Skip to main content

Advertisement

Table 2 Framework for a minimal sedation protocol implementation a

From: Evaluation of a minimal sedation protocol using ICU sedative consumption as a monitoring tool: a quality improvement multicenter project

Nature of barrier Barrier Intervention Categorization Description Comments
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.
  1. aICU, Intensive care unit.