Assessment of Pain and Delirium in Adult ICU Patients: A Cross-sectional Observation Study at a Tertiary-Care Teaching Center.
CCCF ePoster library. Munawar S. Oct 27, 2015; 117382; P68
Saleha Munawar
Saleha Munawar
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Abstract
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P68


Topic: Quality Assurance/Quality Improvement Project


Assessment of Pain and Delirium in Adult ICU Patients: A Cross-sectional Observation Study at a Tertiary-Care Teaching Center.



Saleha Munawar

Medicine, Queen's University, Kingston, Canada

Introduction:

Appropriate identification and management of pain and delirium in critically ill patients can positively affect various clinical and organizational outcomes. Despite the availability of validated pain and delirium assessment tools they are often underutilized.



Objectives:

To examine utilization rates of standard pain and delirium screening tools in the intensive care unit of Kingston General Hospital, a tertiary-care, teaching center in Ontario, Canada.



Methods: A multifaceted observational study, including attendance in clinical rounds, chart review, and interviews with attending physicians and nurses. We recorded (1) whether pain and delirium were assessed, documented and discussed by the team; and (2) attending physician and nurses’ perceptions regarding pain and delirium for their respective patients.

Results:

Between June 1 and August 31, 2015, 78 patients and a total of 129 patient days were reviewed. Pain was discussed during morning rounds on 73 (57%) patient days. Some form of pain assessment was documented for 82 (64%) and 41 (32%) patient days by nurses and by physicians, respectively. The patient’s attending physician and nurse identified pain as an issue in the last 24 hours for 53 (41%) and 55 (43%) patient days, respectively, of which the physicians and the nurses were satisfied with the pain control in 53 (41%) and 93 (72%) of patient days, respectively. There was modest correlation between physician and nurses’ perception regarding pain being an issue in the last 24 hours (R2=0.30; p=0.01), and regarding the level of satisfaction with pain control (R2=0.29; p=0.04).

Delirium was discussed during morning rounds on 52 (40%) patient days. Some form of delirium assessment was documented for 60 (46%) and 31 (24%) patient days by nurses and by physicians, respectively. The patient’s attending physician and nurse identified delirium as an issue in the last 24 hours for 28 (22%) and 25 (19%) patient days, respectively, of which the physicians and the nurses were satisfied with the management of delirium in 19 (15%) and 49 (38%) of patient days, respectively. An incident of 'agitation, aggressiveness, restlessness, confusion, disorientation, hallucinations, and/or delirium/delirious behaviour' was documented in the last 24 hours by nurses for 39 (30%) of patient days. There was no correlation between physician and nurses’ perception regarding delirium being an issue.



Conclusion:

Assessment, documentation and discussion of pain and delirium were inconsistent. Clinicians’ perception regarding the presence and management of pain and delirium varied substantially. The implications to patients and to the hospital (not examined in this study) may be serious. The results of this study will inform quality improvement activities to address the identified gaps.



References: N/A
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