Table 2 Framework for a minimal sedation protocol implementation ^a

Knowledge

Lack of familiarity

Interactive educational session

An evidence-based review of the benefits of minimal sedation and the guidelines were shown.

In this section, the first concerns and questions about the minimal sedation policy could be discussed.

Educational outreach visit

Random bedside rounds accompanied by two of the authors responsible for the coordination of the group of ICUs

Mechanically ventilated patients were identified and the possibility of minimal sedation institution was discussed individually for each patient.

Lack of awareness; commonly, doctors state they already use ideal sedation

Initial benchmarking

The range of outcome (length of mechanical ventilation and sedative consumption) was demonstrated to all the ICU leaders.

There was wide variability among ICUs, suggesting there was an opportunity for improvement.

Lack of self-efficacy

Use of early adopters’ example

The experience of one unit and its methods used to overcome barriers were shown to all other ICU leaders.

One of the least resourced ICUs was the first to obtain positive results.

Lack of self-efficacy

Performance coaching

Monthly/weekly feedback concerning sedative consumption and length of mechanical ventilation

In selected cases, weekly feedback was given, with identification of specific days of larger sedative consumption (mostly on weekends).

Attitude

Lack of agreement

External validation

Knowledgeable doctor was invited to give the initial presentation.

The credibility of the proposed policy was endorsed by an academic leader.

Behavior

Conflict among the multidisciplinary team

Definition of common goals

Multidisciplinary involvement in meetings and bedside rounds

Nurses, respiratory therapists, clinical pharmacists and physicians were encouraged to get involved in the discussion of sedation goals at rounds.