Introduction: Appropriate levels of sedation in critical illness are important because poorer outcomes are associated with over- or under- sedation. Environmental factors, such as staffing levels, decreased patient visibility, greater distance between patients and nursing patients in single rooms, also impact sedation practices because of the perception of increased personal and patient risk.

Objectives/Aims: To explore the effect of a single room environment on sedation practices in critically ill adults.

Methods: A pre-post quasi-experimental design with data collected 12 months before in an open-plan ICU (n=319) and after (n=306) the move to a new ICU with single rooms. Data were collected for the first 14d of ICU admission or until ICU discharge from all adult patients requiring mechanical ventilation for >12h.

Results: Patient characteristics such as age, sex, APACHE II score, length of stay and ventilation were similar in both groups. In the single room environment, there was no difference in the median total dose of midazolam delivered across the first 4d of ICU admission. The median total dose was statistically higher for fentanyl on days 1 (981.6mcg vs 1201.7mcg) and 3 (1019.7mcg vs 1219.1mcg) of ICU admission; for morphine on day 2 (71.9mg vs. 134.3mg) and day 3 (58.3mg vs 125.3mg); and for propofol on day 1 (1134.0mg v 1692.1mg) and day 3 (1208.7mg vs 2053.4mg). Time series analysis demonstrated a sharp increase in the proportion of patients over-sedated on days 1-3 for the 2 months following the move to single rooms; this decreased over the subsequent 10 months.

Conclusion: Moving from an open plan to a single room environment may contribute to perceptions of increased personal and patient risk which results in administration of higher levels of sedation medication. In our context initial over-sedation corrected over time to be similar to pre-move levels.