Abstract
This quality improvement study was conducted at a comprehensive cancer care center with the aim to decrease the percentage of on continuous infusion (CI) midazolam by 30% by May 5, 2023. The pre-intervention and post-intervention data collection phases occurred from January 1, 2022, to October 31, 2022, and March 7, 2023, to May 5, 2023, respectively. Sedation was assessed utilizing the Richmond Agitation and Sedation Scale (RASS), and delirium was assessed utilizing the Intensive Care Delirium Screening Checklist (ICDSC). A sedation pathway and associated educational materials were developed by a multidisciplinary team and frontline staff. Interventions in the sedation pathway included prioritization of analgesics and non-benzodiazepine sedatives or intermittent lorazepam following intubation and incorporation of a provider time-out 4 hours after the start of CI midazolam. Secondary endpoints were the percentage of RASS within target range, percentage of ICDSC greater than or equal to 4, number of days to positive ICDSC, percentage of inappropriate titrations, and total number of benzodiazepine infusions. A total of 59 patients were included for analysis, with 39 in the pre-intervention group and 20 in the post-intervention group. The percentage of intubation time on CI midazolam decreased from 76% to 59% in the post-intervention group (P = .545). The time within intended RASS range improved by 45% in the post-intervention group (P < .0001), which was driven primarily by reduction in the percentage of RASS < -1. The percentage of inappropriate titrations was reduced from 30% to 22%; these included inappropriate up and down titrations of CI midazolam and omissions of a midazolam bolus when warranted. Generation of an interdisciplinary algorithm helped to reduce intubation time on CI midazolam in critically ill patients. Time spent within the targeted RASS range and adherence to the sedation order set improved, and the number of days to positive ICDSC following intubation was reduced. Future studies should evaluate an extended follow-up period to determine the full effect of the sedation algorithm’s implementation on clinical practice.
DOI
https://doi.org/10.52519/ACEQI.25.1.1.a17
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Recommended Citation
Brown A, Highsmith E, Horng M. Reducing the Percentage of Intubation Time on Continuous Infusion Midazolam. Advances in Cancer Education and Quality Improvement. 2025; 1(1). doi: https://doi.org/10.52519/ACEQI.25.1.1.a17.
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