PT  - JOURNAL ARTICLE
AU  - Carolyn M Tan
AU  - Mercedes Camargo
AU  - Franziska Miller
AU  - Katie Ross
AU  - Ramez Maximous
AU  - Priscilla Yung
AU  - Carl Marshall
AU  - Dimitra Fleming
AU  - Madelyn Law
AU  - Jennifer LY Tsang
TI  - Impact of a nurse engagement intervention on pain, agitation and delirium assessment in a community intensive care unit
AID  - 10.1136/bmjoq-2018-000421
DP  - 2019 Aug 01
TA  - BMJ Open Quality
PG  - e000421
VI  - 8
IP  - 3
4099  - http://bmjopenquality.bmj.com/content/8/3/e000421.short
4100  - http://bmjopenquality.bmj.com/content/8/3/e000421.full
SO  - BMJ Open Qual2019 Aug 01; 8
AB  - Background In 2013, the Society of Critical Care Medicine published a revised version of the ICU Pain, Agitation, and Delirium (PAD) guidelines. Immobility and sleep were subsequently added in 2018. Despite the well-established advantages of implementing these guidelines, adoption and adherence remain suboptimal. This is especially true in community settings, where PAD assessment is performed less often, and the implementation of PAD guidelines has not yet been studied. The purpose of this prospective interventional study is to evaluate the effect of a multifaceted nurse engagement intervention on PAD assessment in a community intensive care unit (ICU).Methods All patients admitted to our community ICU for over 24 hours were included. A 20-week baseline audit was performed, followed by the intervention, and a 20-week postintervention audit. The intervention consisted of a survey, focus groups and education sessions. Primary outcomes included rates of daily PAD assessment using validated tools.Results There were improvements in the number of patients with at least one assessment per day of pain (67.5% vs 59.3%, p=0.04), agitation (93.1% vs 78.7%, p<0.001) and delirium (54.2% vs 39.4%, p<0.001), and the number of patients with target Richmond Agitation-Sedation Scale ordered (63.1% vs 46.8%, p=0.002). There was a decrease in the rate of physical restraint use (10.0% vs 30.9%, p<0.001) and no change in self-extubation rate (0.9% vs 2.5%, p=0.2).Conclusion The implementation of a multifaceted nurse engagement intervention has the potential to improve rates of PAD assessment in community ICUs. Screening rates in our ICU remain suboptimal despite these improvements. We plan to implement multidisciplinary interventions targeting physicians, nurses and families to close the observed care gap.