Implementation of a multiphase, multi-institutional QI initiative to optimise sedation practices in cardiac ICU...

Area of Science:

• Pediatric Critical Care Medicine
• Clinical Education
• Pharmacology

Background:

• Sedation practices in pediatric cardiac intensive care units (ICU) show significant institutional variability.
• Validated tools like the State Behavioral Scale (SBS) and Richmond Agitation Sedation Scale (RASS) are crucial for standardizing sedation.
• Optimizing patient safety and comfort in the pediatric cardiac ICU is a primary concern.

Purpose of the Study:

• To assess the effectiveness of a novel educational intervention in improving healthcare providers' knowledge of sedation scoring tools.
• To evaluate the impact of a web-based learning module on the application of the State Behavioral Scale and Richmond Agitation Sedation Scale.

Main Methods:

• A multi-phase, multi-center prospective study was conducted.
• Phase one involved a self-paced, web-based educational video module on optimal sedation practices.
• Knowledge assessment utilized pre- and post-test surveys comparing aggregate scores via t-tests.

Main Results:

• A statistically significant increase in mean post-test scores was observed for both the State Behavioral Scale (4 to 4.8, p=0.01) and Richmond Agitation Sedation Scale (4.5 to 4.9, p=0.04).
• A substantial majority of participants indicated their practice would change: 81% for RASS and 88.1% for SBS post-tests.
• Data included 259 pre-tests and 142 post-tests.

Conclusions:

• The developed learning module effectively enhanced short-term knowledge of optimal sedation and scoring.
• Further research (phase two) will evaluate long-term compliance with sedation screening tools.
• Future efforts include developing objective scores for cumulative opioid dosing in cardiac critical care units.