CLINICAL ISSUES Implementation of standard sedation management in paediatric intensive care: effective and feasible? Erwin Ista, Matthijs de Hoog, Dick Tibboel and Monique van Dijk Objective. To study the effects of the introduction of a sedation treatment protocol for children in intensive care, including nurses’ compliance. Background. While several sedation guidelines for adults and children have been developed and implemented, there is little evidence on use of sedation protocols in critically ill infants. Design. Pretest–posttest intervention study. Methods. Administered sedatives and analgesics over the first seven days of admission were documented for convenience samples, before (n = 27) and after (n = 29) implementation of standard sedation assessments and a sedation protocol. Sedation was assessed with the COMFORT behaviour scale, Nurse Interpretation of Sedation Score and the Visual Analogue Scale for three-month periods, both pretest and posttest. Starting 21 months after the posttest, nurses’ compliance with the sedation protocol, as well as administered sedatives and analgesics were evaluated for 12 months. Results. Infants in the posttest period received significantly more midazolam and morphine. The proportion of patients ade- quately sedated on the grounds of COMFORT scores had increased from 63% pretest to 72% posttest and to 75% in the long run. Adequate sedation as judged from the sedation protocol cutoffs was found in 71% of the assessments. In 45% of assessments indicating undersedation, the infusion rate had been increased on the guidance of the protocol. A survey among staff revealed that most considered the sedation protocol comprehensible and useful. Conclusion. This study showed that regular sedation assessment in critically ill children was feasible and had become standard practice two years after the first posttest. There is insufficient evidence to conclude whether implementation of a sedation treatment protocol indeed improves sedation treatment. Relevance to clinical practice. This sedation protocol provides decision trees for increasing or weaning of sedatives in both haemodynamically stable and unstable patients. It standardises sedation management and allows nurses to adapt medication themselves. Key words: assessment, nurses, nursing, paediatric intensive care, protocol, sedation Accepted for publication: 11 December 2008 Introduction With a view on optimising sedation and pain treatment in critically ill children, several authors and societies have recommended to assess levels of sedation and pain and to titrate sedatives and analgesics on the guidance of guidelines, protocols or algorithms (Jacobi et al. 2002, Gordon et al. 2005, Playfor et al. 2006, Jenkins et al. 2007). Clinical Authors: Erwin Ista, PhD, RN, Clinical Researcher, Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands; Matthijs de Hoog, MD, PhD, Paediatric Intensivist, Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands; Dick Tibboel, MD, PhD, Professor, Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands; Monique van Dijk, PhD, RN, Senior Researcher, Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands Correspondence: Erwin Ista, Clinical Researcher, Erasmus MC-Sophia Children’s Hospital, PO Box 2060, Office Sk-3146, 3000 CB Rotterdam, the Netherlands. Telephone: +31 10 7037028. E-mail: w.ista@erasmusmc.nl Ó 2009 The Authors. Journal compilation Ó 2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2511–2520 2511 doi: 10.1111/j.1365-2702.2009.02836.x