LETTERS
LETTERS
TO THE
EDITOR
Submit all Letters to the Editor online at http://ees.elsevier.com/jen/
Propofol: Sedation with or without Analgesia?
Response
Dear Editor: I enjoyed reading the article about propofol for procedural sedation and analgesia in the September 2013 issue of the Journal 1 and appreciate this content because it is particularly applicable to the field in which I work. Propofol is a great drug, and I am seeing it used more and more in ED settings (I am a critical care transport/flight registered nurse). In the not-so-distant past, anesthesia providers were the only clinicians administering this drug with little exception. The reason for my letter is this: several times in the article, propofol is referred to as a drug used in procedural sedation and analgesia. In all of the training and education I have received on the use of this drug, it has been communicated that propofol does not have analgesic properties, but instead is a sedative/hypnotic agent only. I have always been taught to combine propofol with an analgesic agent when administering propofol to patients who have injuries or painful disease processes. A review of the literature showed some studies that report propofol to have some analgesic properties and that pain scales are reduced with its use. However, the majority of sources report propofol as a sedative/hypnotic only. My concern is that some readers who are not well practiced with the administration of propofol may read and falsely take from the article that propofol alone is sufficient for analgesia. Does this article promote propofol for analgesia as well as sedation, or have I misunderstood the tone of the article?—Stephen Teitelman, BS, RN, CCRN, CFRN, CEN, CTRN, Transport Specialist, Temple Transport Team, Temple Health System, Philadelphia, PA; E-mail: [email protected]
Dear Editor: We thank Mr Teitelman for his appreciation of our work, and we share his enthusiasm for propofol use in the emergency department. Mr Teitelman raises a concern about a possible implication that propofol has analgesic properties. The American College of Emergency Physicians defines procedural sedation and analgesia as the “technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures” [italics added]. 1 We did not intend to imply by use of this phrase that propofol has analgesic properties; strictly speaking, it does not. It is conventional practice to administer an analgesic in addition to propofol for patients with painful injuries or conditions that require procedural sedation. In our study, supplemental analgesia was provided at the discretion of the provider, but this information was not available in the registry. 2—Joshua C. Reynolds, MD, MS, Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.019
REFERENCES 1. Godwin SA, Caro DA, Wolf SJ. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45(2): 177-96. 2. Reynolds JC, Abraham MK, Barrueto FF Jr, Lemkin DL, Hirshon JM. Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department. J Emerg Nurs. 2013;39(5):502-7.
http://dx.doi.org/10.1016/j.jen.2013.12.011
Using Telemedicine in Stroke Care
REFERENCE 1. Reynolds JC, Abraham MK, Barrueto FFJr., Lemkin DL, Hirshon JM. Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department. J Emerg Nurs. 2013;39(5):502-7. J Emerg Nurs 2014;40:209-11. 0099-1767/$36.00 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
May 2014
VOLUME 40 • ISSUE 3
Dear Editor: After reading the article “Implementing a Stroke Program Using Telemedicine” by Cronin 1 in the November 2013 issue of the Journal, I was pleased to see the author highlighting the awareness of the severity of strokes and the effectiveness of implementing telestroke services within a facility. I would like to commend your publication for bringing this to light.
WWW.JENONLINE.ORG
209
LETTERS
According to Jauch et al, 2 the implementation of a telemedicine service in stroke-capable hospitals potentially can greatly extend the reach of stroke systems of care into underserved regions and may help solve the shortage of neurologists. I am currently a part of a facility that uses a telemedicine program. Upon becoming a primary stroke center, we implemented the telestroke services in our acute stroke protocol. Since then, we have increased our number of patients treated for acute ischemic stroke and decreased our door-to-needle treatment times for intravenous tissue plasminogen activator. Before the implementation of the telestroke process, accessibility to neurologists was limited and many patients required transfer to another facility for evaluation. As pointed out by Jauch et al, “Although the economic issues regarding the use of telestroke remain to be fully explored, the benefit of telestroke in extending timely stroke care to remote hospitals is clear.” We as nurse leaders need to continue to educate on the effectiveness of this evidence-based decision-making tool and the benefits of stroke awareness and care.—Crystal K. Perry, BSN, RN, CEN, Stroke Coordinator, Denton Regional Medical Center, Denton, TX; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.009
REFERENCES 1. Cronin T. Implementing a stroke program using telemedicine. J Emerg Nurs. 2013;39(6):613-8. 2. Jauch EC, Saver JL, Adams HP. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013;44:870-947.
