{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:19:00Z","timestamp":1787015940777,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008644","name":"Faculty of Medicine, McGill University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008644","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aims to assess the impact of a quality improvement initiative to increase assessments of pain, agitation, and iatrogenic withdrawal syndrome, on the use of sedative and analgesic medication in a pediatric intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective pre and post, observational, quality improvement study conducted in an 18\u2010bed medical\u2010surgical\u2010cardiac, tertiary intensive care unit. We included patients consecutively admitted from October 1 to March 31 (pre\u2010period 2015\u20102016, post\u2010period 2016\u20102017) who were mechanically ventilated beyond 48\u00a0hours. A multidisciplinary team, including a family advisor, implemented the following interventions using rapid \u201cPlan\u2010Do\u2010Study\u2010Act cycles:\u201d (a) standardized pain and sedation assessments, (b) standardized sedation goal setting, and (c) non\u2010pharmacological strategies to manage pain and agitation. We did not implement any specific sedation protocol. We used audit and feedback to reinforce change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The post\u2010intervention phase started once sedation scores were documented q12h for &gt;60% of patients. The groups (n\u00a0=\u00a045 per group) were similar regarding demographics, severity of illness, and mechanical ventilation duration, but different in length of intensive care stay. The cumulative dose of midazolam equivalent was significantly lower in the post\u2010intervention period (3.71 vs 2.65\u00a0mg\/kg\/mechanical ventilation day,\n                      <jats:italic>P\u00a0<\/jats:italic>\n                      =\u00a00.009, 95% CI: \u22121.12 (\u22121.89, \u22120.31)). Morphine equivalent usage went from 3.51 to 2.57\u00a0mg\/kg\/mechanical ventilation day (\n                      <jats:italic>P\u00a0<\/jats:italic>\n                      =\u00a00.066, 95% CI: \u22120.67 [\u22121.44, 0.05]). There were no significant pre\u2010post\u2010differences in the use of other sedative agents, rates of iatrogenic withdrawal syndrome or severe pain, nor medication cost.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of a multifaceted QI project was successful at increasing standardized assessments of pain and agitation, and was associated with a significant reduction in midazolam use. We also observed a decrease in morphine use without increasing rates of severe pain. Incidence of iatrogenic withdrawal syndrome and cost were unchanged.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.13591","type":"journal-article","created":{"date-parts":[[2019,1,21]],"date-time":"2019-01-21T09:05:43Z","timestamp":1548061543000},"page":"322-330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The impact of a quality improvement project to standardize pain, agitation, and withdrawal assessments on the use of morphine and midazolam in the Pediatric Intensive Care Unit"],"prefix":"10.1111","volume":"29","author":[{"given":"Lalida","family":"Kongkiattikul","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics McGill University Montreal Quebec Canada"},{"name":"Department of Pediatrics, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryse","family":"Dagenais","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ni","family":"Ruo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy McGill University Health Centre Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Fontela","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics McGill University Montreal Quebec Canada"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Di Genova","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4447-1977","authenticated-orcid":false,"given":"Samara","family":"Zavalkoff","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006428"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2971-3"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318181600d"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4344-1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002250"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000306"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12257"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000326"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12649"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000864"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2010624"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00620.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-1609"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2012.01.006"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e318203f495"},{"key":"e_1_2_9_17_1","unstructured":"The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper.Boston:Institute for Healthcare Improvement;2003.http:\/\/www.IHI.org. Accessed November 10 2017."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182783b72"},{"key":"e_1_2_9_19_1","volume-title":"The improvement guide: a practical approach to enhancing organizational performance","author":"Langley G","year":"2009"},{"key":"e_1_2_9_20_1","unstructured":"Health Quality Ontatio.Change concepts and ideas primer Ontario: Queen's Printer for Ontario;2013.http:\/\/www.hqontario.ca\/Portals\/0\/Documents\/qi\/qi-change-concepts-and-ideas-primer-en.pdf. 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