Mixed methods rapid evaluation of sedation practices in the intensive care units of a public sector tertiary academic hospital in South Africa

<ns3:p>Background Sedation is routinely administered to mechanically ventilated ICU patients. Evidence-based practices such as the Richmond Agitation and Sedation Scale (RASS), Spontaneous Awakening Trials (SAT), and Spontaneous Breathing Trials (SBT) are known to reduce harm. This study evaluated current sedation practices in the ICU of a South African tertiary academic hospital, explored contextual factors influencing implementation, and assessed readiness for quality improvement (QI). Methods A mixed-methods rapid evaluation was conducted, integrating data from focus group discussions, observations, process mapping, and an electronic ICU registry. Barriers and facilitators were analysed using the Consolidated Framework for Implementation Research. Organisational capacity for improvement was assessed using the Model for Understanding Success in Quality (MUSIQ) tool. Results RASS was inconsistently applied, limiting its effectiveness for sedation targeting and monitoring. SAT and SBT were conducted at the discretion of individual doctors, with variable practices and limited documentation. Informal communication and poor data capture hindered quality monitoring. Key barriers included limited staff familiarity with sedation protocols, workforce constraints, and a low prioritisation of sedation management. However, facilitators included strong leadership support, previous QI successes, and existing QI infrastructure. Conclusions Current sedation practices in this ICU fall short of evidence-based standards. Despite this, the presence of an electronic registry, leadership engagement, and QI capacity signal readiness for improvement. Future efforts should prioritise structured implementation of sedation protocols and evaluate their impact on patient outcomes.</ns3:p>