title: Development, dissemination and implementation of a sedation and analgesic guideline in a pediatric intensive care unit...it takes creativity and collaboration.
abstract: Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children. An evidence-based sedation and analgesia management (SAM) guideline for critically ill, intubated and ventilated infants and children was developed over a six-month period by a team composed of PICU physicians, pharmacists and nurses. The quality of patient care initiative focused on consistent use of (a) validated sedation and analgesia assessment tools, (b) a goal-directed approach by identifying daily therapeutic target scores and titrating interventions accordingly, and (c) non-pharmacologic, pharmacologic and adjunctive measures. The authors describe their experience in the development, dissemination and implementation of an interprofessional guideline directed at improving sedation and analgesia and patient safety in the PICU. Tools developed to support the practice change, challenges and lessons learned are shared.
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa. thomas@cheo.on.ca
authors.forename: Margot
authors.initials: M
authors.lastname: Thomas
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
authors.forename: Danica
authors.initials: D
authors.lastname: Irwin
authors.forename: Hilary
authors.initials: H
authors.lastname: Writer
authors.forename: Dermot
authors.initials: D
authors.lastname: Doherty
mesh_terms: D000465:Algorithms; D000698:Analgesia / Q000451:nursing*; D002648:Child; D016292:Procedural Sedation / Q000451:nursing*; D003422:Critical Care / Q000379:methods* / Q000592:standards; D003663:Decision Trees; D004059:Diffusion of Innovation; D016903:Drug Monitoring / Q000451:nursing; D004509:Education, Nursing, Continuing; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education; D009864:Ontario; D017410:Practice Guidelines as Topic; D057170:Translational Research, Biomedical