they should expect regarding testing and time in the emergency department. With this knowledge upfront at triage, patients would better understand that it may take a few hours to receive test results and a diagnosis. Waiting for long periods with no communication from staff has a strong correlation with patient dissatisfaction. According to Castner et al, 2 “The timeliness of emergency care is essential to good patient outcomes in the emergency department,” and this also affects mortality rates, treatment delays, inadequate pain control, and patient satisfaction. Over a third of the patients who come to an emergency department for care have to wait more than 1 hour just to see a physician after being triaged by a registered nurse. As nursing leaders, we should streamline this practice by starting nursing protocols that are accepted by our emergency physicians. This would take some effort to educate each nurse on what is expected for each patient complaint but would be well worth the payoff of better patient care and greater patient satisfaction. Evidence supports the use of nursing protocols for experienced ED nurses. I firmly believe this would help lower the anxiety rate and increase patient satisfaction. I have confidence that all ED leaders would be able to address this issue and implement changes to achieve less anxiety for our patients, better patient care, and better patient outcomes.—Sandra Elings, BSN, RN; Administrator, Emergency Department, E-are Emergency Centers, North Richland Hills, TX; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.008
REFERENCES Relieving Anxiety in the Emergency Department for Our Patient Population
Dear Editor: After reading the article “Acuity and Anxiety From the Patient’s Perspective in the Emergency Department” by Ekwall 1 in the November 2013 issue of the Journal, I started looking at my emergency department and how the staff evaluated the patients in triage to attain their acuity level and signs of anxiety that the patients showed. Then I reviewed and assessed the patient satisfaction survey that each patient has the opportunity to complete while in the department or can fill out at home and send in. I am the administrator in a freestanding emergency department and have worked in emergency medicine for over 25 years. I feel that this article and study could provide an excellent tool for educating ED nurses on the power of communication with all patients to instruct them on their acuity level and what
210
JOURNAL OF EMERGENCY NURSING
1. Ekwall A. Acuity and anxiety from the patient’s perspective in the emergency department. J Emerg Nurs. 2013;39(6):534-8. 2. Castner J, Grinslade S, Guay J, Hettinger A, Seo J, Boris L. Registered nurse scope of practice and ED complaint-specific protocols. J Emerg Nurs. 2013;39(5):467-73.
2013 November Military Issue
Dear Editor: It has been a few months since I received the November 2013 issue of the Journal of Emergency Nursing, and I am still reading articles and rereading them. I want to thank you and the staff that put together the Journal of Emergency Nursing articles for publishing a special military issue. I am in the final months of my doctor of nursing practice (DNP) project that focuses on women veterans and found the edition to be especially helpful and inspiring. I have been an emergency nurse my entire career and just completed family nurse practitioner (FNP) training this past
VOLUME 40 • ISSUE 3
May 2014
LETTERS
TO THE
EDITOR
Submit all Letters to the Editor online at http://ees.elsevier.com/jen/
Propofol: Sedation with or without Analgesia?
Response
Dear Editor: I enjoyed reading the article about propofol for procedural sedation and analgesia in the September 2013 issue of the Journal 1 and appreciate this content because it is particularly applicable to the field in which I work. Propofol is a great drug, and I am seeing it used more and more in ED settings (I am a critical care transport/flight registered nurse). In the not-so-distant past, anesthesia providers were the only clinicians administering this drug with little exception. The reason for my letter is this: several times in the article, propofol is referred to as a drug used in procedural sedation and analgesia. In all of the training and education I have received on the use of this drug, it has been communicated that propofol does not have analgesic properties, but instead is a sedative/hypnotic agent only. I have always been taught to combine propofol with an analgesic agent when administering propofol to patients who have injuries or painful disease processes. A review of the literature showed some studies that report propofol to have some analgesic properties and that pain scales are reduced with its use. However, the majority of sources report propofol as a sedative/hypnotic only. My concern is that some readers who are not well practiced with the administration of propofol may read and falsely take from the article that propofol alone is sufficient for analgesia. Does this article promote propofol for analgesia as well as sedation, or have I misunderstood the tone of the article?—Stephen Teitelman, BS, RN, CCRN, CFRN, CEN, CTRN, Transport Specialist, Temple Transport Team, Temple Health System, Philadelphia, PA; E-mail: [email protected]
Dear Editor: We thank Mr Teitelman for his appreciation of our work, and we share his enthusiasm for propofol use in the emergency department. Mr Teitelman raises a concern about a possible implication that propofol has analgesic properties. The American College of Emergency Physicians defines procedural sedation and analgesia as the “technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures” [italics added]. 1 We did not intend to imply by use of this phrase that propofol has analgesic properties; strictly speaking, it does not. It is conventional practice to administer an analgesic in addition to propofol for patients with painful injuries or conditions that require procedural sedation. In our study, supplemental analgesia was provided at the discretion of the provider, but this information was not available in the registry. 2—Joshua C. Reynolds, MD, MS, Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.019
REFERENCES 1. Godwin SA, Caro DA, Wolf SJ. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45(2): 177-96. 2. Reynolds JC, Abraham MK, Barrueto FF Jr, Lemkin DL, Hirshon JM. Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department. J Emerg Nurs. 2013;39(5):502-7.
