Abstract:
Aim: The paper presents a study assessing the rate of adoption of a sedation scoring
system and sedation guideline.
Background: Clinical practice guidelines including sedation guidelines have been
shown to improve patient outcomes by standardizing care. In particular sedation
guidelines have been shown to be beneficial for intensive care patients by reducing
the duration of ventilation. Despite the acceptance that clinical practice guidelines
are beneficial, adoption rates are rarely measured. Adoption data may reveal other
factors which contribute to improved outcomes. Therefore, the usefulness of the
guideline may be more appropriately assessed by collecting adoption data.
Method: A quasi-experimental pre-intervention and postintervention quality
improvement design was used. Adoption was operationalized as documentation of
sedation score every 4 hours and use of the sedation and analgesic medications
suggested in the guideline. Adoption data were collected from patients' charts on a
random day of the month; all patients in the intensive care unit on that day were
assigned an adoption category. Sedation scoring system adoption data were collected
before implementation of a sedation guideline, which was implemented using
an intensive information-giving strategy, and guideline adoption data were fed back
to bedside nurses. After implementation of the guideline, adoption data were collected
for both the sedation scoring system and the guideline. The data were collected
in the years 2002-2004.
Findings: The sedation scoring system was not used extensively in the pre-intervention
phase of the study; however, this improved in the postintervention phase.
The findings suggest that the sedation guideline was gradually adopted following
implementation in the postintervention phase of the study. Field notes taken during
the implementation of the sedation scoring system and the guideline reveal widespread
acceptance of both.Conclusion: Measurement of adoption is a complex process. Appropriate operationalization
contributes togreater accuracy. Further investigation is warranted to
establish the intensity and extent of implementation required to positively affect
patient outcomes.
