title: What stops us from following sedation recommendations in intensive care units? A multicentric qualitative study.
abstract: OBJECTIVE
  The purpose of the study is to explore health care professionals' (HCPs) perceptions regarding sedation recommendations.
  
  
  METHODS
  This is a qualitative study, using face-to-face semistructured interviews. Health care professionals from 4 Belgian hospitals were purposively sampled. We focused on recommendations involving strategies such as protocolized sedation, sedation scales, daily sedation interruption (DSI), and providing analgesia before sedation. Knowledge, perceived barriers, expected outcomes, and responsibilities were discussed for each recommendation. Two researchers independently performed content analysis, classifying quotes according to an interdisciplinary framework and creating new categories for emerging themes.
  
  
  RESULTS
  Data saturation was reached after 21 HCPs (physicians, nurses, and physiotherapists) were interviewed. Quotes were related to HCPs, guidelines or the system. Barriers were diverse according to the type of HCP or level of experience. Task characteristics impairing implementation of protocolized sedation included lack of means communicating goals or tasks to all HCPs providing care, ambiguous responsibilities, and unclear methodology on how to execute the recommendation. Fear of adverse events and lack of clarity regarding contraindications impair implementation of DSI.
  
  
  CONCLUSIONS
  Barriers impairing implementation of sedation recommendations vary according to the type of HCP and the choice of strategy targeting light sedation (protocolized sedation vs DSI). Improvement strategies must target HCPs separately and tailored to specific recommendation choices.
authors.affiliation: Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Department of Pharmacy, Cliniques universitaires saint Luc, Brussels, Belgium. Electronic address: Barbara.Sneyers@uclouvain.be.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sneyers
authors.affiliation: Department of Intensive Care and Emergency Medicine, Cliniques universitaires saint Luc, Brussels, Belgium.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
authors.affiliation: Inter Aide, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bricq
authors.affiliation: Faculty of Pharmacy, Université de Montréal.
authors.forename: Marc M
authors.initials: MM
authors.lastname: Perreault
authors.affiliation: Department of Pharmacy, Cliniques universitaires saint Luc, Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Wouters
authors.affiliation: Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Department of Pharmacy, Centre hospitalier universitaire Mont-Godinne/Dinant, Université catholique de Louvain, Yvoir, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Spinewine
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D002985:Clinical Protocols; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D026761:Physical Therapy Specialty; D036301:Qualitative Research
chemical_list: D006993:Hypnotics and Sedatives
keywords: Daily sedation interruption and qualitative study; Protocols; Sedation; Sedation scales