http://dx.doi.org/10.1016/j.jen.2013.12.011
Using Telemedicine in Stroke Care
REFERENCE 1. Reynolds JC, Abraham MK, Barrueto FFJr., Lemkin DL, Hirshon JM. Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department. J Emerg Nurs. 2013;39(5):502-7. J Emerg Nurs 2014;40:209-11. 0099-1767/$36.00 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
May 2014
VOLUME 40 • ISSUE 3
Dear Editor: After reading the article “Implementing a Stroke Program Using Telemedicine” by Cronin 1 in the November 2013 issue of the Journal, I was pleased to see the author highlighting the awareness of the severity of strokes and the effectiveness of implementing telestroke services within a facility. I would like to commend your publication for bringing this to light.
WWW.JENONLINE.ORG
209
LETTERS
According to Jauch et al, 2 the implementation of a telemedicine service in stroke-capable hospitals potentially can greatly extend the reach of stroke systems of care into underserved regions and may help solve the shortage of neurologists. I am currently a part of a facility that uses a telemedicine program. Upon becoming a primary stroke center, we implemented the telestroke services in our acute stroke protocol. Since then, we have increased our number of patients treated for acute ischemic stroke and decreased our door-to-needle treatment times for intravenous tissue plasminogen activator. Before the implementation of the telestroke process, accessibility to neurologists was limited and many patients required transfer to another facility for evaluation. As pointed out by Jauch et al, “Although the economic issues regarding the use of telestroke remain to be fully explored, the benefit of telestroke in extending timely stroke care to remote hospitals is clear.” We as nurse leaders need to continue to educate on the effectiveness of this evidence-based decision-making tool and the benefits of stroke awareness and care.—Crystal K. Perry, BSN, RN, CEN, Stroke Coordinator, Denton Regional Medical Center, Denton, TX; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.009
REFERENCES 1. Cronin T. Implementing a stroke program using telemedicine. J Emerg Nurs. 2013;39(6):613-8. 2. Jauch EC, Saver JL, Adams HP. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013;44:870-947.
they should expect regarding testing and time in the emergency department. With this knowledge upfront at triage, patients would better understand that it may take a few hours to receive test results and a diagnosis. Waiting for long periods with no communication from staff has a strong correlation with patient dissatisfaction. According to Castner et al, 2 “The timeliness of emergency care is essential to good patient outcomes in the emergency department,” and this also affects mortality rates, treatment delays, inadequate pain control, and patient satisfaction. Over a third of the patients who come to an emergency department for care have to wait more than 1 hour just to see a physician after being triaged by a registered nurse. As nursing leaders, we should streamline this practice by starting nursing protocols that are accepted by our emergency physicians. This would take some effort to educate each nurse on what is expected for each patient complaint but would be well worth the payoff of better patient care and greater patient satisfaction. Evidence supports the use of nursing protocols for experienced ED nurses. I firmly believe this would help lower the anxiety rate and increase patient satisfaction. I have confidence that all ED leaders would be able to address this issue and implement changes to achieve less anxiety for our patients, better patient care, and better patient outcomes.—Sandra Elings, BSN, RN; Administrator, Emergency Department, E-are Emergency Centers, North Richland Hills, TX; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2013.12.008
REFERENCES Relieving Anxiety in the Emergency Department for Our Patient Population
Dear Editor: After reading the article “Acuity and Anxiety From the Patient’s Perspective in the Emergency Department” by Ekwall 1 in the November 2013 issue of the Journal, I started looking at my emergency department and how the staff evaluated the patients in triage to attain their acuity level and signs of anxiety that the patients showed. Then I reviewed and assessed the patient satisfaction survey that each patient has the opportunity to complete while in the department or can fill out at home and send in. I am the administrator in a freestanding emergency department and have worked in emergency medicine for over 25 years. I feel that this article and study could provide an excellent tool for educating ED nurses on the power of communication with all patients to instruct them on their acuity level and what
210
JOURNAL OF EMERGENCY NURSING
1. Ekwall A. Acuity and anxiety from the patient’s perspective in the emergency department. J Emerg Nurs. 2013;39(6):534-8. 2. Castner J, Grinslade S, Guay J, Hettinger A, Seo J, Boris L. Registered nurse scope of practice and ED complaint-specific protocols. J Emerg Nurs. 2013;39(5):467-73.
2013 November Military Issue
Dear Editor: It has been a few months since I received the November 2013 issue of the Journal of Emergency Nursing, and I am still reading articles and rereading them. I want to thank you and the staff that put together the Journal of Emergency Nursing articles for publishing a special military issue. I am in the final months of my doctor of nursing practice (DNP) project that focuses on women veterans and found the edition to be especially helpful and inspiring. I have been an emergency nurse my entire career and just completed family nurse practitioner (FNP) training this past
VOLUME 40 • ISSUE 3
May 2014
