilator support (Dunn and Baker, 2011). The medications used by Cottage include Lorazepam, Propofol, and Midazolam. If the pt does fail the RASS, then 50% of the previous sedation dose is infused and titrated accordingly. Hospital protocols are followed thereafter.

Reference:

Santa Barbara Cottage Hospital Daily Awakening Trial/Weaning Protocol in Mechanically Ventilated Patients

Dunn, J., Baker, M.W. (2011). Daily Sedation Breaks and Breathing Trials Help Wean Patients from Ventilators Safely: The Authors Give Advice on Developing a Nurse-Implemented Sedation Protocol. American Nurse Today, 6(3). Retrieved from: http://www.medscape.com/viewarticle/741046_6