D25-05 Comparison of Implementation Climate for Light Sedation and Early Mobilization in Day and Night Shift Nurses

Abstract Rationale Deep sedation in mechanically ventilated patients was recently linked to loss of functional independence. About a third of the association between deep sedation and loss of independence was mediated by immobilization. Thus, to preserve functional independence, implementation of light sedation practices and early mobilization may have synergy. Implementation climate, or the extent to which team members “perceive that innovation is expected, supported, and rewarded,” is an important determinant for whether change is possible within an organization. We sought to evaluate the implementation climate for light sedation and early mobilization practices among ICU nursing staff. Methods This was a cross-sectional, single-center study at the University of Chicago. The Implementation Climate Scale (ICS) was used to measure nursing perception of the organization’s climate for implementation of evidence-based sedation practices and early mobilization. The ICS has six subscales: Focus on Evidence-Based Practice, Educational Support for Evidence-based Practice, Recognition for Evidence-Based Practice, Rewards for Evidence-Based Practice, Selection for Evidence-Based Practice, Selection for Openness. Each question is scored from 0-5, with 0 being “Not at all” and 5 being “Very great extent.” Higher subsection scores indicate a strong climate supportive of evidence-based practice. Day- and night-shift ICU nurses completed the survey on REDCap. Descriptive statistics and t-tests were performed. Subscales were reported if sufficient reliability (Chronbach 0.7) was present. Results Of 81 eligible nurses (39 day, 42 night), 42 (51.9%) completed the survey (21 day, 21 night). Overall scores for implementation climate were low-moderate for both sedation and early mobilization for both day and night shift nurses (Table 1). Of the subscales, nursing staff from both day and night shift reported the lowest implementation climate scores for being rewarded for using evidence-based sedation and early mobilization. Day shift nursing reported significantly more educational support than the night teams (sedation: day mean 1.75 vs. night 1.05, P = 0.03; early mobilization: day mean 1.71 vs. night 1.08, P = 0.046). Conclusion The overall implementation climate for light sedation and early mobilization was poor-to-moderate. As such, in order to implement evidence-based programs, changes in this culture must be addressed. Two possible areas of intervention include increasing educational support, primarily for night nurses, and offering rewards and incentives for the use of evidence-based sedation and mobilization practices. Increasing educational initiatives about sedation and early mobilization are an ongoing effort and the effect of these strategies on implementation climate will be evaluated. This abstract is funded by: Healthcare Delivery Science and Innovation Grant