Clinician perspectives on protocols designed to minimize sedation

Louise Rose; Emma Fitzgerald; Deborah Cook; Scott Kim; Marilyn Steinberg; John W Devlin; Betty Jean Ashley; Peter Dodek; Orla Smith; Kerri Poretta; Yoon Lee; Karen Burns; Johanne Harvey; Yoanna Skrobik; Dean Fergusson; Maureen Meade; Alan Kraguljac; Lisa Burry; Sangeeta Mehta; SLEAP Investigators; Canadian Critical Care Trials Group

doi:10.1016/j.jcrc.2014.10.021

Clinician perspectives on protocols designed to minimize sedation

J Crit Care. 2015 Apr;30(2):348-52. doi: 10.1016/j.jcrc.2014.10.021. Epub 2014 Oct 30.

Authors

Louise Rose¹, Emma Fitzgerald², Deborah Cook³, Scott Kim⁴, Marilyn Steinberg⁴, John W Devlin⁵, Betty Jean Ashley⁶, Peter Dodek⁷, Orla Smith⁸, Kerri Poretta⁸, Yoon Lee⁸, Karen Burns⁹, Johanne Harvey¹⁰, Yoanna Skrobik¹¹, Dean Fergusson¹², Maureen Meade¹³, Alan Kraguljac¹⁴, Lisa Burry¹⁵, Sangeeta Mehta¹⁶; SLEAP Investigators; Canadian Critical Care Trials Group

Affiliations

¹ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
² Academic Department of Critical Care, Queen Alexandra Hospital, University of Portsmouth, Portsmouth, UK.
³ Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada.
⁴ Mount Sinai Hospital, Toronto, Ontario, Canada.
⁵ School of Pharmacy, Northeastern University, Boston, MA.
⁶ St Paul's Hospital, Vancouver, British Columbia, Canada.
⁷ Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
⁸ St Michael's Hospital, Toronto, Ontario, Canada.
⁹ Keenan Research Centre and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Hôpital Maisonneuve Rosemont, Université de Montréal, Montréal, Québec, Canada.
¹¹ Département de Médecine, Soins Intensifs, Hôpital Maisonneuve Rosemont, Université de Montréal, Montréal, Québec, Canada.
¹² Clinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada.
¹⁴ Mount Sinai Hospital, and Program in Developmental Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁵ Department of Pharmacy and Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
¹⁶ Department of Medicine and Interdepartmental Division of Critical Care, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: Geeta.mehta@utoronto.ca.

PMID: 25466317
DOI: 10.1016/j.jcrc.2014.10.021

Abstract

Purpose: Within a multicenter randomized trial comparing protocolized sedation with protocolized sedation plus daily interruption (DI), we sought perspectives of intensive care unit (ICU) clinicians regarding each strategy.

Methods: At 5 ICUs, we administered a questionnaire daily to nurses and physicians, asking whether they liked using the assigned strategy, reasons for their responses, and concerns regarding DI.

Results: A total of 301 questionnaires were completed, for 31 patients (15 protocol only and 16 DI); 117 (59 physicians and 58 nurses) were the first questionnaire completed by that health care provider for that patient and were included in analyses. Most respondents liked using the assigned strategy (81% protocol only and 81% DI); more physicians than nurses liked DI (100% vs 61%; P < .001). Most common reasons for liking the assigned sedation strategy were better neurologic assessment (70% DI), ease of use (58% protocol only), and improved patient outcomes (51% protocol only and 44% DI). Only 19% of clinicians disliked the assigned sedation strategy (equal numbers for protocol only and DI). Respondents' concerns during DI were respiratory compromise (61%), pain (48%), agitation (45%), and device removal (26%). More questionnaires from nurses than physicians expressed concerns about DI.

Conclusions: Most respondents liked both sedation strategies. Nurses and physicians had different preferences and rationales for liking or disliking each strategy.

Trial registration: ClinicalTrials.gov NCT00675363.

Keywords: Analgesia; Attitudes of health personnel; Daily interruption; Intensive care unit; Mechanical ventilation; Sedation protocol.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Attitude of Health Personnel*
Clinical Protocols*
Conscious Sedation / methods*
Critical Care Nursing*
Critical Illness
Female
Humans
Intensive Care Units
Male
Patient Care Team
Psychomotor Agitation / prevention & control
Randomized Controlled Trials as Topic
Respiration, Artificial* / methods
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT00675363

Grants and funding

Canadian Institutes of Health Research/Canada