Adoption of a sedation scoring system and sedation guideline in an intensive care unit.
OBJECTIVE
The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline.


BACKGROUND
Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data.


METHODS
A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004.


RESULTS
The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both.


CONCLUSIONS
Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.
Clinical Nurse Consultant, Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW, Australia. rmelliot@nsccahs.health.nsw.gov.au
Rosalind
R
Elliott
Sharon
S
McKinley
Leanne
L
Aitken
D000293:Adolescent; D000328:Adult; D003422:Critical Care / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D009732:Nursing Care / Q000379:methods; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods
D006993:Hypnotics and Sedatives