Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units.
BMJ Open
; 9(5): e024549, 2019 05 24.
Article
em En
| MEDLINE
| ID: mdl-31129576
ABSTRACT
OBJECTIVES:
Various strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.DESIGN:
A qualitative exploratorydesign:
We conducted focus groups (FG) with clinicians during the preintervention period. Setting andparticipants:
Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee.RESULTS:
Three themes emerged from the inductiveanalysis:
(a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of 'just sedate less' imposed by the pain-agitation-delirium guidelines.CONCLUSIONS:
The current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation-analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation-analgesia strategies should allow a system-level approach to improve sedation-analgesia quality. DESIST REGISTRATION NUMBER NCT01634451.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sedação Consciente
/
Cuidados Críticos
/
Melhoria de Qualidade
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prognostic_studies
/
Qualitative_research
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article