title: Predictors of clinicians' underuse of daily sedation interruption and sedation scales.
abstract: The purpose of the study is to identify predictors of underuse of sedation scales and daily sedation interruption (DSI).
  
  
  
  We surveyed all physicians and seven nurses in every Belgian intensive care unit (ICU), addressing practices and perceptions on guideline recommendations. Underuse was defined for sedation scales as use less than 3× per day and for DSI as never using it. Classification trees and logistic regressions identified predictors of underuse.
  
  
  
  Underuse of sedation scales and DSI was found for 16.6% and 32.5% of clinicians, respectively. Strongest predictors of underuse of sedation scales were agreeing that using them daily takes much time and being a physician (rather than a nurse). Further predictors were confidence in their ability to measure sedation levels without using scales, for physicians, and nurse/ICU bed ratios less than 1.98, for nurses. The strongest predictor of underuse of DSI among physicians was the perception that DSI impairs patients' comfort. Among nurses, lack of familiarity with DSI, region, and agreeing DSI should only be performed upon medical orders best predicted underuse.
  
  
  
  Workload considerations hamper utilization of sedation scales. Poor familiarity, for nurses, and negative perception of impact on patients' comfort, for physicians, both reduce DSI utilization. Targeting these obstacles is essential while designing quality improvement strategies to minimize sedative use.
authors.affiliation: Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Bâtiment Van Helmont, Brussels, Belgium; Department of Pharmacy, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: Barbara.Sneyers@chu-charleroi.be.
authors.forename: B
authors.initials: B
authors.lastname: Sneyers
authors.affiliation: Université Catholique de Louvain, Institute of Health and Society (IRSS), Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Henrard
authors.affiliation: Department of Intensive Care and Emergency Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: P F
authors.initials: PF
authors.lastname: Laterre
authors.affiliation: Faculté de Pharmacie, Université de Montréal, Montréal, QC H3C 3 J7, Canada.
authors.forename: M M
authors.initials: MM
authors.lastname: Perreault
authors.affiliation: Information and Medical Statistics, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Beguin
authors.affiliation: Department of Pharmacy, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Wouters
authors.affiliation: Université Catholique de Louvain, Institute of Health and Society (IRSS), Brussels, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Speybroeck
authors.affiliation: Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Bâtiment Van Helmont, Brussels, Belgium; Department of Pharmacy, Université Catholique de Louvain, Centre Hospitalier Universitaire Dinant-Godinne UCL Namur, 5330 Yvoir, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Spinewine
mesh_terms: D001530:Belgium; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D003422:Critical Care; D003663:Decision Trees; D004334:Drug Administration Schedule; D006801:Humans; D006993:Hypnotics and Sedatives / Q000600:supply & distribution*; D007362:Intensive Care Units; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives
keywords: Barriers; Daily sedation interruption; Intensive care unit; Protocols; Quality improvement; Sedation scales