Improving analgesia and sedation in critically ill, mechanically ventilated ICU patients via real-time nursing feedback Mancheril B; Kram B; Schultheis J; Kram S; Trammel M; Jordan W; Cox C Duke University Hospital PGY2 - Critical Care - Durham, NC
Background/Purpose: The management of analgesia and sedation in critically ill, mechanically ventilated patients in the ICU remains a challenge among health care providers. Duke University Hospital utilizes a nursing-driven pain, agitation, and delirium (PAD) protocol to optimize management of pain and agitation for mechanically ventilated patients. The primary objective of this project is to determine whether periodic, real-time nursing feedback improves sedation quality. Secondary objectives will include determining whether real-time feedback impacts adherence to the nurse-driven PAD protocol and nursing comprehension, attitude, and perceptions of the PAD protocol.
Methodology: Nurses in the medical ICU and surgical ICU are provided regular feedback on the attainment of PAD goals. The feedback includes: (1) time with pain controlled, as measured by the Numeric Rating Scale (NRS) or Critical Care Pain Observation Tool (CPOT); (2) time with agitation controlled, as measured by Richmond Agitation Sedation Scale (RASS); and (3) absence of delirium, as assessed by the Confusion Assessment Method for the ICU (CAM-ICU). These results are displayed in the ICU's and discussed periodically during morning and evening nursing huddles at shift change. Additionally, nurses are provided with a survey before and after the intervention phase to gather qualitative data regarding nursing attitudes toward the achievement of PAD goals and their level of comprehension of the PAD protocol.
