Nursing and organizational barriers to daily interruption of sedation in U.S. hospitals: A thematic review of the literature

Abstract

Despite focused attention on hospital-acquired infections, ventilator-associated pneumonia (VAP) infections and deaths continueto be a problem in U.S. hospitals. Research indicates that protocols are in place across hospitals but actual implementationlags behind. The inconsistencies in protocol implementation may be due to workarounds created during the process of dailyinterruption of sedation (DIS), which is the process of stopping the ventilated patient’s sedation at a prescribed time each day toevaluate the patient’s ability to wean. The purpose of this thematic synthesis of the literature was to understand how nursing andorganizational barriers may affect adherence to DIS protocols in U.S. hospitals. We conducted a search using the CumulativeIndex of Nursing and Allied Health Literature, using terms related to sedation and mechanical ventilation, then coded andcategorized the study findings, and developed themes. Three themes emerged: (1) organizational structure does not influenceDIS at either the hospital or unit level, (2) a collaborative, multidisciplinary culture may be needed to influence changes insedation practices, and (3) the gap between evidence and practice may be due to lack of nursing education and experience. Toimprove outcomes, intensive care units should evaluate the impact of multidisciplinary ventilator rounding teams that includenursing, on DIS adherence and VAP rates, and ensure that nurses are up-to-date on the evidence around all aspects of sedationmanagement.