Sedation study: National survey and point prevalence study of sedation practice in UK critical care
Background
Sedation is the action of administering a sedative agent (drug) to produce a state of calm or sleep. Sedation and analgesia (medication that acts to relieve pain) are frequently administered to patients in critical care to facilitate therapies, such as mechanical ventilation and other invasive procedures, with the objectives of ensuring patient safety and comfort.
The aim of the sedation study was to (1) establish current sedation practice in UK critical care and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study.
Design
Adult general critical care units participating in the Case Mix Programme, and the Scottish Intensive Care Society Audit Group were asked to complete the sedation survey either online between January and May 2014.
The point prevalence study took place in 52 critical care units participating in the Case Mix Programme, who were asked to complete a short data collection form for every patient in the unit at 14:00 on 11 December 2013. For patients who were sedated, information was collected on the sedative and/or analgesic agents received.
Results
Survey responses were received from 214 (91%) of 235 eligible critical care units. Of these, 57% reported having a written sedation protocol, 94% having a policy of daily sedation holds and 94% using a sedation scale to assess depth of sedation.
In the point prevalence study, for units reporting a policy of daily sedation holds, a median of 50% of sedated patients were considered for a sedation hold. A median of 88% of patients were assessed using the same sedation scale as reported in the survey.
Both the survey and the point prevalence study indicated propofol as the preferred sedative and alfentanil, fentanyl and morphine as the preferred analgesics. In most of the units, all patients had received the unit’s reported first-choice sedative, and most patients had received the unit’s reported first-choice analgesic. Most units (83 %) reported in the survey that sedatives are usually administered in combination with analgesics. For units that participated in the point prevalence study, 69 % of patients had received a combination of agents – most frequently propofol combined with either alfentanil or fentanyl.
Conclusion
Clinical practice reported in the national survey did not accurately reflect actual clinical practice at the patient level observed in the PPS. Employing a mixed methods approach provided a more complete picture of sedation practice in terms of breadth and depth of information.
Who led the study?
Dr Sheila Harvey, ICNARC
This study is funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) Programme (Project: 13/159/01). This study was sponsored by ICNARC.
Publications
Richards-Belle A, Canter RR, Power GS, Robinson EJ, Reschreiter H, Wunsch H, Harvey SE. National survey and point prevalence study of sedation practice in UK critical care. Crit Care 2016; 20(1):355. http://dx.doi.org/10.1186/s13054-016-1532-x
