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J Crit Care. 2017 Apr;38:182-189. doi: 10.1016/j.jcrc.2016.07.021. Epub 2016 Aug 11.

Predictors of clinicians' underuse of daily sedation interruption and sedation scales.

Author information

1
Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Bâtiment Van Helmont, Brussels, Belgium; Department of Pharmacy, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: Barbara.Sneyers@chu-charleroi.be.
2
Université Catholique de Louvain, Institute of Health and Society (IRSS), Brussels, Belgium.
3
Department of Intensive Care and Emergency Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium.
4
Faculté de Pharmacie, Université de Montréal, Montréal, QC H3C 3 J7, Canada.
5
Information and Medical Statistics, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium.
6
Department of Pharmacy, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
7
Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Bâtiment Van Helmont, Brussels, Belgium; Department of Pharmacy, Université Catholique de Louvain, Centre Hospitalier Universitaire Dinant-Godinne UCL Namur, 5330 Yvoir, Belgium.

Abstract

PURPOSE:

The purpose of the study is to identify predictors of underuse of sedation scales and daily sedation interruption (DSI).

METHODS:

We surveyed all physicians and seven nurses in every Belgian intensive care unit (ICU), addressing practices and perceptions on guideline recommendations. Underuse was defined for sedation scales as use less than 3× per day and for DSI as never using it. Classification trees and logistic regressions identified predictors of underuse.

RESULTS:

Underuse of sedation scales and DSI was found for 16.6% and 32.5% of clinicians, respectively. Strongest predictors of underuse of sedation scales were agreeing that using them daily takes much time and being a physician (rather than a nurse). Further predictors were confidence in their ability to measure sedation levels without using scales, for physicians, and nurse/ICU bed ratios less than 1.98, for nurses. The strongest predictor of underuse of DSI among physicians was the perception that DSI impairs patients' comfort. Among nurses, lack of familiarity with DSI, region, and agreeing DSI should only be performed upon medical orders best predicted underuse.

CONCLUSIONS:

Workload considerations hamper utilization of sedation scales. Poor familiarity, for nurses, and negative perception of impact on patients' comfort, for physicians, both reduce DSI utilization. Targeting these obstacles is essential while designing quality improvement strategies to minimize sedative use.

KEYWORDS:

Barriers; Daily sedation interruption; Intensive care unit; Protocols; Quality improvement; Sedation scales

PMID:
27930995
DOI:
10.1016/j.jcrc.2016.07.021
[Indexed for MEDLINE]

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