Division of Emergencies and Critical Care, Department of Postoperative and Intensive Care, Oslo University Hospital, Oslo, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway.
Acta Anaesthesiol Scand. 2021 Nov;65(10):1466-1474. doi: 10.1111/aas.13969. Epub 2021 Aug 19.
The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. Therefore, the primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-guidelines in four ICUs.
A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Proportion of nursing shifts with documented PAD-assessment (PAD-QIs) were retrieved from the electronical medical chart from included adult ICU patient-stays in four participating ICUs. Difference between the two time periods was assessed using generalised mixed model for repeated measures with unstructured covariance matrix, and presented as Beta (B) with 95% confidence interval (CI).
Finally, 1049 ICU patient-stays were analysed; 534 in Before and 515 in Intervention. All three PAD-QIs significantly increased in Intervention by 31% (B = 30.7, 95%CI [25.7 to 35.8]), 26% (B = 25.8, 95%CI [19.4 to 32.2]) and 34% (B = 33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively.
A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, particularly as social distancing impacts clinical education and training and new approaches are needed.
社交媒体具有速度快、覆盖范围广和易于访问等特点，但其在干预措施中对改善对指南的依从性（如评估疼痛、躁动/镇静和谵妄）的影响尚未得到描述。因此，本质量改进研究的主要目的是评估包括通过 Facebook 群组对质量指标（QI）进行审核和反馈、教育活动以及利用意见领袖来提高四个 ICU 中对疼痛、躁动/镇静和谵妄（PAD）指南的依从性的多方面干预措施的影响。
设计了一项准实验性中断时间序列研究，在两个阶段（干预前和干预期间）中每月进行 8 个数据点。从四个参与 ICU 的电子病历中检索包含的成年 ICU 患者入住期间记录的护理班次中 PAD 评估（PAD-QI）的比例。使用非结构化协方差矩阵的广义混合模型重复测量来评估两个时间段之间的差异，并以 95%置信区间（CI）的 Beta（B）表示。
最终分析了 1049 例 ICU 患者入住情况；干预前 534 例，干预后 515 例。所有三个 PAD-QI 在干预期间均显著增加，疼痛分别增加 31%（B=30.7，95%CI [25.7 至 35.8]）、躁动/镇静增加 26%（B=25.8，95%CI [19.4 至 32.2]）和谵妄增加 34%（B=33.9，95%CI [28.4 至 39.4]）。
包括使用 Facebook 群组在内的多方面干预措施与四个 ICU 中 PAD 评估的 PAD 指南依从性的提高有关。需要进一步研究使用社交媒体来提高指南的依从性，特别是因为社交距离会影响临床教育和培训，需要新的方法。
