scholarly journals Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

2018 ◽  
Vol 7 (4) ◽  
pp. e000304 ◽  
Author(s):  
Mairi Mascarenhas ◽  
Michelle Beattie ◽  
Michelle Roxburgh ◽  
John MacKintosh ◽  
Noreen Clarke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Assessment ◽  
Best Practice ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Self Report ◽  
Process Measures ◽  
Adult Intensive Care Unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

Pain in Intensive Care Unit: Italian critical care nurses' best practice

2021 ◽  
Vol 87 (7) ◽  
Author(s):  
Alessandro GALAZZI ◽  
Gian D. GIUSTI ◽  
Nicola PAGNUCCI ◽  
Stefano BAMBI ◽  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Best Practice ◽  
Critical Care Nurses

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

scholarly journals An educational strategy for the implementation of a delirium assessment tool

2021 ◽  
Vol 6 (1) ◽  
pp. 015-020
Author(s):  
Bonaga Beatriz ◽  
Taravilla Elena Ruiz-Escribano ◽  
Carrilero-López Carmen ◽  
Castillo-Lag María Dolores ◽  
Boehm Leanne M ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Daily Practice ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Critically Ill Patient ◽  
Daily Routine

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

scholarly journals Implementation of the Critical Care Pain Observation Tool

2018 ◽  
Author(s):  
Carla Salvadore
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Pain Assessment ◽  
The United States ◽  
Posttest Score ◽  
Assessment Instrument ◽  
Post Intervention ◽  
Nurses Knowledge

In the United States, greater than half of the adult patients who are admitted to critical care experience pain and report poor pain control. Inadequate management of acute pain is associated with negative outcomes, including high blood sugar, insulin resistance, higher infection risk, increased discomfort, decreased satisfaction, and chronic pain. Patients in the intensive care unit (ICU) cannot always express that they are having pain. Recently modified guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult recommend a reliable and valid pain assessment instrument for patients who are unable to verbalize pain. For the adult critically ill population, the Critical Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) were identified as the most reliable and valid instruments. The purpose of this program development was to provide education for nurses in the Cardiovascular Intensive Care Unit (CVICU) on the CPOT to assist in transitioning to the CPOT as part of the CVICU pain assessment. A pretest-posttest design was utilized to evaluate the nurses’ knowledge of the CPOT. The intervention consisted of a one-hour education session on pain assessment and the CPOT. Thirteen out of a potential twenty-two nurses (n=13, 59%) participated in the educational session with a mean pretest score of 42.3% and a mean posttest score of 93.1%. There was a 50.8% improvement post-intervention total scores. Findings from this quality improvement education intervention suggest that the CVICU nurses’ knowledge increased in both pain assessment and the CPOT following the intervention.

Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review

2019 ◽  
Vol 30 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Geraldine Martorella
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Scoping Review ◽  
Elderly Women ◽  
The Elderly ◽  
Self Report ◽  
Pharmacological Interventions

Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.

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