Building a Sedation Minimization Culture - PROJECT SUMMARY/ABSTRACT For many years, sedation has been integral to managing patients receiving ventilatory support in the intensive care unit (ICU). However, patients who are deeply sedated in the ICU suffer from increased immobilization, delirium, post-traumatic stress disorder, and death. The 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult ICU Patients recommend against the routine use of deep sedation, and the Society of Critical Care Medicine has implemented nationwide campaigns to disseminate evidence-based sedation minimization strategy, the Spontaneous Awakening Trial. Yet, more than 50% of patients who receive mechanical ventilation are being deeply sedated worldwide, and only 20-40% of ICUs regularly practice SAT. Interprofessional teamwork is key to SAT implementation, but optimal strategies to enhance interprofessional team performance around sedation minimization remain unknown. The objectives of this project are 1) to understand how individual ICU staff characteristics and their shared assumptions, values, and beliefs shape their collective approaches to sedation and 2) to promote sedation minimization in the ICU by optimizing the team performance around SAT. This K23 proposal builds on Dr. Fuchita’s preliminary work at the University of Colorado, which reduced deep sedation by promoting a sedation minimization culture. Dr. Fuchita seeks to apply rigorous science to understand the mechanisms of change and develop tools, processes, and strategies that are effective, implementable, scalable, and sustainable across diverse ICU settings. Aim 1 will identify individual ICU staff characteristics associated with intentions to minimize sedation using the Sedation Culture survey. Aim 2 will explore how culture influences interprofessional team dynamics, communications, and collaboration around SAT using qualitative methods. Aim 3 will use Implementation Mapping to develop and pilot PROMISE-ICU (PROmoting MInimal SEdatIon CUlture), a program of multifaceted implementation strategies to improve the adoption and fidelity of SAT at a single ICU and evaluate its acceptability, appropriateness, and feasibility. Dr. Fuchita’s long-term career goal is to catalyze a fundamental culture change in ICUs worldwide to liberate patients receiving mechanical ventilation from unnecessary deep sedation. Dr. Fuchita has co-designed comprehensive career development plans with excellent mentors and advisors to provide him with advanced training in survey and qualitative research, the science of organizational behavior, implementation science, and hybrid effectiveness-implementation trials. The University of Colorado is nationally recognized for its excellence in interdisciplinary health services research, and Dr. Fuchita has unparalleled institutional support and resources to achieve the proposed research, training, and career development objectives. This K23 Award will support Dr. Fuchita’s path toward independence by providing him with the unique skills necessary to design, implement, and evaluate novel interventions to solve complex real-world problems in the ICU.
