Development and Psychometric Testing of the Optimizing Context in Assessing Sedation in ICU (OCEAN-ICU) Instrument to Optimize Sedation Use in Intensive Care

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CONTEXT: Sedation and pain management are core strategies used to manage discomfort, anxiety, and pain in intensive care; however, strategies to improve this practice are inconsistently implemented with differential effect. OBJECTIVES: We describe the development and psychometric testing of the Optimizing ContExt in Assessing sedatioN in ICU (OCEAN-ICU) instrument intended for use in intensive care to guide development of change strategies to optimize sedation. We also provide descriptive results. METHODS AND MODELS: A prospective instrument development study was undertaken in the United Kingdom. Clinical staff who self-identified as responsible for prescribing, administering, and/or advising on sedation to invasively mechanically ventilated intensive care patients participated. Developed from previous interviews and refined during pilot testing, the draft instrument incorporated 68 statements aligned with the theoretical domains framework. Interested clinicians completed an online survey. Item responses were summed descriptively. Congruence between rankings of agreement and importance were assessed descriptively. Construct validity was assessed using confirmatory factor analysis. RESULTS: 252 usable responses were received from U.K.-based critical care clinicians (53 medical doctors, 149 nurses, 25 pharmacists, 16 physiotherapists, and nine other healthcare professionals). After refining, 39 items were retained with an overall internal consistency of 0.81 and construct validity of χ 2/degrees of freedom = 1.86, comparative fit index = 0.73, and root mean square error of approximation = 0.058. INTERPRETATION: Areas of practice with high levels of agreement and perceived importance focused on the value of light sedation and the lack of progress in sedation minimization. Conflict between importance and agreement was reported in the effective assessment and management of pain, delirium, and agitation. CONCLUSIONS: The OCEAN-ICU instrument has been developed to determine barriers and facilitators to improving sedation practice in local intensive care contexts. Further validation is required before testing whether the development of change strategies based on identified barriers and facilitators are effective in optimizing sedation practice.

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