Amanda Chadwell BISPECTRAL INDEX (BIS) MONITORING Summer Arruda Arynn Freburger Will the use of the bispectral index (BIS) monitoring system versus the current scoring system, RASS, lead to better patient outcomes related to sedation and paralytic use in ICU patients? Background Appraisal of Evidence & Research Summary of Evidence Current practice at UM BWMC for sedating and paralyzing ICU patients utilizes Methods the RASS scoring system and train of four electrode stimulator. Current studies have Conclusions shown the effectiveness of using the bispectral index (BIS) monitoring system in •“The Bispectral Index monitor may be a useful addition to using RASS and Train of Four. Using the Johns Hopkins addition to observational scales in assessing According to the evidence, we Nursing Evidence Based sedation, comfort, and the patient’s own Our goal is to determine the effectiveness of using the BIS monitoring system Practice Appraisal Tool, we experience” (Wilf Yeo, MD Fracp, and Joseph are currently using best practice to and to gain insight on how it could positively affect our patient population. conducted our evidence Chung, MBChB, 2017) appraisal based on the ensure the safety of our patients and following parameters: The evidence appraisal we performed aimed to discover if the utilization •“BIS monitoring is an easy to use adjunct to improve patient outcomes. Proper • Search terms: BIS monitoring sedation in the critically ill patient, of the BIS monitoring system could decrease hospital length of stay, monitoring, RASS education needs to be provided to that may reduce costs, morbidity, and mortality decrease mortality in the ICU patient population, and decrease scoring, ICU sedation, related to sedation in the ICU” (Ellie Z. Franges, the staff to ensure proper use of the hospital and patient cost while staying in the ICU. Paralytic use, Anesthesia FOCUS monitoring, BIS vs RASS 2009) BIS monitoring system so that every patient is provided the best care • Criteria: peer-reviewed, •“Numerous studies have documented the ability evidence-based of BIS to reduce intermediate outcomes such as possible. Using the BIS monitoring experimental studies or hypnotic drug administration, extubation time, reviews published within postoperative nausea, and shorten recovery system in adjunct with the last 10 years room discharge.” (Jay W. Johansen, 2006) RASS and Train of Four • Our evidence appraisal •“In a study conducted with patients older than to help improve patient comprised of 1 age 60, delirium incidence was lower in patients outcomes, hospital experimental with BIS monitoring.”(Diana Lopez, 2016) length of stay, and study/randomized trial, 3 quasi-experimental decreased cost of •“Bispectral index monitoring of ICU patient on studies, 2 opinions of hospitalization. respected authorities, continuous infusions of paralytics and sedatives Nursing Implications and 1 article based on reduces sedative drug cost as well as the recall evidence obtained from phenomenon. Significant under-0sedation may literature reviews and occur using subjective analysis of sedation in the • Standard practice for all quality improvement ICU.” (LJ Kaplan and H Bailey, 2000) patients on both a paralytic reports. and a sedative

Education Fairs • By using the BIS monitoring RECOMMENDATIONS Next Steps for Education system on every patient, staff Based on evidence will be decreasing the appraisal, it is best • Update the CCW unit policy occurrence of delayed Education Committees practice to use a and procedure guidelines extubation, delirium, and decrease ICU length of stay combination of vital signs, Frequent in-services • Develop education at a unit- BIS, and RASS for patients level first who are sedated and on • Education about BIS monitoring • Engage unit education in conjunction with RASS and the paralytic agents in order to committees and unit practice use of the Train of Four electrode provide the best care with councils to give nurses the the least amount of added knowledge and would allow for better resources needed in order to understanding of the use and negative outcomes. apply practices to patient care. importance of proper sedation. This will inspire a change in • Incorporate in-services for staff to learn on the job training. practice in Critical Care West Provide one super-user per shift (CCW) on all of our patients and to assist staff in the use of the BIS enhance patient satisfaction, monitoring system. Special Thanks Karen A. Allicock, MS, RN-BC– Clinical Educator decrease cost of hospitalization, Jason Heavner, MD – Chief of Critical Care. and increase positive outcomes.

*References available upon request