KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director 6 Hospital Administrator 7 Other (Please specify): 2. What type of ICU do you represent? 1 Medical 2 Surgical 3 Cardiac 4 Neuro 5 Trauma 6 Mixed or other (explain) 7 More than 1 unit (please list): 3. How many beds does your unit have? 4. Does your unit/hospital have the following (select all that apply): 1 Association with a medical school 2 Residency/House Officers 3 Surgical Critical Care Fellows 4 Pulmonary/Critical Care Fellows 5 Critical Care Fellows (other) 6 Other academic affiliation 5. Is your unit model: 1 Closed (only intensivist led critical care team writes orders) 2 Open (any physician may write orders) 3 Other (please describe. Examples: critical care team in cooperation with primary team, mandatory critical care consultation, optional critical care team consultation, participation by hospitalists) 6. Please classify the medical decision making model in your unit: 1 Intensivist makes primary decisions 2 There is shared decision making between teams 3 Non intensivist makes primary decisions 4 Other (please explain) 1 KICU SAT Survey
7. Do you have an ICU director? 1 Yes 2 No 3 Don t Know 4 Other (please explain) 8. Do you have a spontaneous awakening trial (SAT) protocol in place? 1 Yes 2 No 3 Don t Know 9. On which patients in your unit is your SAT protocol ordered? 1 Every patient, held only by exception 2 Most patients get the protocol 3 Some patients get the protocol 4 The rounding attending decides if the patient should get the protocol 5 Don t know (or not applicable) 10. The staff members in my unit see survivor patients after they are discharged from the unit. 1 Often 2 Sometimes 3 Rarely 4 Never In this section, we want to learn how you and your staff think about the patient experience of spontaneous awakening trials (SATs). Select the option that BEST fits your opinion. Neither or 11. In my opinion, spontaneous awakening trials (SATs) increase patient distress and agitation. 12. In my opinion, during spontaneous awakening trials (SATs), the patient is at higher risk for adverse events such as self extubation. 13. Staff members in my unit feel that during spontaneous awakening trials (SATs), the patient is at higher risk for adverse events such as self extubation. 14. It is better for patients not to remember their experience in the ICU. 2 KICU SAT Survey
15. In my opinion, use of spontaneous awakening trials (SATs) increases short term adverse effects (even if it is worth it in the long run). 16. Staff members in my unit are often afraid to perform spontaneous awakening trials (SATs). Neither or 17. The experience of being an ICU patient must be terrible. 18. Sedation prevents PTSD (posttraumatic stress disorder). 19. Spontaneous awakening trials (SATs) allow me to take better care of my patients. 20. Staff members in my unit feel that spontaneous awakening trials (SAT s) allow them to take better care of patients. 21. Performing spontaneous awakening trials (SATs) is a part of my unit culture. 22. Performing spontaneous awakening trials (SATs) is hard work. 23. Performing spontaneous awakening trials (SATs) is something to be proud of. 24. If the patient is still on sedative drips, but is awake and cooperative, the spontaneous awakening trial (SAT) is complete and successful. 25. If the patient is moving all of his/her extremities, the spontaneous awakening trial (SAT) is complete and the patient can be re sedated. 3 KICU SAT Survey
In this section, we want to know how your unit protocols are structured to support spontaneous awakening trials (SATs). 26. Which sedation scale do you use to monitor sedation level? 1 We do not use a sedation monitoring scale 2 RASS (Richmond Agitation Scale) 3 SAS (Riker Sedation Agitation Scale) 4 MAAS (Motor Activity Assessment Scale) 5 Ramsay Sedation Scale 6 Don t know 7 Other (Please specify): 27. What delirium assessment tool do you use? 1 We do not use a delirium assessment tool 2 CAM ICU (Confusion Assessment Method for the ICU) 3 Delirium Rating scale 4 Delirium Screening checklist 5 MMSE (Mini Mental State Examination) 6 General assessment 7 DSM based assessment 8 Don t know 9 Other (Please specify): 28. How often are sedation goals addressed in rounds for mechanically ventilated patients? 1 Routinely (>70%) 2 Sometimes (20 70%) 3 Rarely (<20%) 4 Never 29. Thinking about the last month, what percentage of mechanically ventilated patients are assessed for spontaneous awakening trials (SATs) each day? 1 <10% 2 11 25% 3 26 50% 4 51 75% 5 76 99% 6 100% 4 KICU SAT Survey
