Maximous Ramez, Miller Franziska, Tan Carolyn, Camargo Mercedes, Ross Katie, Marshall Carl, Yung Priscilla, Fleming Dimitra, Law Madelyn, Tsang Jennifer L Y
Niagara Health, St Catharines, Ontario, Canada.
Niagara Regional Campus, Michael G DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada.
BMJ Open Qual. 2018 Oct 15;7(4):e000413. doi: 10.1136/bmjoq-2018-000413. eCollection 2018.
Delirium is a common manifestation in the intensive care unit (ICU) that is associated with increased mortality and morbidity. Guidelines suggested appropriate management of pain, agitation and delirium (PAD) is crucial in improving patient outcomes. However, the practice of PAD assessment and management in community hospitals is unclear and the mechanisms contributing to the potential care gap are unknown.
This quality improvement initiative aimed to review the practice of PAD assessment and management in a community medical-surgical ICU (MSICU) and to explore the community MSICU nurses' perceived comfort and satisfaction with PAD management in order to understand the mechanisms of the observed care gap and to inform subsequent quality improvement interventions.
We prospectively collected basic demographic data, clinical information and daily data on PAD process measures including PAD assessment and target Richmond Agitation-Sedation Scale (RASS) score ordered by intensivists on all patients admitted to a community MSICU for >24 hours over a 20-week period. All ICU nurses in the same community MSICU were invited to participate in an anonymous survey.
We collected data on a total of 1101 patient-days (PD). 653 PD (59%), 861 PD (78%) and 439 PD (39%) had PAD assessment performed, respectively. Target RASS was ordered by the intensivists on 515 PD (47%). Our nurse survey revealed that 88%, 85% and 41% of nurses were comfortable with PAD assessment, respectively.
Delirium assessment was not routinely performed. This is partly explained by the discomfort nurses felt towards conducting delirium assessment. Our results suggested that improvement in nurse comfort with delirium assessment and management is needed in the community MSICU setting.
谵妄是重症监护病房（ICU）的常见表现，与死亡率和发病率增加相关。指南建议，对疼痛、躁动和谵妄（PAD）进行适当管理对于改善患者预后至关重要。然而，社区医院中PAD评估和管理的实践情况尚不清楚，导致潜在护理差距的机制也尚不明确。
这项质量改进计划旨在回顾社区内科-外科ICU（MSICU）中PAD评估和管理的实践情况，并探讨社区MSICU护士对PAD管理的舒适度和满意度，以了解观察到的护理差距的机制，并为后续的质量改进干预提供依据。
我们前瞻性收集了在20周内入住社区MSICU超过24小时的所有患者的基本人口统计学数据、临床信息以及PAD过程指标的每日数据，包括PAD评估和重症监护医生下达的目标里士满躁动镇静量表（RASS）评分。邀请同一社区MSICU的所有ICU护士参与一项匿名调查。
我们共收集了1101个患者日（PD）的数据。分别有653个PD（59%）、861个PD（78%）和439个PD（39%）进行了PAD评估。重症监护医生下达目标RASS的有515个PD（47%）。我们的护士调查显示，分别有88%、85%和41%的护士对PAD评估感到舒适。
谵妄评估未常规进行。这部分是由于护士在进行谵妄评估时感到不适。我们的结果表明，在社区MSICU环境中，需要提高护士对谵妄评估和管理的舒适度。
