Use of guidelines by healthcare professionals in the intensive care : easier said than done ? The example of analgesia and sedation

Analgesics and sedatives are universally administered in intensive care units (ICUs). Ideally, healthcare professionals must minimize sedative use (e.g. through protocolized sedation or daily sedation interruption) and assess pain, agitation, and delirium (PAD) to improve patient outcomes. However, putting knowledge into action is easier said than done. The objectives of this thesis are to describe knowledge use, challenges to its application, and improvement strategies pertaining to PAD management in ICUs. Using semi-structured interviews, the perspectives of physicians, nurses, and physiotherapists were explored. Different challenges to appropriate implementation of PAD recommendations were found with respect to profession, level of experience, and recommendation type, suggesting improvement strategies must be tailored to healthcare professional type. Using a nationwide survey of ICU physicians and nurses, PAD practices in Belgian ICUs were described. The results showed poor use of sedation minimization strategies, with only 31% of healthcare professionals using protocolized sedation, and 75% using DSI in fewer than 25% of their patients. Only 12% of healthcare professionals used validated pain scales for patients unable to self-report. Challenges to the use of sedation minimization strategies included negative attitudes of healthcare professionals caused by common misperceptions, knowledge issues, and staffing considerations. A systematic review identified various types of knowledge translation interventions (KT-Is) designed to enhance the use of ICU PAD recommendations internationally. The majority of these improved outcomes and process measurements. A secondary analysis, of a previous observational study in Canada, identified several PAD management components were associated with the use of physical restraints. The present thesis provides valuable information for key stakeholders, to inform the design of KT-Is aimed at adopting or enhancing the use of PAD recommendations, from a unique Belgian perspective. Now is the time to turn knowledge into action, in the context of the redesign of Belgian hospital financing and the pressure to improve quality and safety in healthcare. ; (BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 2015.

Medienart:	E-Book

Erscheinungsjahr:	2015
Erschienen:	Erscheinungsort nicht ermittelbar: [Verlag nicht ermittelbar] ; 2015

Sprache:	Englisch

Beteiligte Personen:	Sneyers, Barbara [VerfasserIn]
Hochschulschrift:	Dissertation, 2015

Links:	hdl.handle.net [kostenfrei]

Weitere IDs:	2078.1/162112

Förderinstitution / Projekttitel:

PPN (Katalog-ID):	1803726989