Pain, Agitation and Delirium Management in an Adult Intensive Care Unit

The Centers of Disease Control reports an estimated 300,000 patients receive mechanical ventilation each year. Patients receiving mechanical ventilation therapy have a high risk for complications and poor outcomes. Current clinical practice guidelines recommend managing pain, agitation and delirium to improve outcomes of critically ill adults in the ICU. In 2013 the American College of Critical Care Medicine published Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium in Adult Patients in the Intensive Care Unit. Current recommendations include assessing and treating pain, daily interruption of continuous intravenous sedation or titrating sedative medications to maintain a light depth of sedation, and assessing for and preventing delirium. Pain, agitation, and delirium should be monitored and treated in conjunction with targeted light depth of sedation or daily interruption of sedation to improve patient outcomes. The purpose of this scholarly project was to promote application of evidenced-based guidelines for the management of pain, agitation, and delirium in adult intensive care patients. This project was comprised of four objectives: The development of a pain, agitation and delirium management support document and order form; Educate ICU staff regarding pain, agitation and delirium management in critically ill adults; Implement the pain, agitation and delirium management support document and order form in the adult ICU at a community hospital; Disseminate the information related to this project. A literature review was performed and current clinical practice guidelines were identified. A pain, agitation and delirium management support document and order form were developed based off of the current clinical practice guidelines. The pain, agitation and delirium management support document and order set were presented to the intensivists and pertinent department directors. Suggestions and edits were incorporated into the documents. A pain, agitation and delirium management education module was developed. Each nurse in the ICU and float pool was approached to participate. There were 41 nurses eligible and 36 participated. Nurses were approached individually. A pretest was administered followed by a 10-minute educational presentation. After education a posttest comprised of the same questions as the pretest was administered. Nurses' knowledge of pain, agitation and delirium management improved after education as evidenced by test scores increasing from an average of 70% to 81%. The management support document was approved and incorporated into the ICU Policy Manual. The order set was taken before the critical care committee. Suggestions and edits were incorporated into the document. The order set was again taken to the critical care committee and at the time of this publication is awaiting final approval. The information related to this project was summarized in poster format and submitted for presentation at the annual Utah Nurse Practitioner Associations annual CME conference. It is recommended that the critical care committee implement the management support document and order form after final approval. Continuing education on the management of pain, agitation and delirium should be provided to staff members. The education module should be added to new employee education for ICU and Float Pool Nurses.