Make ‘Em Dream, Not Scream: Education, Order Set Modifications, and Clinical Champions Improve Postintubation Sedation Adherence Rates

BACKGROUND: Awareness with paralysis is a growing concern in emergency department (ED) intubated patients who receive rocuronium for intubation. Following an internal audit that identified suboptimal adherence with postintubation sedation (PIS) practices, our institution launched an initiative to improve adherence to PIS standards. OBJECTIVE: Determine whether the multidisciplinary initiative decreased the time to initiation of PIS at institutionally recommended doses. METHODS: This pre-post intervention study was conducted at 2 institutions within a health care system, including an academic-affiliated hospital (site A) and a nonacademic-affiliated hospital (site B). The primary endpoint was the rate of PIS adherence before and after a multidisciplinary intervention that included education, order set modifications, and the establishment of clinical champions. Outcomes were compared across 3 groups: site AM (PIS managed by ED resident and supervising physicians), site AT (PIS managed by trauma resident and supervising physicians), and site B (PIS managed by ED supervising physicians). The order set changes were implemented at sites AM and B, but education and designation of clinical champions occurred only at site AM. RESULTS: < 0.001). There were no significant differences in PIS adherence rates between the preintervention and postintervention periods at sites AT and B. During the preintervention period, no significant differences in PIS adherence rates were observed across the groups, whereas during the postintervention period, site AM demonstrated significantly higher PIS adherence rates than sites AT and B. CONCLUSION AND RELEVANCE: This study demonstrated that a focused, multidisciplinary strategy can significantly improve adherence to PIS best practices in the ED. The marked improvements seen only at the site receiving the full intervention underscores the importance of combining education, workflow optimization, and clinical champions for successful practice change.