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Make 'Em Dream, Not Scream: Education, Order Set Modifications, and Clinical Champions Improve Postintubation
Francisco Ibarra1,2, Corinne Cushing2, Crystal Ives Tallman2
1Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA.
The Annals of Pharmacotherapy
|July 23, 2026
Summary
A multidisciplinary initiative significantly improved postintubation sedation (PIS) adherence in emergency departments. The full intervention, including education and clinical champions, was key to enhancing PIS practices for intubated patients.
Area of Science:
- Emergency Medicine
- Critical Care
- Patient Safety
Background:
- Awareness with paralysis is a concern in intubated ED patients receiving rocuronium.
- Internal audits revealed suboptimal postintubation sedation (PIS) adherence.
- An initiative was launched to improve PIS practices.
Purpose of the Study:
- To determine if a multidisciplinary initiative improved the timeliness and adherence to PIS at recommended doses.
- To assess the impact of a PIS improvement initiative across different hospital settings.
Main Methods:
- A pre-post intervention study was conducted at two healthcare system sites (academic and non-academic).
- The intervention included education, order set modifications, and clinical champions.
- PIS adherence rates were compared across three groups (site AM, AT, and B) before and after the intervention.
Main Results:
- PIS adherence at site AM (full intervention) increased from 1% to 20% (P < 0.001).
- No significant PIS adherence changes were observed at sites AT and B.
- Site AM showed significantly higher postintervention PIS adherence than sites AT and B.
Conclusions:
- A focused, multidisciplinary strategy effectively improves PIS best practices in the ED.
- Combining education, workflow optimization, and clinical champions is crucial for successful practice change.
- The results highlight the importance of a comprehensive approach to enhance patient safety in intubated ED patients.
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