A Census of Current Sedation Monitoring Practices in Adult General Intensive Care Units in England. (April 2014) - Freilich, Simon
Under- and over-sedation in intensive care units (ICUs) have potentially deleterious consequences. The Intensive Care Society (ICS) produced guidelines in 2007 to unify sedation management. The aim of the current census was to investigate how sedation practice was subsequently implemented in England. A telephone-based questionnaire to the 'nurse-in-charge' was iteratively developed at the host institution until respondent concordance was greater than 80%. Two hundred and four adult general ICUs across England were then contacted. One hundred and sixty units (79%) completed the survey; 82% of responding ICUs had a written sedation policy; all responding ICUs used a sedation scoring system, mainly the Richmond Scale (64%). All responding ICUs assessed and documented sedation levels, with 73% formally assessing this at least two-hourly; 91% of responding ICUs had a formal sedation holding policy; 73% of responding nurses felt there was adequate medical guidance provided on sedation depth; 27% of responding ICUs had bispectral index (BIS) monitors, with 74% of these units using them for monitoring sedated patients receiving neuromuscular blocking agents. Sedation management has improved nationally over the last five years. Written sedation policies, sedation scoring and sedation holding are standard practice. However, some nurses feel they need more guidance on choosing sedation depth, and some units assess sedation depth less frequently than two-hourly. In order to optimise clinical practice, we propose that sedation depth be a goal-directed therapy that is addressed at each patient review.