Interprofessional Optimization of Analgosedation in the Surgical Intensive Care Unit

Introduction: The Society of Critical Care Medicine has published guidelines supporting the utilization of analgesia-first based sedation, also known as analgosedation, for critically ill patients. However, staff identified opportunities for improvement to our current utilization and perception of analgosedation. This quality improvement (QI) project seeks to improve the application of evidence-based guidelines regarding analgosedation into our daily institutional practice in the surgical intensive care unit (SICU).


Methods: This quasi-QI project was approved as a quality improvement determination by the OhioHealth Office of Human Subjects Protections. The study involved a pharmacist-led QI intervention that included a provider and staff education, a survey capturing current practices and perceptions of analgosedation, and finally a quarterly focus on the analgosedation aspect of the unit’s daily rounding checklist. Included within the study were adult patients admitted to the SICU requiring mechanical ventilation with a goal Richmond Agitation Sedation Scale of -1 to +1. We aimed to compare the differences between the pre-intervention and post-intervention study groups with each intervention group covering a 3-month timeframe. The primary outcome was the percentage of patients on propofol 50mcg/kg/min or greater without the use of an opioid infusion.


Results: The overall percentage of patients on propofol 50mcg/kg/min or greater without the use of an opioid infusion was 9.6% (7.5% pre-intervention vs. 11.8% post-intervention). Overall percentage of patients on propofol 50mcg/kg/min or greater while on less than fentanyl 100mcg/hour was 20.5% (17.5% pre-intervention vs. 24.2% post-intervention). The mean perception of utilization of analgosedation was 3.5 in the pre-intervention vs. 3.9 in the post-intervention. However, the percent of correct knowledge-based questions ranged from 15.3-92.3% in the pre-intervention and 33-100% in the post-intervention.


Conclusions: Pharmacist-led QI interventions aimed at improving application of analgosedation best practices were not associated with measurable improvement within our SICU. Additionally, survey data suggests ongoing opportunities in analgosedation-related knowledge and perception.