title: How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study.
abstract: OBJECTIVE
  Systematic monitoring of sedation, pain and delirium in the ICU is of paramount importance in delivering adequate patient care. While the use of systematic monitoring instruments is widely agreed upon, these tools are infrequently implemented into daily ICU care. The aim of this study is to compare the effectiveness of two different training strategies (training according to the local standard vs. modified extended method) on the implementation rate of scoring instruments on the ICU.
  
  
  METHODS
  In this experimental cohort study we analyzed the frequency of scoring on three surgical ICUs before and after training, and in a 1 year follow-up. A modified extended training included establishing a local support team helping to resolve immediate problems. In addition we evaluated the impact on patients' outcome.
  
  
  RESULTS
  ICUs trained by the modified extended method showed increased documentation rates of all scores per patient and day. In a 1 year follow-up, increased scoring rates for all scores were maintained. Scoring rates with training according to the local standard training protocol did not increase significantly. Implementation of delirium and pain monitoring were associated with a decrease in mortality [odds ratio (OR) 0.451; 95 % confidence interval (CI): 0.22-0.924, and, respectively, OR 0.348; 95 % CI: 0.140-0.863]. Monitoring had no significant influence on ventilation time or ICU length of stay.
  
  
  CONCLUSIONS
  A modified extended training strategy for ICU monitoring tools (sedation, pain, delirium) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome. However, these findings may have been biased by unmeasured confounders.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. finn.radtke@charite.de
authors.forename: Finn M
authors.initials: FM
authors.lastname: Radtke
authors.forename: Anja
authors.initials: A
authors.lastname: Heymann
authors.forename: Martin
authors.initials: M
authors.lastname: Franck
authors.forename: Friederike
authors.initials: F
authors.lastname: Maechler
authors.forename: Tanja
authors.initials: T
authors.lastname: Drews
authors.forename: Alawi
authors.initials: A
authors.lastname: Luetz
authors.forename: Irit
authors.initials: I
authors.lastname: Nachtigall
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D003693:Delirium / Q000517:prevention & control*; D016903:Drug Monitoring; D005260:Female; D005858:Germany; D006284:Health Plan Implementation; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D011446:Prospective Studies