PROBLEM

From length of stay (LOS) reports, and as recognised by nurse and physician experts, sedation management was problematic for the mechanically ventilated medical intensive care unit (MICU) patient. The growing body of knowledge about sedation management has not been consistently applied in practice, leading to inadequate or oversedation of mechanically ventilated patients, thus prolonging ventilator hours and MICU and hospital LOS and increasing cost.

The purpose of the evidence-based, sedation management project was to implement evidence-based sedation management practices for the mechanically ventilated critically ill adult patient and thereby, improve patient outcomes related to sedation. Anticipated improvements in patient outcomes were (a) decrease in the duration of mechanical ventilation, (b) decrease in MICU and hospital LOS, and (c) decrease in cost per case. Objectives to achieve these goals include (1) increasing nurses’ knowledge regarding evidence-based sedation management practices; (2) increasing documentation of the level of sedation, interventions, and reassessment; and (3) developing and implementing an evidence-based sedation management practice protocol inclusive of analgesic and sedative titration using level of sedation and daily interruption of sedatives for a “wake-up” test.

SYNTHESIS OF EVIDENCE

Evidence was obtained through advanced search strategies using Medline and CINAHL. MeSH search terms used in the Ovid …