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Pain, agitation and delirium assessment and management in a community medical-surgical ICU: results from a prospective observational study and nurse survey
  1. Ramez Maximous1,
  2. Franziska Miller2,
  3. Carolyn Tan2,
  4. Mercedes Camargo2,3,
  5. Katie Ross1,
  6. Carl Marshall2,
  7. Priscilla Yung2,
  8. Dimitra Fleming1,
  9. Madelyn Law3,
  10. Jennifer L Y Tsang1,2,3,4
  1. 1 Niagara Health, St Catharines, Ontario, Canada
  2. 2 Niagara Regional Campus, Michael G DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada
  3. 3 Brock University, St Catharines, Ontario, Canada
  4. 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Jennifer L Y Tsang; jennifer.tsang{at}


Background 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.

Objectives 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.

Methods 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.

Results 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.

Conclusions 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.

  • attitudes
  • critical care
  • nurses
  • performance measures

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  • FM is the first author.

  • 33 JLYT is the senior author.

  • Contributors RM performed data analysis and prepared the manuscript. KR planned the study, developed the survey and performed data analysis. FM, PY, CM, CT and MC performed data analysis. DF and ML planned the study. JLYT planned the study, developed the survey, developed data collection form and prepared the manuscript.

  • Funding This work was supported by the Ontario Nurses’ Association and the McMaster University, Department of Medicine, EJ Moran Campbell Internal Research Career Award 2015–2018 (JLYT).

  • Competing interests None declared.

  • Ethics approval Hamilton Integrated Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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