Authors (including presenting author) :
Mak PC(1), Yu SL(1), Tse CH(1), Mok SC(1), Mac HT(1), Leung PWR(1), Leung KHA(1)
Affiliation :
(1) Intensive Care Unit, Queen Elizabeth Hospital
Introduction :
Pain in critically ill patients were commonly underestimated and undiagnosed. According to a meta-analysis, “being in pain” was ranked as the top one stressor by ICU patients. Studies showed that undiagnosed and untreated pain lead to increase of mechanical ventilation (MV) days and hemodynamic instability. Early recognition and effective management of pain can be achieved by systematic pain assessment with subjective physiological indicators and objective pain rating tools. The use of Critical Care Pain Observation Tool (CPOT), recommended by the Society of Critical Care Medicine, was implemented in the ICU of Queen Elizabeth Hospital (QEH) and a nurse-driven protocol was developed aiming at facilitating effective pain management and sedation weaning.
Objectives :
The purpose of the study is to examine the effectiveness of nurse-driven pain management and sedation weaning protocol, and to evaluate the change of patient outcomes after intervention such as the duration of MV, the ICU length of stay (LOS), and the adverse outcomes in sedation weaning process.
Methodology :
Our ICU is a 21-bed mixed medical-surgical unit located in a tertiary care regional hospital. Data was retrospectively collected from 220 patients over age 18 who admitted to QEH ICU between 2016 and 2017. Six-month data before and after the launch of protocol were collected, including 1) Patients’ demographic data 2) APACHE II and IV score 3) ICU LOS 4) Duration of MV 5) Sedation and pain score 6) Usage of sedation and analgesics 7) Adverse events in sedation weaning process. The collected data were then compared and analyzed with the use of t-test and chi-square tests.
Result & Outcome :
The data analysis from 220 patients showed statistically significant in the reduction of duration of MV and patients’ ICU LOS after implementation of the protocol. Both groups shared similar demographics. In the post-intervention group, the total duration of MV was decreased (166 hours v. 121 hours with p=0.012) and the ICU LOS was also shortened (10.9 v. 7.4 with p=0.011). Less patients experienced ventilator dysynchrony and unstable hemodynamic were reported (14.5% v. 6.4% with p=0.047; 6.4% v. 1.8% with p=0.171). Less episodes of self-removal of medical device (2.7% v. 0.9%) and agitation (31.8% v. 23.6%) were also observed in the study in the post-intervention group. In conclusion, the study showed that the use of nurse-driven sedation and pain management protocol can effectively improve patients’ duration of MV and ICU LOS, and experienced less adverse outcomes in sedation weaning process.
