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. SpiesEmail author



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.


Sedation Delirium Pain Training Implementation 



Acute physiology and chronic health evaluation


Behaviour pain scale


Confidence interval


Delirium detection score


Intensive care unit


Length of stay


Numeric rating scale


Odds ratio


Patient data management system


Richmond agitation sedation score


Ramsay sedation scale


Simplified acute physiology score


Standard deviation


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.

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
    Email author
  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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