Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. Issue 5 (24th May 2019)

• Record Type: Journal Article
• Authors: Kydonaki, Kalliopi; Hanley, Janet; Huby, Guro; Antonelli, Jean; Walsh, Timothy Simon
• Other Names: author non-byline.; Hay Alasdair author non-byline.; Pollock Fiona author non-byline.; Boardman Louise author non-byline.; Mcculloch Corrienne author non-byline.; Dawson Heidi author non-byline.; Hope David author non-byline.; Kefala Kallirroi author non-byline.; Gillies Michael author non-byline.; Bell Louise author non-byline.; Rodgers Deborah author non-byline.; Wright Sue author non-byline.; Everingham Kirsty author non-byline.; Phillips Emma author non-byline.; Rutherford John author non-byline.; Williams Dr Dewi author non-byline.; Jardine Catherine author non-byline.; Quasim Tara author non-byline.; Puxty Alex author non-byline.; Henderson Steven author non-byline.; Hickey Naomi author non-byline.; Lennon Elizabeth author non-byline.; Ireland Jane author non-byline.; Dickinson Natalie author non-byline.; Callaghan Marie author non-byline.; Rimmer Dominic author non-byline.; Davidson Alan author non-byline.; Mcguigan Katherine author non-byline.; Benchiheub Anissa author non-byline.; Rooney Laura author non-byline.; Richards Jonathan author non-byline.; Grant Janice author non-byline.; Scott Pamela author non-byline.; Mallice Marianne author non-byline.; Mcdougall Marcia author non-byline.; Mcginn Claire author non-byline.; Gray Sarah author non-byline.; Boath Keith author non-byline.; Doig Louise author non-byline.; Berry Lesley author non-byline.; Greenwood Edward author non-byline.; Daglish Elish author non-byline.; Bullions Carolyne author non-byline.; Black Elaine author non-byline.; Beattie Donna author non-byline.; Paton Elaine author non-byline.; Connelly Alison author non-byline.; Hudson Nancy author non-byline.; Tomkins Neville author non-byline.; Cook Julia author non-byline.; Hughes Terry author non-byline.; Cairns Lynne author non-byline.; Rowe Jennifer author non-byline.; Slater Ben author non-byline.; Russell Susan author non-byline.; Savage Bob author non-byline.; Simpson Gavin author non-byline.; Shippey Ben author non-byline.; Cole Stephen author non-byline.; Cabrelli Louise author non-byline.; Duffy Jackie author non-byline.; Amory Pauline author non-byline.; Ruddy James author non-byline.; Harkins Margaret author non-byline.; Reaney Elizabeth author non-byline.; Kearney Lyndsey author non-byline.; Hamill Angela author non-byline.; Paterson Isobel author non-byline.; Harkess Ronald author non-byline.; Thomas Samantha author non-byline.; Weir Christopher author non-byline.; Lee Robert author non-byline.; Stephens Jacqueline author non-byline.; Peltola Petra author non-byline.; Uutela Kimmo author non-byline.; Kamppari Lasse author non-byline.; Sarkela Mika author non-byline.; Blaydon Christine author non-byline.; Mcwhinnie Shaun author non-byline.; Mcauley Danny author non-byline.; Norrie John author non-byline.; Wright Stephen author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 5(2019)
• Publication Date: 2019-05-24
• Subjects: qualitative research -- quality In health care; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-024549
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: Various strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings. Design: A qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period. Setting and participants : Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee. Results: Three themes emerged from the inductive analysis: (a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of 'just sedate less' imposed by the pain–agitation–delirium guidelines. Conclusions: The current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation–analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation–analgesia strategies should allow a system-level approach to improve sedation–analgesia quality. DESIST registration number: NCT01634451