What question did this study set out to answer?

To implement unit-wide sedation and delirium monitoring in accordance with clinical practice guidelines and assess nurse compliance, scoring accuracy, and organizational barriers across two medical centers.

June 1, 2005Critical Care Medicine

Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers*

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Authors

BPBrenda T. PunVanderbilt University SGSharon M. GordonIcahn School of Medicine at Mount Sinai JPJosh F. PetersonVanderbilt University Medical Center

Discussion

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Implication

Prospective cohort study demonstrates high monitoring compliance and rater accuracy in medical ICU patients, indicating feasible routine assessment adoption.

Key Points

To implement unit-wide sedation and delirium monitoring in accordance with clinical practice guidelines and assess nurse compliance, scoring accuracy, and organizational barriers across two medical centers.
Prospective observational cohort study conducted across two medical ICUs (Vanderbilt University Medical Center [VUMC] and York-VA community hospital) evaluating 711 patients across 4,163 ICU days over a 21-month period.
Unit-wide nursing documentation was updated to incorporate the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU), supported by a 20-minute introductory in-service and staged educational follow-ups for 64 nurses.
Compliance was tracked daily, and interrater agreement was assessed via daily random spot-checks comparing bedside nurses to reference raters across 40% of active nurses.
Nursing compliance was 94.4% (21,931 of 23,220 shifts) for RASS and 90% (7,323 of 8,166 shifts) for CAM-ICU at VUMC, compared to 99.7% (5,387 of 5,403 shifts) for RASS and 84% (1,571 of 1,871 shifts) for CAM-ICU at York-VA.
Interrater agreement between bedside nurses and reference raters yielded weighted-kappas for RASS of 0.89 (95% CI, 0.88 to 0.92) at VUMC and 0.77 (95% CI, 0.72 to 0.83) at York-VA.
CAM-ICU interrater agreement demonstrated kappas of 0.92 (95% CI, 0.90 to 0.94) at VUMC and 0.75 (95% CI, 0.68 to 0.81) at York-VA, with physician buy-in and clinical time constraints cited as the primary implementation barriers.

Cite This Study

Pun et al. (2005) studied this question.

synapsesocial.com/papers/6a7cdd3f0eb18aa3c85aec70 https://doi.org/10.1097/01.ccm.0000166867.78320.ac

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Implication

Prospective cohort study demonstrates high monitoring compliance and rater accuracy in medical ICU patients, indicating feasible routine assessment adoption.

Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers*

Discussion

Member takes

Implication

Key Points

Cite This Study

Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers*

Discussion

Member takes

Implication

Key Points

Cite This Study

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