Nurses' Sedation Practices During Weaning of Adults From Mechanical Ventilation in an Intensive Care Unit

Marta Borkowska; Sonia Labeau; Tom Schepens; Dominique Vandijck; Katrien Van de Vyver; Daphné Christiaens; Christelle Lizy; Bronagh Blackwood; Stijn I Blot

doi:10.4037/ajcc2018959

Nurses' Sedation Practices During Weaning of Adults From Mechanical Ventilation in an Intensive Care Unit

Am J Crit Care. 2018 Jan;27(1):32-42. doi: 10.4037/ajcc2018959.

Authors

Marta Borkowska¹, Sonia Labeau², Tom Schepens², Dominique Vandijck², Katrien Van de Vyver², Daphné Christiaens², Christelle Lizy², Bronagh Blackwood², Stijn I Blot²

Affiliations

¹ Marta Borkowska is a registered nurse in the surgical intensive care unit at Ghent University Hospital, Ghent, Belgium. Sonia Labeau is head of the nursing degree program, Faculty of Education, Health, and Social Work, University College Ghent, Ghent, Belgium. Tom Schepens is a clinical fellow, Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Canada, and a doctoral student at University of Antwerp, Antwerp, Belgium. Dominique Vandijck is a professor, Faculty of Medicine and Life Sciences, Department of Patient Safety, Hasselt University, Diepenbeek, Belgium, and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, and director of quality and safety, Zorgnet-Icuro, Brussels, Belgium. Katrien Van de Vyver is an infection prevention and control nurse, AZ Maria Middelares Hospital, Ghent, Belgium. Daphné Christiaens is a study nurse, SAFE-PEDRUG study team, Pediatric Nephrology and Rheumatology, Ghent University Hospital. Christelle Lizy is head nurse, Nephrology, Endocrinology, Cardiology Department, Ghent University Hospital. Bronagh Blackwood is professor of critical care, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland. Stijn I. Blot is a research professor, Department of Internal Medicine, Ghent University, and an honorary professor, Burns Trauma and Critical Care Research Centre, University of Queensland, Bris-bane, Australia. marta_bork@hotmail.com.
² Marta Borkowska is a registered nurse in the surgical intensive care unit at Ghent University Hospital, Ghent, Belgium. Sonia Labeau is head of the nursing degree program, Faculty of Education, Health, and Social Work, University College Ghent, Ghent, Belgium. Tom Schepens is a clinical fellow, Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Canada, and a doctoral student at University of Antwerp, Antwerp, Belgium. Dominique Vandijck is a professor, Faculty of Medicine and Life Sciences, Department of Patient Safety, Hasselt University, Diepenbeek, Belgium, and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, and director of quality and safety, Zorgnet-Icuro, Brussels, Belgium. Katrien Van de Vyver is an infection prevention and control nurse, AZ Maria Middelares Hospital, Ghent, Belgium. Daphné Christiaens is a study nurse, SAFE-PEDRUG study team, Pediatric Nephrology and Rheumatology, Ghent University Hospital. Christelle Lizy is head nurse, Nephrology, Endocrinology, Cardiology Department, Ghent University Hospital. Bronagh Blackwood is professor of critical care, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland. Stijn I. Blot is a research professor, Department of Internal Medicine, Ghent University, and an honorary professor, Burns Trauma and Critical Care Research Centre, University of Queensland, Bris-bane, Australia.

PMID: 29292273
DOI: 10.4037/ajcc2018959

Abstract

Background: Sedation and analgesia have an important impact on the outcome of patients treated with mechanical ventilation. International guidelines recommend use of sedation protocols to ensure best patient care.

Objective: To determine the sedation practice of intensive care nurses weaning adults from mechanical ventilation.

Methods: A cross-sectional survey with a self-administered questionnaire was used to determine sedation practices of Flemish critical care nurses during weaning. Consensus on content validity was achieved through a Delphi procedure among experts. Data were collected during the 32nd Annual Congress of the Flemish Society of Critical Care Nurses in Ghent, Belgium, December 2014.

Results: A total of 342 nurses were included in the study. Of these, 43.7% had a sedation protocol in their unit that was used by 61.8% of the respondents. Sedation protocols were more often available (P < .001) in academic hospitals (72%) than in general hospitals (41.5%). Sedatives were administered via continuous infusion with bolus doses if needed (81%). Level of sedation was assessed every 2 hours (56%), mostly via the Richmond Agitation-Sedation Scale (59.1%). Daily interruption of sedation was used by 16.5% of respondents. The biggest barriers to daily interruption were patient comfort (49.4%) and fear of respiratory worsening (46.6%).

Conclusions: A considerable discrepancy exists between international recommendations and actual sedation practices. Standardization of sedation practices across different institutions on a regional and national level may improve the quality of care.

MeSH terms

Adult
Analgesics / administration & dosage
Attitude of Health Personnel
Belgium
Clinical Protocols / standards*
Cross-Sectional Studies
Female
Guideline Adherence
Humans
Hypnotics and Sedatives / administration & dosage*
Intensive Care Units / organization & administration*
Male
Middle Aged
Nurse's Role
Patient Acuity
Practice Guidelines as Topic
Ventilator Weaning / methods
Ventilator Weaning / nursing*

Substances

Analgesics
Hypnotics and Sedatives