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Clinician perspectives on protocols designed to minimize sedation
Louise Rose1, Emma Fitzgerald2, Deborah Cook3
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Journal of Critical Care
|December 4, 2014
Summary
Most intensive care unit (ICU) clinicians liked both protocolized sedation and daily interruption (DI) strategies. However, nurses and physicians differed in their preferences and reasons for liking or disliking these sedation methods.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Nursing Research
Background:
- Sedation protocols are standard in intensive care units (ICUs) to manage patient comfort and reduce ventilator days.
- Daily interruption (DI) of sedation is a strategy aimed at improving patient outcomes and reducing sedation duration.
- Understanding clinician perspectives is crucial for the successful implementation of sedation strategies in ICUs.
Purpose of the Study:
- To investigate the perspectives of intensive care unit (ICU) clinicians on protocolized sedation versus protocolized sedation plus daily interruption (DI).
- To identify clinician preferences, reasons for liking/disliking sedation strategies, and concerns regarding daily interruption.
Main Methods:
- A multicenter randomized trial comparing two sedation strategies was conducted across 5 ICUs.
- Nurses and physicians completed daily questionnaires regarding their assigned sedation strategy and concerns about DI.
- Analysis included 117 initial questionnaires from healthcare providers for specific patients.
Main Results:
- A high percentage of clinicians (81%) liked both sedation strategies.
- Physicians showed a stronger preference for DI compared to nurses (100% vs. 61%).
- Key concerns during DI included respiratory compromise (61%), pain (48%), and agitation (45%); nurses reported more concerns than physicians.
Conclusions:
- Both protocolized sedation and DI are generally well-liked by ICU clinicians.
- Significant differences exist in preferences and rationales between nurses and physicians regarding sedation strategies.
- Addressing clinician concerns is vital for optimizing the use of DI in clinical practice.
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