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

Abstract

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.

Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday Care

“…One study, for example, that explored the implementation of sedation, pain and delirium tools found that extended repetitive training led to higher implementation rates than one time training alone. 28 Another possible explanation was that the research team did almost all of the education and monitoring of outcomes. If these changes were initiated and implemented purely by the clinical staff, buy-in may have improved due to an increased sense of ownership.…”

Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study

“…In contrast, a point prevalence analysis within an international survey showed that 73% of observed patients were not monitored with a validated delirium score [18]. Despite the low implementation rates, delirium monitoring implementation has been shown to be feasible [25,28].…”

“…The training method used, included on-the-job-training periods provided by a multi-professional team of nurses and physicians [25].…”

Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm

“…In addition, as part of the implementation of the algorithm, the principal investigator and the resource person reminded the nurses to use the algorithm, because feedback strategies were shown to improve adherence in other studies. 20,23,24 Radtke and colleagues 26 found that sustained documentation rates for sedation, pain, and delirium scores increased significantly when they used an expanded training program (i.e., resource group, lectures, movie, handouts, one to one instructions over three cycles) compared to a traditional training program (i.e., over one cycle). In the current study, a traditional training approach was used.…”