Assessing sedation levels in patients on mechanical ventilation in an intensive care unit: a best practice implementation project.

INTRODUCTION

Protocols for assessing sedation levels are important strategies in intensive care units (ICUs). Such protocols promote multidisciplinary knowledge, proper sedation monitoring, choice of appropriate sedatives, and the use of non-pharmacological interventions.

OBJECTIVE

This project aimed to improve sedation level assessments in patients under mechanical ventilation in the adult ICU of a private hospital in São Paulo, Brazil.

METHOD: The project used the JBI Evidence Implementation Framework, together with JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) method. The JBI approach is grounded in an audit and feedback strategy, together with a structured approach to addressing barriers to best practices. A baseline audit was conducted to evaluate current practices against five best practice criteria. A follow-up audit was then carried out to evaluate changes in compliance with the evidence-based strategies.

RESULTS

Forty-four patient records were analyzed during the baseline and follow-up audits. The main barriers found among nurses were low compliance with sedation level assessments, no daily sedation targets, inadequate knowledge of sedation assessment using the RASS, and low engagement in training sessions. Strategies were implemented to address these barriers, including the development of a protocol and nursing team training. The follow-up audit showed improvement in three criteria (3, 4, and 5). However, compliance with Criterion 1 decreased from 100% to 71%, potentially resulting from changes in patient record registration. Criterion 2 remained at 47%, indicating that further improvements were necessary.

CONCLUSION

This project improved sedation assessment practices in ICU patients under mechanical ventilation, with a 60% increase in compliance with best practices.

SPANISH ABSTRACT: http://links.lww.com/IJEBH/A403.