scholarly journals Pain Assessment, Using the Critical Care Pain Observational Tool in Intensive Care Unit. An Observational Study, Lahore, Pakistan

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Direct Observation ◽  
Pain Assessment ◽  
Chronically Ill ◽  
Staff Nurses ◽  
Care Hospital ◽  
Staff Nurse ◽  
Observational Tool

Aim: Aim this study is to determine impact of enforcement of the critical Care Pain Observation Tool (CPOT) on the quantity and frequency of ICU’s management of analgesic. Background: Severely critically admitted patients to the Intensive care unit may also experience from specific painful stimuli, but the evaluation of pain is difficult due to the fact that the maximum number of patients are almost sedated and also unable to self report. Thus, optimizing pain assessment in those sufferers is far-reaching. Pain control or management of the pain is one of furthermost important obligations of staff nurses in an extensive care unit. The Critical Care Pain Observational Tool (CPOT) is the one of important behavioral pain scale that have been developed and tested to detect pain in significantly ill nonverbal adults. Methods: A observational quantitative study is done in a tertiary care hospital in Lahore. Study duration is 4 months, from January 2020 to May 2020. The target population of study is nurses who are working in different type of (Icu) units. Sample size is 200. An observational checklist consisted of 22 items is used as research instrument. Result: No any pain assessment or used any pain tool or intervention done by any staff nurse. Pain assessment checked through direct observation in first phase, In this phase observe nurses pain assessment in 24 hours, physician pain assessment in 24 hours, After direct observation there was held a educational session about pain assessment and pain management according pain observation tool, And then We then carried out this empirical analysis in order to verify the CPOT validity and feasibility through questioners and make it accessible around the staff nurses. Mostly nurses believed that there was sufficient helpful in assessing patients pain by using of CPOT in nursing practice. Conclusion: lThe results of this research indicate that the Critical Care Pain Monitoring Method may be used as a reliable method for pain appraisal in chronically ill adult intubated patients. This method is effective and efficient in patients who are chronically ill with a regimen of analgo-sedation focused on no-hypnotic, opioid-infusion. CPOT ratings were well associated with the self-reported pain experience of patients, and demonstrated outstanding reliability amongst raters. That makes the CPOT’s a powerful method for pain evaluation.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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.

Mortality Review of Children Admitted in Pediatric Intensive Care Unit Over One Year in a Tertiary Care Hospital

2021 ◽  
Vol 6 (1) ◽  
pp. 1369-1372
Author(s):  
Pun Narayan Shrestha ◽  
Sumit Agrawal ◽  
Kosh Raj R C ◽  
Prakash Joshi ◽  
Ajit Rayamajhi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Female Ratio

Introduction: Childhood mortality is still high in developing countries. This can be reduced with good preventive and curative services especially with critical care. The treatment of critically ill children must be focused for better outcome. The pediatrics deaths audit and review provide feedback to health workers and to the institution. The outcome measures of critical care medicine include mortality, morbidity and disability rate. Objectives: The aim of this study is to review the causes and mode of death in children and length of PICU (pediatric intensive care unit) stay. Methodology: A retrospective study was conducted of the patients who were admitted and died within the period of 16 July 2019 to 15 July, 2020 at PICU of Kanti Children Hospital (KCH). Variables recorded were patient's demography, diagnosis, co- morbidities, complications, length of PICU stay (LOS), mode and time of death. Data were tabulated into MS Excel and analyzed using SPSS version 23. Result: Out of 718 admitted children, 99 (13.78%) died with male to female ratio of 1.8:1. The maximum death (75%) was observed in less than five year of age and most of them were from outside the Kathmandu valley. The leading causes of death were pneumonia (28%), sepsis (20%) and congenital heart diseases (21%). The common complications seen were disseminated intravascular coagulation (DIC), multi- organ dysfunction syndrome (MODS), acute kidney injury (AKI) (5.1 %) and acute respiratory distress syndrome (ARDS) (6.1%) and co- morbidities were congenital heart disease (CHD) (18.2%) and global developmental delay (GDD) (9.1%). Mechanical ventilation was needed in 80.8%. Most of the cases (86%) died despite active treatment and (75%) during off hours (4pm-9am). Conclusion: Pneumonia, sepsis and CHD were the main reason of death and most of them were from outside the valley. 

Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation

2015 ◽  
Vol 35 (3) ◽  
pp. 17-31 ◽  
Author(s):  
Judy E. Davidson ◽  
Chris Winkelman ◽  
Céline Gélinas ◽  
Anna Dermenchyan
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Practice ◽  
Practice Guidelines ◽  
Guideline Implementation ◽  
Critical Care Medicine ◽  
Staff Nurse ◽  
Nurse Leader ◽  
Professional Guidelines

The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses’ involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.

scholarly journals Performance of Pediatric Index of Mortality-2 in a Pediatric Intensive Care Unit of a Tertiary Care Hospital of Nepal

2019 ◽  
Vol 21 (2) ◽  
pp. 89-94 ◽  
Author(s):  
Sangita Puree Dhungana ◽  
P.P. Panta ◽  
S.K. Shrestha ◽  
S. Shrestha
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Scoring System ◽  
College Teaching ◽  
Pediatric Intensive Care ◽  
Care Hospital ◽  
Goodness Of Fit Test ◽  
Pediatric Index Of Mortality

Various scoring system have been developed and are becoming essential part of Pediatric and other critical care units. The Pediatric department wants to introduce Pediatric Index of Mortality-2 (PIM 2) as a predictive scoring system in Pediatric critical care unit of Nepal Medical College Teaching Hospital (NMCTH). This was a prospective cohort study done in Pediatric Intensive Care Unit (PICU) of NMCTH. Study was done from August 2017 to December 2018. All cases admitted in ICU were taken consecutively from term newborn to 14 yrs of age. PIM 2 scoring system was done in all patients. PIM 2 performed well in terms of discrimination with area under curve for PIM 2 scor e was 0.809 with 95% Confidence Interval of 0.0709 to 0.910 and Standard Error of 0.051. Good calibration was observed across deciles of risk as measured by Hosmer-Lemeshow goodness of fit test with P value of 0.163, chi-square value of 11.752 (8). Mortality observed in our PICU was 28.4% with standardized mortality ratio of 1. PIM 2 scoring system performed well in our PICU.

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%.

scholarly journals Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) infections among patients admitted in critical care units in a tertiary care hospital

2017 ◽  
Vol 5 (6) ◽  
pp. 2362 ◽  
Author(s):  
Arunkumar V. ◽  
Prabagaravarthanan R. ◽  
Bhaskar M.
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Critical Care ◽  
Intensive Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Critical Care Units ◽  
Two Samples

Background: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital leads to significant morbidity and mortality. Hence the present study was undertaken to estimate the prevalence of MRSA in critical care units (CCUs) at our centre. The objective of this study was to find the prevalence of MRSA infections in CCUs, to determine their antibiotic profile. And to screen for MRSA in the environment of CCUs in order to find whether they act as a source of infection.Methods: The present cross-sectional study included 100 patients admitted to various CCUs in our hospital. The clinical specimens (urine, Sputum, pus, blood and CSF) were collected from the admitted patients along with environmental samples from these CCUs. Two samples were collected from each patient and subjected to culture and antibiotic susceptibility testing.Results: 168 samples from 100 patients were processed. Out of which five pus samples from five different patients admitted in surgical intensive care unit (SICU) were positive for MRSA infection showing 5% prevalence in CCUs. All MRSA strains were sensitive to vancomycin and teicoplanin. Out of 30 environmental swabs, 1 swab taken from paediatric intensive care unit (PICU) showed positivity for MRSA (3%).Conclusions: CCUs in our hospital have shown 5% prevalence of MRSA among the admitted patients. There was no correlation between environmental MRSA presence and infection in the samples from patient.

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