A Survey of Pain, Agitation and Delirium Management by Nurses in a Community Intensive Care Unit
CCCF ePoster library. Marshall C. 10/03/17; 198107; 44
Carl Marshall
Carl Marshall
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A Survey of Pain, Agitation and Delirium Management by Nurses in a Community Intensive Care Unit

Carl Marshall1, Katie Ross2, Franziska Miller1, Priscilla Yung1, Mercedes Camargo2, 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. Yet, its dissemination in a community 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:

  1. Examine nurses’ comfort in, perception, practice style and satisfaction of PAD management

  2. Explore potential barriers to and improvement strategies of PAD management

An anonymous 23-question paper-based survey was administered to nurses in Niagara Health St Catharines Site ICU.
There were 81 responses (98% response rate) with a median ICU experience of 6 years. >85% of nurses were comfortable with pain and agitation assessment. Only 41% of nurses were comfortable with delirium screening. 94, 70 and 57% of nurses were comfortable with pain, agitation and delirium treatment, respectively. In terms of practice style, 70% of nurses stated that they would calm down an agitated patient first before using medications. 54% of nurses would perform sedation vacation more than 75% of the time and 55% of nurses would use non-pharmacological therapy to treat delirium. In terms of satisfaction, 47 and 43% of nurses were satisfied with PAD management by nurses and physicians, respectively. Multiple barriers to optimal PAD management were identified and they included inconsistencies in PAD management among physicians and nurses, inadequate education and staff shortage. Nurses also identified education, PAD protocol and consistency of patient care among physicians as potential improvement strategies.
This study provided improved understanding of nurses’ comfort in and practice style of PAD management which in turn would help guide the development of educational interventions to improve PAD management. This study also identified potential barriers to and improvement strategies of PAD management. The results of this study will inform the design and development of multifaceted and multidisciplinary interventions for the PAD QI Program.

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