Intensive Care Medicine

, Volume 38, Issue 12, pp 1974–1981 | Cite as

How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study

  • Finn M. Radtke
  • Anja Heymann
  • Martin Franck
  • Friederike Maechler
  • Tanja Drews
  • Alawi Luetz
  • Irit Nachtigall
  • Klaus-Dieter Wernecke
  • Claudia D. Spies
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Sedation Delirium Pain Training Implementation 

Abbreviations

APACHE

Acute physiology and chronic health evaluation

BPS

Behaviour pain scale

CI

Confidence interval

DDS

Delirium detection score

ICU

Intensive care unit

LOS

Length of stay

NRS

Numeric rating scale

OR

Odds ratio

PDMS

Patient data management system

RASS

Richmond agitation sedation score

RSS

Ramsay sedation scale

SAPS

Simplified acute physiology score

SD

Standard deviation

SOFA

Sequential organ failure assessment

TISS

Therapeutic intervention scoring system

Notes

Acknowledgments

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.

Supplementary material

134_2012_2658_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 38 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Finn M. Radtke
    • 1
  • Anja Heymann
    • 1
  • Martin Franck
    • 1
  • Friederike Maechler
    • 1
  • Tanja Drews
    • 1
  • Alawi Luetz
    • 1
  • Irit Nachtigall
    • 1
  • Klaus-Dieter Wernecke
    • 2
    • 3
  • Claudia D. Spies
    • 1
  1. 1.Department of Anesthesiology and Surgical Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-KlinikumCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of BiomathematicsCharité-Universitätsmedizin BerlinBerlinGermany
  3. 3.SOSTANA GmbH (CRO)BerlinGermany

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