Protocolized Intensive Care Unit Management of Analgesia, Sedation, and Delirium Improves Analgesia and Subsyndromal Delirium Rates

Skrobik, Yoanna; Ahern, Stéphane P.; Leblanc, Martine; Marquis, François; Awissi, Don Kelena; Kavanagh, Brian P.

doi:10.1213/ane.0b013e3181d7e1b8

Cited by 257 publications

(252 citation statements)

References 31 publications

Supporting

Mentioning

232

Contrasting

Unclassified

Order By: Relevance

“…A ‘0–3’ score was most frequently employed, and it is unclear what this score represented; it might have been an observed version of a self‐report measure, the verbal rating scale (VRS) 24, a tool that has not been validated for use in critical care. The lack of adherence to the ACCM guidelines is concerning, as regular, validated pain assessment has consistently been associated with improved patient outcomes 6, 8.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

et al. 2017

View full text Add to dashboard Cite

SummaryPain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

show abstract

Section: Discussionmentioning

confidence: 99%

“…This is thought to be due to increased prioritisation of pain and more frequent alterations to analgesic prescriptions 2. Indeed, protocolised analgesic management, reliant on validated and frequent assessment, improves patient outcomes 8.…”

Section: Introductionmentioning

confidence: 99%

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Seven studies [18][19][20][21][22][23][24] were done in critically ill patients, 5 in geriatric general medicine patients, 9-13 3 in postoperative patients, [14][15][16] and 2 in patients who had a hip fracture. 7,8 A total of 13 of the studies were prospective investigations, [7][8][9][10][11]13,15,16,18,[21][22][23][24] and 4 were randomized control trials. [14][15][16]24 The Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was the most frequently used tool and was used in 10 studies.…”

Section: All Studiesmentioning

confidence: 99%

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Rivosecchi

Smithburger

Svec

et al. 2015

Critical Care Nurse

View full text Add to dashboard Cite

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

show abstract

“…The handling of these symptoms has a considerable influence on the patient's outcome [1,2,[4][5][6][7][8]. Antiemetics, cathartic medicine, analgosedatives and blood pressure medication are often prescribed on a 'pro re nata' (PRN) or 'as needed' basis.…”

Section: Introductionmentioning

confidence: 99%

Gender-specific differences in nursing staff’s administration patterns of ‘pro re nata’ medication: A prospective observational study

Glasmeyer¹,

Creutzenberg²,

Eder³

et al. 2017

Nurs Palliat Care

View full text Add to dashboard Cite

Background: Pro re nata'(PRN) medications are important parts of the management of critically ill patients. PRN medications are predominantly administered by nurses, and indications, frequencies and doses of PRN might be influenced by experience, attitude, and empathy. Since it is advocated that empathy has a genderspecific pattern, we compared the PRN prescription model in female and male nurses.

show abstract

Protocolized Intensive Care Unit Management of Analgesia, Sedation, and Delirium Improves Analgesia and Subsyndromal Delirium Rates

Abstract: Educational initiatives incorporating systematic management protocols with nonpharmacologic measures and individualized titration of sedation, analgesia, and delirium therapies are associated with better outcomes.

Cited by 257 publications

References 31 publications

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Gender-specific differences in nursing staff’s administration patterns of ‘pro re nata’ medication: A prospective observational study

Contact Info

Product

Resources

About