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Adherence to Sedation Withdrawal Protocols and Guidelines in Ventilated Patients

Burns, Suzanne M. MSN, RN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP

doi: 10.1097/NUR.0b013e31823bfae8
Feature Article

Purpose/Objectives: The purpose of this article is to delineate what we know about adherence with sedation withdrawal protocols and guidelines. Reasons for lack of adherence and associated outcomes are explored in addition to potential solutions.

Background/Rationale: Research has demonstrated the positive outcomes associated with sedation withdrawal in ventilated patients, such as decreased ventilator duration, intensive care unit and hospital length of stay, and mortality. Subsequently, protocols and guidelines used in the trials have been introduced into clinical practice to ensure that practice is evidence based and that clinical outcomes improve. Unfortunately, evidence suggests that adherence to these protocols and guidelines is poor.

Description of Project/Innovation: A literature review was performed for years 1998–2011 using PubMed, Ovid MEDLINE, and Cumulative Index to Nursing and Allied Health Literature. Searches included the key terms sedation management, sedation interruption, sedation withdrawal, mechanical ventilation, protocol adherence, guideline adherence, sedation management adherence, sedation interruption adherence, and mechanical ventilation weaning.

Outcomes: Twelve articles that focused on adherence to sedation withdrawal protocols or guidelines were reviewed to determine adherence rates and reasons for lack of adherence. An additional 5 research articles testing the efficacy of sedation withdrawal protocols or guidelines in practice were reviewed to determine clinical outcomes associated with their use.

Interpretation/Conclusions: Despite the current emphasis on the importance of sedation withdrawal in mechanically ventilated patients, protocols and guidelines that are designed to ensure adherence do not appear to be working. Multiple reasons for the lack of adherence are suggested in the literature, including caregiver perceptions, complexity, and processes of care. In addition, clinician education, unit culture, and philosophy may all play a part.

Implications: The findings described in this article suggest that adherence to sedation withdrawal protocols and guidelines is not good despite perceptions to the contrary. The article delineates potential solutions as suggested by the authors of the reviewed articles and those of the author of this article.

Author Affiliation: Professor of Nursing, Acute and Specialty Care; APN 2, Critical Care; and Professional Nursing Staff Organization Research Program Director, School of Nursing, University of Virginia Health System, Charlottesville.

The author reports no conflicts of interest.

Correspondence: Suzanne M. Burns, MSN, RN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP, School of Nursing, University of Virginia Health System, Claude Moore Nursing Education Building, 225 Jeanette Lancaster Way, Box 800826, Charlottesville, VA 22903-3395 (smb4h@virginia.edu).

© 2012 Lippincott Williams & Wilkins, Inc.