Abstract
It has been 10 years since the last publication of the clinical practice guidelines
for pain, agitation/sedation, and delirium (PAD). The results of new studies have
directed significant changes in critical care practice. Using the Grades of Recommendation,
Assessment, Development, and Evaluation (GRADE) methodology, the guidelines were revised,
resulting in 32 recommendations and 22 summary statements. This article provides guidance
toward guideline implementation strategies and outlines 10 key points to consider.
Compared with its predecessor, the 2013 PAD guidelines are less prescriptive in that
they recommend approaches to patient care rather than giving specific medication recommendations.
This will help focus care teams on the process and structure of patient management
and result in more flexibility when choosing specific medications. This article outlines
approaches to guideline implementation that take into account the changes in philosophy
surrounding medication selection. The manuscript focuses on the areas anticipated
to generate the most change such as lighter sedation targets, avoidance of benzodiazepines,
and early mobility. A gap analysis grid is provided. The release of any guideline
should prompt reevaluation of current institutional practice standards. This manuscript
uses the PAD guidelines as an example of how to approach the interprofessional work
of guideline implementation.
Keywords
pain - agitation - sedation - delirium - implementation - guideline - protocol
