title: Adherence to sedation withdrawal protocols and guidelines in ventilated patients.
abstract: OBJECTIVE
  The purpose of this article is to delineate what we know about adherence with sedation withdrawal protocols and guidelines. Reasons for lack of adherence and associated outcomes are explored in addition to potential solutions.
  
  
  BACKGROUND
  Research has demonstrated the positive outcomes associated with sedation withdrawal in ventilated patients, such as decreased ventilator duration, intensive care unit and hospital length of stay, and mortality. Subsequently, protocols and guidelines used in the trials have been introduced into clinical practice to ensure that practice is evidence based and that clinical outcomes improve. Unfortunately, evidence suggests that adherence to these protocols and guidelines is poor. DESCRIPTION OF PROJECT/INNOVATION: A literature review was performed for years 1998-2011 using PubMed, Ovid MEDLINE, and Cumulative Index to Nursing and Allied Health Literature. Searches included the key terms sedation management, sedation interruption, sedation withdrawal, mechanical ventilation, protocol adherence, guideline adherence, sedation management adherence, sedation interruption adherence, and mechanical ventilation weaning.
  
  
  RESULTS
  Twelve articles that focused on adherence to sedation withdrawal protocols or guidelines were reviewed to determine adherence rates and reasons for lack of adherence. An additional 5 research articles testing the efficacy of sedation withdrawal protocols or guidelines in practice were reviewed to determine clinical outcomes associated with their use.
  
  
  CONCLUSIONS
  Despite the current emphasis on the importance of sedation withdrawal in mechanically ventilated patients, protocols and guidelines that are designed to ensure adherence do not appear to be working. Multiple reasons for the lack of adherence are suggested in the literature, including caregiver perceptions, complexity, and processes of care. In addition, clinician education, unit culture, and philosophy may all play a part.
  
  
  CONCLUSIONS
  The findings described in this article suggest that adherence to sedation withdrawal protocols and guidelines is not good despite perceptions to the contrary. The article delineates potential solutions as suggested by the authors of the reviewed articles and those of the author of this article.
authors.affiliation: School of Nursing, University of Virginia Health System, Charlottesville, VA 22903-3395, USA. smb4h@virginia.edu
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Burns
mesh_terms: D002985:Clinical Protocols; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015300:Ventilator Weaning / Q000379:methods*; D028761:Withholding Treatment / Q000592:standards*
chemical_list: D006993:Hypnotics and Sedatives