An assessment of a sedative algorithm for sleep in an intensive care unit

The difficulty for intensive care unit (ICU) patients to obtain frequent and extensive sleep has been well-documented. This project assessed the benefit of an algorithm of pharmacological assistance (lorazepam and methotrimeprazine) on sedation level and sleep duration in the ICU. The setting was a 15-bed closed ICU dealing with medical and surgical patients in a tertiary care, teaching hospital. Desired and actual levels of sedation for individual patients were determined hourly by the bedside nurse. Medications could be administered to facilitate achieving the desired level of sedation. Our results should no difference occurred in the achievement of the target sedation or duration of sleep with the implementation of the sedation algorithm. The amount of additional medication required during the night did change with the implementation of the sedation algorithm. A reduction in the amount of diazepam, morphine, and additional methotrimeprazine was noted. Efforts to change nursing practice will be required to improve the quality and quantity of sleep in ICU patients. This clinical evaluation demonstrates that the implementation of an algorithm for medication use is not effective alone in obtaining the desired level and duration of sleep in ICU patients. Nursing practice should continue to look at non-pharmacological factors, such as environmental noise, patient interruptions, and patient care practice to determine strategies in addition to medications which would aid the critically ill patient in achieving adequate sleep.