Response to a nursing-driven protocol for sedation and analgesia in a burn-trauma ICU

A nursing-driven protocol for sedation and analgesia for our burn unit was developed based on Society of Critical Care Medicine recommendation. Our goal was to evaluate nursing staff perceptions of how the protocol affected their ability to achieve care goals for their patients. From March 1 through August 31, 2007, nursing staff were surveyed at the conclusion of each shift when they cared for a patient on protocol. Three hundred and thirty of 506 possible surveys were completed. The preponderance of respondents was nurses with less than 3 years of clinical experience. Sedation and analgesia holidays were reported as performed per protocol 68% of the time, and 80% of deviations from the protocol holiday were because the patient was already at or above target Riker and Visual Analog Scale scores. The majority of responding nurses agreed or strongly agreed that the protocol was effective (62%), that it allowed them to use their clinical assessment skills (64%), and that the protocol was clearly written (70%). Level of comfort with performing a holiday was inversely associated with years of nursing experience (chi, P = .02). Nursing interest in routinely using the protocol was also inversely associated with years of nursing experience (chi, P = .001). Nursing staff responded positively to the introduction of the nursing-driven protocol. Nurses with less clinical experience were more comfortable with analgesia and sedation holidays and were more supportive of consistently using the protocol for mechanically ventilated patients. Further education may help foster support from more senior nursing staff.