Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs

Abstract

Differences in sedation management between these ICUs are likely related to factors other than nurse-patient ratio or specialised training of ICU nurses.

Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project)

“…RNs systematically and routinely assess pain and agitation at rest and during procedures using dedicated tools validated for ICU patients since 2003 [1]. For patients receiving a continuous infusion of sedatives, RNs have been using a sedation-analgesia algorithm since 2007 [18]. In the absence of continuous sedation, or previous analgesic ordering, a medical doctor was called in case of any pain or agitation events [1].…”

“…The first quality improvement process, aimed at implementing a systematic assessment of pain and agitation in the ICU using validated tools, was initiated in 2002 and evaluated in 2003 [1]. The second project (2006 to 2007) was aimed at evaluating nurse interventions regarding a sedation-analgesia algorithm and at comparing them to a North American ICU [18]. …”

“…Awareness was assessed at baseline by the Richmond Agitation Sedation Scale (RASS) [29]. Inter-rater reliability of these sedation and pain scales has been assessed repeatedly in the ICU [1,18,26,30]. All bedside RNs present during the study phases were fully familiar with using these pain and sedation scales routinely, for both sedated and non-sedated patients.…”

“…Poster referring to continuous sedation-analgesia algorithm, adapted from [18] by the work group to highlight educational objectives and posted in every patient's room. Original French version.…”

Optimizing safe, comfortable ICU care through multi-professional quality improvement: just DO it

“…We view this QI study as the third phase of the investigators' stepwise QI initiative, starting in 2002 with an assessment of pain and agitation [2], followed in 2006 with evaluation of sedation protocol-driven nursing interventions [3], and culminating in the current NURSE-DO project that began in 2010 and evaluates the effect of a QI pain management process on patient outcomes [1]. It is logical that the investigators' continuous engagement, now spanning 10 years, plays a critical role in their success.…”