Penuela Mercedes Camargo, Law Madelyn, Chung Han-Oh, Faught Brent E, Tsang Jennifer L Y
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.
CMAJ Open. 2019 Jun 26;7(2):E430-E434. doi: 10.9778/cmajo.20190015. Print 2019 Apr-Jun.
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).
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).
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.
疼痛和躁动与谵妄的发生密切相关，谵妄影响60%-87%的重症患者。谵妄与死亡率和发病率的增加有关。临床指南建议对疼痛、躁动和谵妄（PAD）进行常规评估、治疗和预防，这对改善患者预后至关重要。然而，PAD指南的采用和遵循情况仍不理想，尤其是在社区医院。这项质量改进研究的目的是评估多方面、多学科干预对加拿大社区重症监护病房（ICU）中PAD管理的影响。
这是一项针对护士（教育模块、视觉提示）、家庭成员（访谈、教育手册和教育视频）、医生（多学科查房脚本）以及整个多学科团队（谵妄海报）的多方面、多学科干预的质量改进、非对照前后研究。在实施干预前，我们将连续6周每天收集数据。数据收集将包括临床信息和护理过程信息。然后我们将实施干预。四周后，我们将连续6周每天收集数据以评估干预效果。根据ICU的规模，我们预计纳入约280名患者。我们已获得汉密尔顿综合研究伦理委员会（HiREB 18-040-C）的当地伦理批准。
这项质量改进研究的结果将提供有关加拿大社区ICU环境中遵循PAD指南的信息。它们还将提供有关在社区ICU中实施多方面、多学科PAD干预措施的可行性的信息。
