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Feasibility of a Nurse-Managed Pain, Agitation, and Delirium Protocol in the Surgical Intensive Care Unit

机译：在外科重症监护室中由护士管理的疼痛，躁动和Deli妄协议的可行性

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BACKGROUND Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed. Protocol adherence was evaluated for interventions implemented after a nursing assessment. Patients were further divided into 2 groups on the basis of adherence, and achievement of pain and sedation goals was evaluated between groups. RESULTS Data on 41 patients were included. Of the 603 pain assessments, 422 (70.0%) led to an intervention adherent to the protocol. Of the 249 sedation assessments, 192 (77.1%) led to an adherent intervention. Among patients with 75% or greater adherent pain interventions, all interventions met pain goals with significantly less fentanyl than that used in interventions that did not meet goals. Despite 75% or greater adherence with interventions for sedation assessments, only 8.7% of the interventions met sedation goals. CONCLUSIONs A nurse-managed pain, agitation, and delirium protocol can be feasibly implemented in a surgical intensive care unit.
机译：背景技术重症监护医学会指南建议在重症监护病房使用疼痛，躁动和ir妄方案。尚未对手术重症监护室中此类方案的护士管理的可行性进行很好的评估。目的通过使用疼痛，镇静和del妄方案评估患者的依从性药物干预百分比。方法回顾性分析2013年1月至2013年9月入院的外科重症监护病房的所有成年患者的数据，这些患者至少使用疼痛，镇静和ir妄方案进行了一次评估。在护理评估后，对实施方案的依从性进行了评估。根据依从性将患者进一步分为2组，并评估各组之间疼痛和镇静目标的达成情况。结果包括41例患者的数据。在603次疼痛评估中，有422次（70.0％）导致遵循该方案的干预措施。在249次镇静评估中，有192次（77.1％）导致了依从性干预。在有75％或更高的依从性疼痛干预措施的患者中，所有干预措施均达到镇痛目标，但芬太尼的含量明显低于未达到目标的干预措施。尽管坚持镇静评估的干预措施达到或超过75％，但只有8.7％的干预措施达到了镇静目标。结论可以在外科重症监护室切实实施护士管理的疼痛，躁动和ir妄方案。

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