Computerized physician order entry of a sedation protocol is not associated with improved sedation practice or outcomes in critically ill patients

BMC Anesthesiology

Research Article

Ahmad M. Deeb¹  Hani M. Tamim²  Abdulaziz S. AlDawood³  Ibrahim Al Babtain⁴  Brintha S. Naidu⁵  Catherine B. Gonzales⁵  Yaseen M. Arabi⁶  Samir H. Haddad⁷ 

[1] King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, Saudi Arabia;Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Trauma & Acute Care Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;Nursing Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia;The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;Surgical Intensive Care Unit, Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, 11426, Riyadh, Saudi Arabia;Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia;

关键词: Sedation;    Protocol;    Computerized physician order entry;    Guidelines;    Analgesics;    Sedatives;    Critically ill;   

DOI  :  10.1186/s12871-015-0161-2

 received in 2015-05-03, accepted in 2015-05-04,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundComputerized Physician Order Entry (CPOE) analgesia-sedation protocols may improve sedation practice and patients’ outcomes. We aimed to evaluate the impact of the introduction of CPOE protocol.MethodsThis was a prospective, observational cohort study of adult patients receiving mechanical ventilation, requiring intravenous infusion of analgesics and/or sedatives, and expected to stay in the intensive care unit (ICU) ≥24 h. As a quality improvement project, the study had three phases: phase 1, no protocol, July 1st to September 30th, 2010; phase 2, post implementation of CPOE protocol, October 1st to December 31st, 2010; and phase 3, revised (age, kidney and liver function adjusted) CPOE protocol, August 1st to October 31st, 2011. Multivariate analyses were performed to determine the independent predictors of mortality.ResultsTwo hundred seventy nine patients were included (no protocol = 91, CPOE protocol = 97, revised CPOE protocol = 91). Implementation of CPOE protocol was associated with increase of the average daily dose of fentanyl (3720 ± 3286 vs. 2647 ± 2212 mcg/day; p = 0.009) and decrease of hospital length of stay (40 ± 37 vs. 63 ± 85 days, p = 0.02). The revised CPOE protocol was associated with, compared to the CPOE protocol, a decrease of the average daily dose of fentanyl (2208 ± 2115 vs. 3720 ± 3286 mcg/day, p = 0.0002) and lorazepam (0 ± 0 vs. 0.06 ± 0.26 mg/day, p = 0.04), sedation-related complications during ICU stay (3.3 % vs. 29.9 %, p <0.0001), and ICU mortality (18 % vs. 39 %, p = 0.001). The impact of the revised CPOE protocol was more evident on patients aged >70 years or with severe kidney or liver impairment. Both the original CPOE protocol and the revised CPOE protocol were not independent predictors of ICU (adjusted odds ratio [aOR] = 1.85, confidence interval [CI] = 0.90–3.78; p = 0.09; aOR = 0.70, CI = 0.32–1.53, p = 0.37; respectively) or hospital mortality (aOR = 1.12, CI = 0.57–2.21, p = 0.74; aOR = 0.80, CI = 0.40–1.59, p = 0.52; respectively).ConclusionsThe implementation of a CPOE analgesia-sedation protocol was not associated with improved sedation practices or patients’ outcome but with unpredicted increases of an analgesic dose. However, the revised CPOE protocol (age, kidney and liver function adjusted) was associated with improved sedation practices. This study highlights the importance of carefully evaluating the impact of changes in practice to detect unanticipated outcomes.

【 授权许可】

CC BY   
© Haddad et al. 2015