How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study
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Systematic monitoring of sedation, pain and delirium in the ICU is of paramount importance in delivering adequate patient care. While the use of systematic monitoring instruments is widely agreed upon, these tools are infrequently implemented into daily ICU care. The aim of this study is to compare the effectiveness of two different training strategies (training according to the local standard vs. modified extended method) on the implementation rate of scoring instruments on the ICU.
In this experimental cohort study we analyzed the frequency of scoring on three surgical ICUs before and after training, and in a 1 year follow-up. A modified extended training included establishing a local support team helping to resolve immediate problems. In addition we evaluated the impact on patients’ outcome.
ICUs trained by the modified extended method showed increased documentation rates of all scores per patient and day. In a 1 year follow-up, increased scoring rates for all scores were maintained. Scoring rates with training according to the local standard training protocol did not increase significantly. Implementation of delirium and pain monitoring were associated with a decrease in mortality [odds ratio (OR) 0.451; 95 % confidence interval (CI): 0.22–0.924, and, respectively, OR 0.348; 95 % CI: 0.140–0.863]. Monitoring had no significant influence on ventilation time or ICU length of stay.
A modified extended training strategy for ICU monitoring tools (sedation, pain, delirium) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome. However, these findings may have been biased by unmeasured confounders.
KeywordsSedation Delirium Pain Training Implementation
Acute physiology and chronic health evaluation
Behaviour pain scale
Delirium detection score
Intensive care unit
Length of stay
Numeric rating scale
Patient data management system
Richmond agitation sedation score
Ramsay sedation scale
Simplified acute physiology score
Sequential organ failure assessment
Therapeutic intervention scoring system
Funding for this study was provided by Charité – Universitaetsmedizin, Berlin. The authors would like to thank the dedicated staff of the three ICUs. Without their valuable contribution, this study would not have been possible.
Conflicts of interest
None of the authors has any potential conflict of interest to disclose.
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