Improved Guideline Adherence and Reduced Brain Dysfunction After a Multicenter Multifaceted Implementation of ICU Delirium Guidelines in 3,930 Patients

Trogrlić, Zoran; Jagt, Mathieu van der; Lingsma, Hester F.; Gommers, Diederik; Ponssen, H. H.; Schoonderbeek, J; Schreiner, Frodo; Verbrugge, Serge; Duran, Servet; Bakker, Jan; Ista, Erwin

doi:10.1097/ccm.0000000000003596

Cited by 41 publications

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“…The effects shown took place over time—during a 6‐year period, and the changes were tested on a small scale with regular feedback on both process and outcomes. These results are in line with other implementation studies demonstrating the long‐term work and structure required to succeed in the adherence to international recommendations (Balas, Devlin, Verceles, Morris, & Ely, ; Morris, Wooding, & Grant, ; Rycroft‐Malone, Fontenla, Bick, & Seers, ; Trogrlić et al, ). The latter study refers to a prospective large pre–post implementation study of health professionals' adherence to delirium guidelines (Trogrlić et al, ).…”

Section: Discussionsupporting

confidence: 90%

“…These results are in line with other implementation studies demonstrating the long‐term work and structure required to succeed in the adherence to international recommendations (Balas, Devlin, Verceles, Morris, & Ely, ; Morris, Wooding, & Grant, ; Rycroft‐Malone, Fontenla, Bick, & Seers, ; Trogrlić et al, ). The latter study refers to a prospective large pre–post implementation study of health professionals' adherence to delirium guidelines (Trogrlić et al, ). With a pragmatic approach including a 3‐year phased implementation period of the ABCDEF bundle elements, they showed improved health professionals' adherence to delirium screening and reduced brain dysfunction among the patients.…”

Section: Discussionsupporting

confidence: 90%

“…With a pragmatic approach including a 3‐year phased implementation period of the ABCDEF bundle elements, they showed improved health professionals' adherence to delirium screening and reduced brain dysfunction among the patients. Early mobilisation, sedation assessment and light sedation improved significantly (Trogrlić et al, ). The time for measuring the real effect of the implementation of the analgosedation protocol in our study was too short, and we continue our monthly follow‐up.…”

Section: Discussionmentioning

confidence: 99%

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Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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Background Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009–2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. Methods In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4–6 months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8 hr, early mobilisation and titration towards a light level of sedation. Results We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from −2.2 in 2009–−1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self‐report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. Conclusion The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6‐year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. Relevance to clinical practice The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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“…The major implementation strategies of the implementation programme were education, audit and feedback, and reminders, as previously described. 17 In brief, education was provided in the form of web-based e-learning (http:// delier. intensivecare.…”

Section: Methods Design Setting and Participantsmentioning

confidence: 99%

“…7 In this study named the 'ICU DElirium in Clinical PracTice Implementation Evaluation' (iDECePTIvE) Study, a multifaceted implementation programme based on preimplementation assessment of barriers was developed and evaluated. [15][16][17] The overall results showed an improved adherence to delirium guidelines and recommendations which have resulted in decreased levels of brain dysfunction, meaning reduced delirium duration and a lower number of coma days. 17 However, variable guideline adoption among different sites is a well-known phenomenon, 18 which may also provide insights on factors that enhance effective implementation and guideline adoption.…”

Section: Introductionmentioning

confidence: 95%

Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation

et al. 2020

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ObjectiveWe aimed to explore: the exposure of healthcare workers to a delirium guidelines implementation programme; effects on guideline adherence at intensive care unit (ICU) level; impact on knowledge and barriers, and experiences with the implementation.DesignA mixed-methods process evaluation of a prospective multicentre implementation study.SettingSix ICUs.Participants4449 adult ICU patients and 500 ICU professionals approximately.InterventionA tailored implementation programme.Main outcome measureAdherence to delirium guidelines recommendations at ICU level before, during and after implementation; knowledge and perceived barriers; and experiences with the implementation.ResultsFive of six ICUs were exposed to all implementation strategies as planned. More than 85% followed the required e-learnings; 92% of the nurses attended the clinical classroom lessons; five ICUs used all available implementation strategies and perceived to have implemented all guideline recommendations (>90%). Adherence to predefined performance indicators (PIs) at ICU level was only above the preset target (>85%) for delirium screening. For all other PIs, the inter-ICU variability was between 34% and 72%. The implementation of delirium guidelines was feasible and successful in resolving the majority of barriers found before the implementation. The improvement was well sustained 6 months after full guideline implementation. Knowledge about delirium was improved (from 61% to 65%). The implementation programme was experienced as very successful.ConclusionsMultifaceted implementation can improve and sustain adherence to delirium guidelines, is feasible and can largely be performed as planned. However, variability in delirium guideline adherence at individual ICUs remains a challenge, indicating the need for more tailoring at centre level.

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Impact of adverse events on patient outcomes in a Japanese intensive care unit: a retrospective observational study

et al. 2021

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Adverse events (AEs) are defined as "unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalization or that results in death (Griffin & Resar, 2009)." Diverse studies from various countries reported that AEs developed in 12% of hospitalized patients (Panagioti et al., 2019) while the severe and unstable patients often seen in the intensive care unit (ICU) experienced more AEs than those in other general wards (Andrews et al., 1997). Up to 20%-25% of ICU patients experience an adverse event (AE), with 45.3-80.5 events per 1000 patient-days, and, within these events, 13% were lethal or life-threatening (Rothschild et al., 2005;Sauro et al., 2020).Numerous international studies show that AEs increase ICU stay length by 8.9 days and the length of a hospital stay by 6.8 days (Ahmed et al., 2015).The incidence of AEs varies according to national background and medical culture. For example, anaesthesia-related mortality is higher in developing countries than in developed countries (Bainbridge et al., 2012). Also, patient safety culture scores have been found to be negatively correlated with AEs incidence (Han et al., 2020;

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Improved Guideline Adherence and Reduced Brain Dysfunction After a Multicenter Multifaceted Implementation of ICU Delirium Guidelines in 3,930 Patients

Cited by 41 publications

References 35 publications

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation

Impact of adverse events on patient outcomes in a Japanese intensive care unit: a retrospective observational study

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