Adoption of a sedation scoring system and sedation guideline in an intensive care unit

Elliott, R., McKinley, S. and Aitken, L. (2006) Adoption of a sedation scoring system and sedation guideline in an intensive care unit. Journal of Advanced Nursing, 54 2: 208-216. doi:10.1111/j.1365-2648.2006.03798.x

Author Elliott, R.
McKinley, S.
Aitken, L.
Title Adoption of a sedation scoring system and sedation guideline in an intensive care unit
Journal name Journal of Advanced Nursing   Check publisher's open access policy
ISSN 0309-2402
Publication date 2006-04
Sub-type Article (original research)
DOI 10.1111/j.1365-2648.2006.03798.x
Volume 54
Issue 2
Start page 208
End page 216
Total pages 9
Editor A. Tierney
Place of publication Oxford, U.K.
Publisher Blackwell Publishing
Collection year 2006
Language eng
Subject C1
321009 Intensive Care
321103 Clinical Nursing - Secondary (Acute Care)
730302 Nursing
Abstract Aim. The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. Background. Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data. Method. A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004. Findings. The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both. Conclusion. Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.
Keyword Nursing
Clinical Practice Guidelines
Intensive Care
Intervention Study
Clinical-practice Guidelines
Critically-ill Patients
Mechanical Ventilation
Icu Sedation
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 07:58:56 EST