An Audit on Pain, Agitation and Delirium Management in a Community Intensive Care Unit
CCCF ePoster library. Miller F. Oct 3, 2017; 198106; 43
Franziska Miller
Franziska Miller
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An Audit on Pain, Agitation and Delirium Management in a Community Intensive Care Unit

Franziska Miller1, Mercedes Camargo2, Carl Marshall1, Priscilla Yung1, Katie Ross2, Gina Fleming2, Madelyn Law3, Jennifer LY Tsang1,2,4

1Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada, 2St Catharines Site, Niagara Health, St Catharines, Ontario, Canada, 3Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada, 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada


Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of 80% in intensive care unit (ICU) patients1. It is associated with multiple complications1. A revised version of the ICU pain, agitation, and delirium (PAD) guidelines was published in 20132. However, its dissemination in a community intensive care unit (ICU) is unclear. 
As the initial phase of a single center multifaceted and multidisciplinary quality improvement (QI) program with an overall aim to improve PAD management in a community ICU, this study aimed to review PAD management practice in Niagara Health St Catharines Site ICU.
Prospective daily data collection of PAD process and outcome measures was conducted on all patients admitted to the ICU for >24 hours over a 20-week period (from April to August 2016).
Process measures included:

  1. Pain assessment using Numeric Report System (NRS)

  2. Agitation assessment using Richmond Agitation Sedation Scale (RASS)

  3. Delirium screening using Confusion Assessment Method for the ICU (CAM-ICU)

  4. Benzodiazepines use

Outcome measures included:

  1. Rate of pain defined as NRS >0

  2. Rate of over-sedation defined as RASS <-1

  3. Rate of delirium defined as positive CAM-ICU screen

Pain using NRS, agitation using RASS and delirium using CAM-ICU were assessed on a median of 53, 73 and 24% of patients per day, respectively. Benzodiazepines were administered to a median of 24% of patients per day. A median of 20 and 36% of patients per day were found to be in pain and over-sedated (RASS <-1), respectively. Delirium rate was not reported due to low delirium screening rate.
This audit has demonstrated a care gap in delirium screening and pain assessment. Moreover, despite reasonable agitation assessment, a third of ICU patients were found to be over sedated and a quarter of ICU patients were given benzodiazepines. This study serves as the basis of a multifaceted and multidisciplinary QI program and will inform the design and development of specific interventions to improve PAD management.   

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