LAUSR

Introduction/Hypothesis: Shivering is a common barrier to achieving target temperature (TT) during targeted temperature management (TTM) following cardiac arrest. Shivering is prevented and treated with skin counter-warming and medications (acetaminophen, buspirone, magnesium, opioids, sedatives, neuromuscular blockers). The most efficient and safe way to prevent shivering has yet to be clearly defined. Higher-risk medications, such as sedatives and neuromuscular blockers, may be over-utilized. Medications may accumulate due to the effect of hypothermia on multiple organ systems resulting in altered pharmacokinetics and pharmacodynamics. The previous TTM protocol at our institution listed medications for prevention and treatment of shivering but did not provide a stepwise approach to guide medication utilization and titration. An updated protocol implemented prophylactic use of low-risk medications (acetaminophen, magnesium, and buspirone) and utilized the bedside shivering assessment scale (BSAS) to guide clinicians in the addition of high-risk medications. The primary outcome is comparison of time to TT preand postimplementation of a stepwise TTM protocol. Secondary objectives are comparison of nursing confidence and medication utilization preand post-protocol implementation. Methods: Single center, retrospective chart review of patients admitted in the cardiac intensive care unit (CICU) who had TTM protocol ordered and achieved TT at an urban academic medical center. A survey was sent to TTM nurses to evaluate the confidence of the end user preand post-protocol implementation. Results: Thirty-six patients were included in the primary analysis (18 pre; 18 post-protocol). Mean time to TT was 4.48hr preand 3.64hr post-protocol (p-value 0.48498). Survey response rates were 35% (13/37) preand 34.5% (10/29) post-protocol. Nurses reported feeling confident with his/her ability to prevent and treat shivering when providing TTM 38.5% of the time preprotocol compared to 60% post-protocol (p < 0.0046). Conclusions: Implementation of a stepwise approach to prevent and treat shivering did not have a statistically significant reduction in time to TT at our institution. The stepwise protocol did support a statistically significant increase in nursing confidence to prevent and treat shivering in a TTM patient.