{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T21:26:58Z","timestamp":1760909218704,"version":"3.44.0"},"reference-count":28,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100009776","name":"McMaster University","doi-asserted-by":"publisher","award":["Department of Medicine Internal Career Research Aw"],"award-info":[{"award-number":["Department of Medicine Internal Career Research Aw"]}],"id":[{"id":"10.13039\/100009776","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2019,7,6]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In 2013, the Society of Critical Care Medicine published a revised version of the ICU Pain, Agitation, and Delirium (PAD) guidelines. Immobility and sleep were subsequently added in 2018. Despite the well-established advantages of implementing these guidelines, adoption and adherence remain suboptimal. This is especially true in community settings, where PAD assessment is performed less often, and the implementation of PAD guidelines has not yet been studied. The purpose of this prospective interventional study is to evaluate the effect of a multifaceted nurse engagement intervention on PAD assessment in a community intensive care unit (ICU).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients admitted to our community ICU for over 24\u2009hours were included. A 20-week baseline audit was performed, followed by the intervention, and a 20-week postintervention audit. The intervention consisted of a survey, focus groups and education sessions. Primary outcomes included rates of daily PAD assessment using validated tools.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were improvements in the number of patients with at least one assessment per day of pain (67.5%\u2009vs 59.3%, p=0.04), agitation (93.1%\u2009vs 78.7%, p&lt;0.001) and delirium (54.2%\u2009vs 39.4%, p&lt;0.001), and the number of patients with target Richmond Agitation-Sedation Scale ordered (63.1%\u2009vs 46.8%, p=0.002). There was a decrease in the rate of physical restraint use (10.0%\u2009vs 30.9%, p&lt;0.001) and no change in self-extubation rate (0.9%\u2009vs 2.5%, p=0.2).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The implementation of a multifaceted nurse engagement intervention has the potential to improve rates of PAD assessment in community ICUs. Screening rates in our ICU remain suboptimal despite these improvements. We plan to implement multidisciplinary interventions targeting physicians, nurses and families to close the observed care gap.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2018-000421","type":"journal-article","created":{"date-parts":[[2019,8,6]],"date-time":"2019-08-06T06:35:29Z","timestamp":1565073329000},"page":"e000421","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of a nurse engagement intervention on pain, agitation and delirium assessment in a community intensive care unit"],"prefix":"10.1136","volume":"8","author":[{"given":"Carolyn M","family":"Tan","sequence":"first","affiliation":[{"name":"Niagara Regional Campus, Michael G. 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DeGroote School of Medicine, McMaster University, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Ross","sequence":"additional","affiliation":[{"name":"Medicine, Niagara Health\u2014Saint Catharines Site, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramez","family":"Maximous","sequence":"additional","affiliation":[{"name":"Medicine, Niagara Health\u2014Saint Catharines Site, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Yung","sequence":"additional","affiliation":[{"name":"Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Marshall","sequence":"additional","affiliation":[{"name":"Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitra","family":"Fleming","sequence":"additional","affiliation":[{"name":"Pharmacy, Niagara Health\u2014Saint Catharines Site, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madelyn","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1935-0791","authenticated-orcid":false,"given":"Jennifer LY","family":"Tsang","sequence":"additional","affiliation":[{"name":"Niagara Regional Campus, Michael G. 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