Background: Studies have shown that standardized sedation algorithms can reduce delirium, mechanical ventilation and length of stay. In 2013 a nurse driven sedation algorithm was introduced and resulted in a statistically significant decrease in the amount of medication (narcotics/benzodiazepines) administered post implementation however compliance with the algorithm has not been audited for several years.

Objectives: Our goal was to refine our nurse driven sedation algorithm and re-educate all members of the medical team. Through doing this we hoped to increase nurse familiarity and compliance with the protocol, improve RASS inter-rater reliability, and decrease the number of vent days, unplanned extubations and length of stay in the ICU.

Methods: A3 Lean and Six Sigma Methodology was used. We Identified current state and target state with a future state process map resulting in a gap analysis. We then identified solution approaches and experiments to better align with best practice regarding sedation of the intubated pediatric patient and outlined a completion plan and defined metrics.

Results: The new sedation algorithm was introduced in May 2020. Compliance as of the second audit was ~ 36%, however there has been improvement in compliance with using the correct starting dose of fentanyl, timing of adding dexmedetomidine, and avoiding the use of other medications such as benzodiazepines. The number of unplanned extubations decreased and overall the length of ICU stay trended down.

Next Steps: Bi-weekly rounding with a multidisciplinary team to address practice gaps in real time and provide just in time education with clinical staff will be implemented. PICU charge RNs will begin to query bedside staff each shift to determine whether their patient has the sedation algorithm ordered and to identify and address any deviations from the algorithm; this will be prompted by an added column to the charge RN handoff tool. Multidisciplinary workgroup meetings to review data and identify areas for improvement will be increased to bi-monthly.