30. Thinking about the last month, what percentage of mechanically ventilated patients were eligible for spontaneous awakening trials (SATs) each day? 1 <10% 2 11 25% 3 26 50% 4 51 75% 5 76 100% 31. What percentage of mechanically ventilated patients undergo spontaneous awakening trials (SATs) each day? 1 <10% 2 11 25% 3 26 50% 4 51 75% 5 76 100% 32. Who participates in rounds? (select ALL that apply) 1 Attending physician, intensivist 2 Attending physician, other 3 Pharmacist 4 Bedside nurse 5 Nurse leader (charge nurse, nurse educator, clinical nurse specialist) 6 Nurse practitioner or Physician Assistant 7 House Officer(s) 8 Fellow(s) 9 Medical student(s) 10 Respiratory therapist 11 Social worker 12 Family members 13 Other (please specify, e.g. PT, nutrition, etc.) 33. Please identify the goal(s) of the sedation holiday: (select any/all that apply) 1 Minimize dose of sedation 2 Ventilator weaning 3 Neurologic exam 4 Reduce ICU length of stay 5 Assessment of pain and discomfort 6 Other (please specify) 5 KICU SAT Survey
34. Select the appropriate exclusion criteria for a spontaneous awakening trial (SAT): 1 Sedative infusion for active seizures or alcohol withdrawal 2 Fever >101.5 3 Pressor infusion 4 Neuromuscular blocker administration 5 FiO2 > 70% 6 Escalating sedative doses due to ongoing agitation 7 PEEP 10 8 Evidence of active myocardial ischemia in the previous 24 hrs 9 Evidence of increased intracranial pressure 10 Ventilator settings other than AC or IMV±pressure support 11 Other (please specify) 35. Thinking about your sedative medications administration (e.g. benzodiazepines, propofol) which statement BEST describes your spontaneous awakening trial (SAT) practice? 1 Sedation cessation is best accomplished by completely turning off sedative drips. 2 Sedation cessation is best accomplished by gradually decreasing the rate of sedative drips. 3 Sedation cessation approach should be individualized for each patient. 36. Thinking about your analgesic medication administration (e.g. narcotics/opiates), which statement BEST describes your treatment of narcotic drips during spontaneous awakening trials (SATs)? 1 Analgesic drips should be left alone during spontaneous awakening trials (SATs). 2 Analgesic drips should be slowly weaned during spontaneous awakening trials (SATs). 3 Analgesic drips should be stopped with every spontaneous awakening trial (SAT). In this section, we want to know how you think about spontaneous awakening trials (SATs). Clinical vignette 1: A spontaneous awakening trial (SAT) has been performed, and spontaneous breathing trial (SBT) begun. The patient s heart rate changed from a baseline of 88 to 135 with a respiratory rate increase from 18 to 38 within 15 minutes of the SBT, with desaturations to 85%. The patient is placed back on mechanical ventilation, with a subsequent decrease in heart rate to 115, and respiratory rate to 24. At this time, the patient is awake and gesturing, but you do not know why. Given the previous information, please answer the following questions (36 and 37). 37. What is your level of agreement with this statement? This is an example of a failed spontaneous awakening trial (SAT). 1 2 3 Neither Nor 4 5 38. Which of these is the most appropriate next step? 1 Restart sedation 2 Implement restraints 3 Communicate with the patient to assess needs 4 Perform a delirium assessment 6 KICU SAT Survey
Clinical vignette 2: A 35 year old female develops H1N1 pneumonia and respiratory failure. She is intubated and mechanically ventilated. She recovers and weans from the ventilator, and is extubated on day 6. During the time that she is ventilated, her head of the bed is elevated 45 degrees, she receives peptic ulcer prophylaxis, and heparin subcutaneously for deep venous thrombosis prophylaxis. She also receives a spontaneous awakening trial (SAT) with a spontaneous breathing trial (SBT) on days 1, 2, 3, 4, 5, and 6 after intubation. After transfer from the ICU, she is discharged home on hospital day 11. Six months later, she is diagnosed with post traumatic stress disorder (PTSD). Given this information, please answer the following questions (37, 38, and 39). 39. What is your level of agreement with this statement? PTSD was an avoidable complication of this patient s care. 1 2 3 Neither Nor 4 5 40. If she had received spontaneous awakening trials (SATs) only on days 5 and 6, her risk of having PTSD would have been: 1 Much higher 2 Somewhat higher 3 The same 4 Somewhat lower 5 Much lower 41. Based on the information available, what is your level of agreement with this statement? This patient received excellent care. 1 2 3 Neither Nor 4 5 42. If you have any feedback regarding this survey or spontaneous awakening trials (SATs), please use the following space (and the back of this page if needed) to describe: Thank you very much for your time!! 7 KICU SAT Survey