(1221) Nurses' Decision-Making With Titration of Vasoactive Medications

Introduction: Critical care nursing practice involves titrating vasoactive medications and, historically, was done so autonomously with few administration parameters. In 2017, the Joint Commission (JC) developed more stringent standards for titrating vasoactive medications. Recent studies examined nurse perceptions of the JC standards, revealing feelings of moral distress, limited autonomy, delays in care, and documentation concerns. Yet, little is known about the methods nurses use when making decisions for titration. The purpose of our study was to explore nurses’ decision-making processes and confidence while titrating vasoactive medications. We hypothesized that nurses use multifactorial processes beyond using a protocol.

Methods: We used a prospective, five hospital-site, mixed-methods descriptive study design. Demographic data was collected. The Clinical Decision-Making Nursing Scale (CDMNS) with 4 modified subscales and Confidence Scale (5-pt. Likert scales) were used for quantitative data. Qualitative methods using semi-structured interviews were conducted and analyzed for themes.

Results: Mean years of nursing experience was 5.16 with 2.78 years in the ICU and 76% were BSN prepared and 66% held certification. Average CDMNS scores: 127.26+10.15 (Range 105-149) out of 165. Average confidence scores: 21.6 +2.75 (Range 15-25) out of 25. No association was found between survey scores and demographics. Four themes evolved: “Using the Protocol”; “Using Knowledge and Critical Thinking”; “Considering the Patient History, and “Collaborating Professionally.”

Conclusions: Overall, decision-making and confidence scores were above average. Nurses described multiple processes for making decisions while titrating vasoactive medications, supporting our initial hypothesis. Protocols were valued but perceived to have limitations. Qualitative descriptions indicated that when making decisions on titration of vasoactive medications, requirements include a robust knowledge base, understanding the complexity of the patient’s past and current history, and collaboration with the multiprofessional team beyond using a protocol. Information gleaned from this study may be used to enhance strategies to promote a collaborative and experiential approach when educating nurses about titration of vasoactive medications.