Successful evidence-based clinical practice change involves organisational and individual commitment.A sedation management team was formed and consisted of an ICU staff nurse, advance practice nurse, nurse manager, assistant nurse manager, pulmonary fellow, staff physician, and pharmacist.After implementation of the sedation management protocol, the average ventilator days decreased from 10.3 to 8.1 (2.2 days).
Outcome indicators included length of time on the mechanical ventilator, MICU and hospital LOS of the mechanically ventilated patients (ICD-9 procedure code 9672), and mean hospital cost.
The knowledge survey indicated that staff was knowledgeable about pharmacological aspects of benzodiazepine use, but they were less satisfied with sedation management in general.
Data from chart audits indicated that there were no structured mechanisms or tools being used to document the level of sedation (ie, there were 175 different terms being used to document sedation level).
After implementation of the agitation and sedation scale and the sedation management protocol, the number of times sedation level was documented increased from 3.5 to 10.9 times per 24 hour period.
Evidence also indicates that the total duration of continuous intravenous sedation is associated with decreased ventilator hours.
The success of a sedation management protocol seems to be achieved in part by allowing rapid clinical decision making at the patient’s bedside.
Research suggests that lack of a sedation protocol in an ICU is associated with prolonged sedation, longer ventilation times, longer hospital stays, and higher costs.
Evidence suggests that the use of a protocol directed sedation policy decreases the duration of mechanical ventilation for patients with acute respiratory failure compared with non-protocol directed care.
Process and outcome indicators were used to evaluate the change in practice.
Process indicators included an increased knowledge level of nurses regarding evidence-based sedation management practices (knowledge survey); use of a standard tool to document level of sedation, number of times sedation level was documented per each 24 hours of mechanical ventilation, and routine use of an agitation scale; and daily assessment of the patient without sedation (chart audits).
Infusion into practice is an ongoing effort in which continued support from nurses, physicians, and pharmacy is difficult.