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Education, Research, and Quality Improvement |

Decreasing Use of Continuous Sedation in the ICU: Identifying Obstacles to Adopting a Protocol

Mitra Sahebazamani*, MD; Donna Bond, RN; Lisha Osborne, RN; Corey Goodwin, PharmD; Mahtab Foroozesh, MD
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CRMH, Roanoke, VA


Chest. 2012;142(4_MeetingAbstracts):542A. doi:10.1378/chest.1389633
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Abstract

SESSION TYPE: Outcomes/Quality Control Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To investigate the effects of a patient-targeted sedation protocol in reducing duration of mechanical ventilation, ICU and hospital stay, as well as identifying the obstacles to adopting the protocol.

METHODS: We performed a prospective cohort study of ICU mechanically ventilated patients treated with a patient-targeted protocol of as needed treatments for pain, agitation, or delirium in a 6-month period and retrospectively compared them with historical data for similar patients in the same period of the previous year. After the study period, participating nurses were asked to answer 7 multiple choice and open-ended questions.

RESULTS: 174 patients met criteria and were started on the sedation protocol. Outcomes were compared with 180 similar patients from the previous year. The median duration of mechanical ventilation was 3.1 days in the intervention group compared with 3.5 days in the control group (P=0.34). The median ICU and hospital stays for treatment versus control groups were 5.45 versus 6.0 days (P=0.31), and 10.20 versus 11.20 days (P=0.41), respectively. Ten nurses (67%) felt they were not helping patients by switching from continuous to as needed sedation. Eighty seven percent were not optimistic about outcomes before implementing the protocol. This decreased to 50% after completing the project. They identified the lack of a protocol order-set in our computer system (94%), lack of residents’ education about the protocol (100%), and differences in attendings’ sedation preferences as major problems during the study.

CONCLUSIONS: Trends towards improvement in outcomes were demonstrated in the patients on the protocol compared with historic controls though not statistically significant. We noted suboptimal nursing and physician adherence to the protocol throughout the study period. We believe a multidisciplinary approach to sedation is needed to improve patient outcomes and to reduce barriers to adopting a sedation protocol.

CLINICAL IMPLICATIONS: Changing the culture and personal perspectives surrounding pain and sedation management and providing a thorough education to all involved care providers are necessary in making the protocol a success.

DISCLOSURE: The following authors have nothing to disclose: Mitra Sahebazamani, Donna Bond, Lisha Osborne, Corey Goodwin, Mahtab Foroozesh

No Product/Research Disclosure Information

CRMH, Roanoke, VA

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