PMID- 15942331
OWN - NLM
STAT- MEDLINE
DCOM- 20050705
LR  - 20220410
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 33
IP  - 6
DP  - 2005 Jun
TI  - Large-scale implementation of sedation and delirium monitoring in the intensive 
      care unit: a report from two medical centers.
PG  - 1199-205
AB  - OBJECTIVE: To implement sedation and delirium monitoring via a 
      process-improvement project in accordance with Society of Critical Care Medicine 
      guidelines and to evaluate the challenges of modifying intensive care unit (ICU) 
      organizational practice styles. DESIGN: Prospective observational cohort study. 
      SETTING: The medical ICUs at two institutions: the Vanderbilt University Medical 
      Center (VUMC) and a community Veterans Affairs hospital (York-VA). SUBJECTS: 
      Seven hundred eleven patients admitted to the medical ICUs for >24 hrs and 
      followed over 4,163 days during a 21-month study period. INTERVENTIONS: Unit-wide 
      nursing documentation was changed to accommodate a sedation scale (Richmond 
      Agitation-Sedation Scale) and delirium instrument (Confusion Assessment Method 
      for the ICU). A 20-min introductory in-service was performed for all ICU nurses, 
      followed by graded, staged educational interventions at regular intervals. Data 
      were collected daily for compliance, and randomly 40% of nurses each day were 
      chosen for accuracy spot-checks by reference raters. An implementation survey 
      questionnaire was distributed at 6 months. MEASUREMENTS AND MAIN RESULTS: The 
      implementation project involved 64 nurses (40 at VUMC and 24 at York-VA). 
      Sedation and delirium monitoring data were recorded for 711 patients (614 at VUMC 
      and 97 at York-VA). Compliance with the Richmond Agitation-Sedation Scale was 
      94.4% (21,931 of 23,220) at VUMC and 99.7% (5,387 of 5,403) at York-VA. 
      Compliance with the Confusion Assessment Method for the ICU was 90% (7,323 of 
      8,166) at VUMC and 84% (1,571 of 1,871) at York-VA. The Confusion Assessment 
      Method for the ICU was performed more often than requested on 63% of shifts 
      (5,146 of 8,166) at VUMC and on 8% (151 of 1871) of shifts at York-VA. Overall 
      weighted-kappa between bedside nurses and references raters for the Richmond 
      Agitation-Sedation Scale were 0.89 (95% confidence interval, 0.88 to 0.92) at 
      VUMC and 0.77 (95% confidence interval, 0.72 to 0.83) at York-VA. Overall 
      agreement (kappa) between bedside nurses and reference raters using the Confusion 
      Assessment Method for the ICU was 0.92 (95% confidence interval, 0.90-0.94) at 
      VUMC and 0.75 (95% confidence interval, 0.68-0.81) at York-VA. The two 
      most-often-cited barriers to implementation were physician buy-in and time. 
      CONCLUSIONS: With minimal training, the compliance of bedside nurses using 
      sedation and delirium instruments was excellent. Agreement of data from bedside 
      nurses and a reference-standard rater was very high for both the sedation scale 
      and the delirium assessment over the duration of this process-improvement 
      project.
FAU - Pun, Brenda Truman
AU  - Pun BT
AD  - Department of Medicine, Division of Allergy/Pulmonary/Critical Care Medicine, and 
      Center for Health Services Research, Vanderbilt University School of Medicine, 
      Vanderbilt University School of Nursing, Nashville, TN 37232, USA. 
      Brenda.Truman@Vanderbilt.edu
FAU - Gordon, Sharon M
AU  - Gordon SM
FAU - Peterson, Josh F
AU  - Peterson JF
FAU - Shintani, Ayumi K
AU  - Shintani AK
FAU - Jackson, James C
AU  - Jackson JC
FAU - Foss, Julie
AU  - Foss J
FAU - Harding, Sharon D
AU  - Harding SD
FAU - Bernard, Gordon R
AU  - Bernard GR
FAU - Dittus, Robert S
AU  - Dittus RS
FAU - Ely, E Wesley
AU  - Ely EW
LA  - eng
GR  - K23 AG01023-01A1/AG/NIA NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Hypnotics and Sedatives)
SB  - IM
CIN - Crit Care Med. 2005 Jun;33(6):1421-2. PMID: 15942366
MH  - Adult
MH  - Aged
MH  - Critical Care/*standards
MH  - Delirium/nursing/*prevention & control
MH  - Drug Utilization Review
MH  - Female
MH  - *Guideline Adherence
MH  - Hospitals, University
MH  - Hospitals, Veterans
MH  - Humans
MH  - Hypnotics and Sedatives/*administration & dosage
MH  - Intensive Care Units/*standards
MH  - Male
MH  - Middle Aged
MH  - *Nursing Assessment
MH  - *Outcome and Process Assessment, Health Care
MH  - Prospective Studies
MH  - Respiration, Artificial/nursing
MH  - Tennessee
EDAT- 2005/06/09 09:00
MHDA- 2005/07/06 09:00
CRDT- 2005/06/09 09:00
PHST- 2005/06/09 09:00 [pubmed]
PHST- 2005/07/06 09:00 [medline]
PHST- 2005/06/09 09:00 [entrez]
AID - 00003246-200506000-00002 [pii]
AID - 10.1097/01.ccm.0000166867.78320.ac [doi]
PST - ppublish
SO  - Crit Care Med. 2005 Jun;33(6):1199-205. doi: 10.1097/01.ccm.0000166867.78320.ac.