Examining the adherence to clinical guidelines for the assessment of pain, agitation and delirium in a Canadian community intensive care unit

Abstract

The purpose of this study was to evaluate the impact of a multifaceted and multidisciplinary intervention on the adherence of assessments for the management of pain, agitation and delirium (PAD) in a community intensive care unit (ICU) setting. All patients admitted to the community ICU for over 24 hours were included. Data were collected on a total of 430 patient-days during the pre-intervention period and 406 patient-days during the post-intervention period. A 6-week baseline data collection was performed, followed by a 4-week intervention, and a 6-week post-intervention data collection. The multifaceted intervention targeted nurses, physicians and family members and included online nurse education sessions, cue cards, posters, physician round scripts, patient family interviews, patient education pamphlets, and patient education videos. In addition, a PAD Advisory Committee was formed to engage, motivate and support frontline healthcare staff during the design and the implementation of the intervention. There were improvements in the number of patient-days with pain assessment at least 4 times per shift using NPRS or CPOT (68.0% vs 87.5%, p=0.0001), agitation assessment at least 4 times per shift using CAM-ICU. There was no significant improvement in the number of patient-days with at least once delirium assessment per shift using CAM-ICU (74.4% vs 76.3%, p=0.514). The mean number of patient-days with significant pain assessed as NPRS ≥ 4 or CPOT ≥3 was 0.026 lower in the post- intervention period compared to the pre-intervention period (95 % CI: 0.043, 0.008). Further, the mean number of patient-days with over sedation defined by RASS of < -2 at least 50% of the time was 0.063 higher in the post-intervention period compared to the pre-intervention period (95 % CI: 0.016, 0.109). This study demonstrates that involving frontline healthcare professionals in the design and implementation of multidisciplinary and multifaceted interventions improved the adherence to PAD care processes in a Canadian community ICU.