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Table 1 Proposed order set quality elements based on the 2002 sedation guidelines expert-validated quality score

From: Association between hospital volume and network membership and an analgesia, sedation and delirium order set quality score: a cohort study

Analgesia elements (n= 10) Expert quality score Sedation elements (n= 10) Expert quality score Delirium elements (n= 4) Expert quality score
Pain is regularly assessed 1.0 (0) Sedation is regularly assessed 1.0 (0) Delirium is regularly assessed 1.7 (0.72)
Pain is regularly documented 1.0 (0) Sedation is regularly documented 1.0 (0) Delirium is treated on a symptom-oriented basis 1.9 (0.64)
Validated pain scale is used to assess pain 1.2 (0.56) Validated sedation assessment scale is used 1.1 (0.26) Antipsychotic medications are included in the order set for the pharmacologic treatment of delirium 1.7 (0.72)
Self-report of pain is used to assess pain 1.2 (0.56) Sedation goal or endpoint is established for each patient 1.0 (0) The QT interval is monitored in patients receiving antipsychotics a 1.8 (0.77)
Therapeutic goal of analgesia is established 1.1 (0.35) The sedative dose is titrated to a defined endpoint 1.0 (0)   
The analgesia goal is patient specific 1.0 (0) Sedation of agitated critically ill patients is started only after providing adequate analgesia 1.4 (0.63)   
Analgesic medications are titrated based on the patient's goal and plan 1.0 (0) Sedation of agitated critically ill patients is started only after treating reversible physiologic causes 1.4 (0.63)   
NSAIDs or acetaminophen should be provided as optional adjuncts to opioids in selected patients 2.0 (0.76) A sedation algorithm or protocol is used to guide the administration of sedation 1.2 (0.41)   
Scheduled opioid doses or a continuous infusion are given preferentially over an as-needed regimen 2.7 (1.1) Daily interruption of sedation is performed in all patients who lack a contraindication 1.1 (0.26)   
A patient-controlled analgesia device is preferred to deliver opioids if the patient is able to understand and operate the device 2.1 (0.74) The daily sedation interruption is explicitly linked to a spontaneous breathing trial 1.4 (0.51)   
  1. Data presented as mean (standard deviation). NSAID, nonsteroidal anti-inflammatory drug. The expert quality score ranged from 1 (all high-quality analgesia/sedation order sets should contain this element) to 4 (a high-quality analgesia/sedation order set would not contain this element). Elements with an average rating of 2 or better were included in the order set quality score. Elements in italics were not included in the final order set quality score. aHospitals without antipsychotics on their order sets may not require this element.