1. J Crit Care. 2014 Apr;29(2):291-7. doi: 10.1016/j.jcrc.2013.11.004. Epub 2013 Nov
7.

What stops us from following sedation recommendations in intensive care units? A 
multicentric qualitative study.

Sneyers B(1), Laterre PF(2), Bricq E(3), Perreault MM(4), Wouters D(5), Spinewine
A(6).

Author information: 
(1)Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université
catholique de Louvain, Brussels, Belgium; Department of Pharmacy, Cliniques
universitaires saint Luc, Brussels, Belgium. Electronic address:
Barbara.Sneyers@uclouvain.be.
(2)Department of Intensive Care and Emergency Medicine, Cliniques universitaires
saint Luc, Brussels, Belgium.
(3)Inter Aide, Paris, France.
(4)Faculty of Pharmacy, Université de Montréal.
(5)Department of Pharmacy, Cliniques universitaires saint Luc, Brussels, Belgium.
(6)Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université
catholique de Louvain, Brussels, Belgium; Department of Pharmacy, Centre
hospitalier universitaire Mont-Godinne/Dinant, Université catholique de Louvain, 
Yvoir, Belgium.

PURPOSE: The purpose of the study is to explore health care professionals' (HCPs)
perceptions regarding sedation recommendations.
MATERIALS AND METHODS: This is a qualitative study, using face-to-face
semistructured interviews. Health care professionals from 4 Belgian hospitals
were purposively sampled. We focused on recommendations involving strategies such
as protocolized sedation, sedation scales, daily sedation interruption (DSI), and
providing analgesia before sedation. Knowledge, perceived barriers, expected
outcomes, and responsibilities were discussed for each recommendation. Two
researchers independently performed content analysis, classifying quotes
according to an interdisciplinary framework and creating new categories for
emerging themes.
RESULTS: Data saturation was reached after 21 HCPs (physicians, nurses, and
physiotherapists) were interviewed. Quotes were related to HCPs, guidelines or
the system. Barriers were diverse according to the type of HCP or level of
experience. Task characteristics impairing implementation of protocolized
sedation included lack of means communicating goals or tasks to all HCPs
providing care, ambiguous responsibilities, and unclear methodology on how to
execute the recommendation. Fear of adverse events and lack of clarity regarding 
contraindications impair implementation of DSI.
CONCLUSION: Barriers impairing implementation of sedation recommendations vary
according to the type of HCP and the choice of strategy targeting light sedation 
(protocolized sedation vs DSI). Improvement strategies must target HCPs
separately and tailored to specific recommendation choices.

Copyright © 2014 Elsevier Inc. All rights reserved.

PMID: 24412211  [PubMed - in process]