Patient comfort in the intensive care unit: a multicentre, binational point prevalence study of analgesia, sedation and delirium management.
OBJECTIVE
To measure the prevalence of assessment and management practices for analgesia, sedation and delirium in patients in Australian and New Zealand intensive care units.


METHODS
We developed survey items from a modified Delphi panel and included them in a binational, point prevalence study. We used a standard case report form to capture retrospective patient data on management of analgesia, sedation and delirium at the end of a 4-hour period on the study day. Other data were collected during independent assessment of patient status and medication requirements.


RESULTS
Data were collected on 569 patients in 41 ICUs. Pain assessment was documented in the 4 hours before study observation in 46% of patients. Of 319 assessable patients, 16% had moderate pain and 6% had severe pain. Routine sedation assessment using a scale was recorded in 63% of intubated and ventilated patients. When assessed, 38% were alert and calm, or drowsy and rousable, 22% were lightly to moderately sedated, 31% were deeply sedated (66% of these had a documented indication), and 9% were agitated or restless. Sedatives were titrated to a target level in 42% of patients. Routine assessment of delirium occurred in 3%, and at study assessment 9% had delirium. Wrist or arm restraints were used for 7% of patients.


CONCLUSIONS
Only two-thirds of sedated patients had their sedation levels formally assessed, half had pain assessed and very few had formal assessment of delirium. Our description of current practices, and other observational data, may help in planning further research in this area.
Faculty of Health, University of Technology, Sydney, NSW, Australia. Doug.Elliott@uts.edu.au
Doug
D
Elliott
Leanne M
LM
Aitken
Tracey K
TK
Bucknall
Ian M
IM
Seppelt
Steven A R
SA
Webb
Leonie
L
Weisbrodt
Sharon
S
McKinley
D000368:Aged; D000698:Analgesia / Q000592:standards*; D016292:Procedural Sedation / Q000592:standards*; D003430:Cross-Sectional Studies; D003693:Delirium / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D010146:Pain / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D015995:Prevalence; D016896:Treatment Outcome