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Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units.
BMJ Open. 2019 05 24; 9(5):e024549.BO

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 exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period. Setting and participants: 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 inductive analysis: (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.

Authors+Show Affiliations

School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.Faculty of Health and Social Studies, Østfold University College, Halden, Norway.Department of Anaesthesia, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh, UK.Department of Anaesthesia, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh, UK.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31129576

Citation

Kydonaki, Kalliopi, et al. "Challenges and Barriers to Optimising Sedation in Intensive Care: a Qualitative Study in Eight Scottish Intensive Care Units." BMJ Open, vol. 9, no. 5, 2019, pp. e024549.
Kydonaki K, Hanley J, Huby G, et al. Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. BMJ Open. 2019;9(5):e024549.
Kydonaki, K., Hanley, J., Huby, G., Antonelli, J., & Walsh, T. S. (2019). Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. BMJ Open, 9(5), e024549. https://doi.org/10.1136/bmjopen-2018-024549
Kydonaki K, et al. Challenges and Barriers to Optimising Sedation in Intensive Care: a Qualitative Study in Eight Scottish Intensive Care Units. BMJ Open. 2019 05 24;9(5):e024549. PubMed PMID: 31129576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. AU - Kydonaki,Kalliopi, AU - Hanley,Janet, AU - Huby,Guro, AU - Antonelli,Jean, AU - Walsh,Timothy Simon, AU - ,, Y1 - 2019/05/24/ PY - 2019/5/27/entrez PY - 2019/5/28/pubmed PY - 2020/4/22/medline KW - qualitative research KW - quality In health care SP - e024549 EP - e024549 JF - BMJ open JO - BMJ Open VL - 9 IS - 5 N2 - 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 exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period. Setting and participants: 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 inductive analysis: (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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31129576/Challenges_and_barriers_to_optimising_sedation_in_intensive_care:_a_qualitative_study_in_eight_Scottish_intensive_care_units L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=31129576 DB - PRIME DP - Unbound Medicine ER -