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Implementation of a multiphase, multi-institutional QI initiative to optimise sedation practices in cardiac ICU patients

Published online by Cambridge University Press:  24 April 2025

Richard U. Garcia Open the ORCID record for Richard U. Garcia [Opens in a new window] ,
Kimberly DiMaria ,
Jamie Penk Open the ORCID record for Jamie Penk [Opens in a new window] ,
Sherrill Caprarola Open the ORCID record for Sherrill Caprarola [Opens in a new window] ,
Amy Romer Open the ORCID record for Amy Romer [Opens in a new window] ,
Michael P. Fundora Open the ORCID record for Michael P. Fundora [Opens in a new window] ,
Deborah U. Frank Open the ORCID record for Deborah U. Frank [Opens in a new window]  and
Barbara-Jo Achuff
Richard U. Garcia*
Affiliation:
Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Kimberly DiMaria
Affiliation:
Department of Pediatric Cardiology, Children’s Hospital Colorado, Aurora, CO, USA
Jamie Penk
Affiliation:
Department of Pediatric Cardiology, Lurie Children’s Hospital, Chicago, IL, USA
Sherrill Caprarola
Affiliation:
Department of Pediatric Cardiology, Children’s Hospital Colorado, Aurora, CO, USA
Amy Romer
Affiliation:
Department of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, USA
Michael P. Fundora
Affiliation:
Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Deborah U. Frank
Affiliation:
Department of Pediatric Cardiology, University of Virginia, Charlottesville, VA, USA
Barbara-Jo Achuff
Affiliation:
Department of Pediatric Cardiology, Monroe Carrell Jr. Children’s Hospital Vanderbilt University, Nashville, TN, USA
*
Corresponding author: Richard Garcia; Email: [email protected]
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Abstract

Introduction:

There is wide variation in institutional sedation strategies in paediatric cardiac ICU. Validated tools such as State Behavioral Scale and Richmond Agitation Sedation Scale were created to help standardise sedation practices.

Methods:

This is a multi-phase, multicentre, prospective project with the goal of optimising safety and comfort for paediatric cardiac ICU patients. Phase one consisted of an educational intervention with a self-paced, web-based video module on optimal sedation practices using validated sedation screening tools. Participant knowledge was assessed via a de-identified, unmatched pre- and post-test survey. Survey scores were reported as an aggregate average score and compared using a t-test.

Results:

There were 259 pre-tests, and 142 post-tests collected during the video-assisted educational intervention. There was a significant increase in mean score on the post-test compared to the pre-test for both instruments: from 4 to 4.8/10 for State Behavioral Scale (p = 0.01) and from 4.5 to 4.9 for Richmond Agitation Sedation Scale (p = 0.04). 81% of respondents who completed the Richmond Agitation Sedation Scale post-test and 88.1% of those who completed the State Behavioral Scale post-test said their practice would change based on the new knowledge acquired.

Conclusion:

We report that our newly developed learning module intervention was effective in increasing short-term knowledge about optimal sedation and sedation scoring. Ongoing phase two efforts include evaluation of long-term compliance of validated sedation screening tools and developing an objective score to measure individual cumulative opioid dosing in the cardiac critical care unit.

Keywords

Sedationstate behavioural scalerichmond agitation sedation scalecardiac critical carequality improvement
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 3
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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References

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