Analgesia, Mechanical Ventilation, Nurse Training
Conditions
Keywords
Nurse driven sedation-analgesia protocols, Adherence to protocol, Pediatric intensive care
Brief summary
Sedation-analgesia is a major concern in the management of children in pediatric intensive care units (PICUs). International guidelines recommend the use of sedation-analgesia protocols, as their implementation has already proven effective in pediatrics. However, maintaining their long-term application remains a challenge. Indeed, healthcare teams adherence to these protocols tends to decrease over time, thereby compromising their long-term impact. This study aims to evaluate the impact of multimodal nurses training on improving and sustaining adherence to sedation-analgesia protocols. This is a non-randomized, before-and-after interventional prospective study conducted in two mixed pediatric intensive care units (Lyon and Nantes). The investigators seek to evaluate sedation practices before and after the implementation of specific multimodal training for nurses on the sedation-analgesia protocol. The primary outcome is protocol adherence. Secondary outcomes include the duration of mechanical ventilation and PICU stay, the number of daily COMFORT-B score assessments, total medication doses, the incidence of ventilator-associated pneumonia, and a qualitative analysis of non-adherence factors.
Interventions
OTHERMultimodal nurse training about nurse driven sedation-analgesia protocol
The training program for nursing staff in the use of the sedation-analgesia protocol includes 3 stages: 1. Initial training: e-learning module to be validated 2. Feedback session: sessions in small groups of 5 to 6 participants, led by a nurse trainer, allowing interprofessional transmission (questions/answers and critical analyzes of sedation collection sheets). 3. Bedside rehearsal: individual practice of the sedation-analgesia protocol at the patient's bedside under the supervision of a doctor or nurse trainer.
Sponsors
Hospices Civils de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
: * patients aged 0 to 18 years * admitted to the PICU * requiring mechanical ventilation * receiving continuous sedation for more than 24 hour
Exclusion criteria
: * patients requiring mechanical ventilation for more than 15 days * transferred from another unit where sedation had already been initiated * patients under sedation as part of withdrawing and withholding life-sustaining treatment * deceased patients * preexisting tracheostomies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Protocol adherence before and after nurse training: daily percentage of therapeutic adjustments in compliance with the sedation-analgesia protocol. | Compliance of therapeutic adjustments with the sedation-analgesia protocol is evaluated over the entire duration of mechanical ventilation. Daily , from initiation of mechanical ventilation until extubation | Sedation management is considered adequate (when dose increases, decreases, or maintenance are appropriate based on the COMFORT-B score), and inadequate (when adjustments are inappropriate or if the COMFORT-B score is not recorded despite a prescribed target). Cases where no target score is prescribed are excluded from the adherence analysis. |
Countries
France
Outcome results
None listed