Blanket Bolus

Massachusetts General Hospital (Boston, Massachusetts)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Added to Collection

Project Topic

Agitation management for ICU patients

Hospital Unit

Medical Intensive Care Unit Blake 7

CSI Participants

Christine McCarthy, MSN, RN
Elizabeth Mover, BSN, RN
Clara Shim, BSN, RN

Project Goals/Objectives

  1. To reduce agitation 5% in patients with a RASS > +1 by utilizing a weighted blanket
  2. To reduce the use of continuous sedation medications 5%
  3. To reduce the use of PRN medications in agitated patients

Project Outcomes

  1. Reduced the average RASS score by -1.33 points
  2. Decreased the use of continuous sedating medications 22.6%
  3. Decreased the use of PRN agitation medications 51.6%
  4. Decreased the average ventilator days 9.4%
  5. Increased patients’ comments of feeling safe and feeling comfort
  6. Increased nurses’ comments of patients’ increased sleep and increased ability to extubate patients
  7. These outcomes resulted in an estimated annual fiscal impact of $492,144.

Project Overview

The Medical Intensive Care Unit (MICU) consists of an acute care patient population, many of whom require mechanical ventilator support and continuous sedating medications. Agitation is common in these patients as their sedating medications are being weaned, with medications often increased or added due to agitation. We wondered if using weighted blankets would help decrease patients’ agitation and the need for sedating pharmacological agents.

Extensive research exists on the use of weighted blankets in patients with autism and psychiatric patients, but no research has been done on using these blankets in an acute care setting. We created a PowerPoint presentation to educate our nursing staff about the benefits of weighted blankets, developed a quick tips sheet for staff daily reference and utilized champions to identify patients each day who would be appropriate to trial a weighted blanket.

We were thrilled to see the average RASS score decrease. Use of continuous sedating medications, and PRN medications, as well as average ventilator days, also decreased. Patients reported feeling safe and comforted with the weighted blankets. Nurses reported patients experienced increased sleep and were able to extubate sooner with the use of the blankets.

We presented our project and results to a group of clinical nurse specialists, who would like to work together on development of a hospital-wide policy for the use of weighted blankets in the acute care setting, and to trial the blankets on a general medical unit, surgical unit and neurology unit. Additionally, we will be meeting with the Director of the Yvonne Munn Research Center at Mass General to hopefully further the research of weighted blankets in the acute care setting.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.