Mercedes Camargo Penuela1, Madelyn Law1, Han-Oh Chung1, Brent E Faught1, Jennifer L Y Tsang2. 1. Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont. 2. Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont. Jennifer.tsang@mail.utoronto.ca.
Abstract
BACKGROUND: Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). METHODS: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). INTERPRETATION: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs. Copyright 2019, Joule Inc. or its licensors.
BACKGROUND:Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). METHODS: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). INTERPRETATION: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs. Copyright 2019, Joule Inc. or its licensors.
Authors: Zechen Ma; Mercedes Camargo Penuela; Madelyn Law; Divya Joshi; Han-Oh Chung; Joyce Nga Hei Lam; Jennifer Ly Tsang Journal: BMJ Open Qual Date: 2021-12