Administering Ketamine Infusions for Depression: Embracing Change in the Post Anesthesia Care Unit

Abstract

<h3>Background Information</h3> Ketamine infusions are emerging as a novel treatment therapy for patients with severe treatment resistant depression. Across the country, there are limited options for receiving ketamine infusions outside of an academic based medical research center. A 171-bed community hospital in the northeast United States wanted to provide ketamine to carefully evaluated patients with severe treatment resistant depression. Since ketamine is traditionally used as an anesthetic agent, it was determined that the Post Anesthesia Care Unit (PACU) would be the appropriate setting to provide this treatment. <h3>Objectives of Project</h3> To educate and engage post anesthesia care nurses to implement a non-traditional treatment procedure, Ketamine Infusions, in the PACU setting. <h3>Process of Implementation</h3> Following the leadership decision to initiate ketamine Infusions, PACU nurse champions were identified and became members of the interdisciplinary task force charged with leading the change process. PACU nurses identified specific practice changes required to successfully implement this new treatment including a dedicated ketamine infusion room with new equipment, updates to the electronic health record, development of new standing orders to ensure availability of medications needed to treat adverse events, and establishment of pre and post infusion huddles with the attending psychiatrist. The nurse champions collaborated with the educator to develop a comprehensive multi-modal education plan to ensure competency for this new practice. <h3>Statement of Successful Practice</h3> Since May 2019, a total of 92 ketamine infusion treatments have been administered without serious adverse events. PACU nurses have embraced the practice change as demonstrated through recent survey results. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The successful implementation of ketamine infusions is a result of PACU nurses being directly involved in the planning, implementation, and on-going evaluation of this initiative. As organizations across the country explore options to meet patient health care needs, PACU nurses will play an important role in addressing strategic initiatives by embracing treatment therapies.