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Abstract

Introduction: There is significant evidence regarding management of pain, agitation, and delirium in critically ill adults. Many barriers exist when translating research into practice to sustain measurable change. Methods: A multidisciplinary team was formed, including representatives from physician, nursing, pharmacy, respiratory therapy, information technology and quality disciplines. Workflows, order sets, and nurse-driven protocols were developed using the 2013 SCCM PAD guideline. Education on practice changes occurred in multidisciplinary learning sessions. Pre & post retrospective chart review of mechanically ventilated adults in a medical/surgical ICU was completed. Results: Patients are more likely to receive a nurse-directed sedation awakening trial after implementation (63 vs. 84%, p=0.005). While daily spontaneous breathing trial (SBT) assessment was standard pre-implementation, the coordination between the RN and RT for sedation and ventilator weaning has improved, with fewer patients receiving continuous infusions failing SBT as a result of over-sedation (39 vs. 29%, p=0.34). Standardized order sets facilitate a goal-directed, PRN-first approach to treating PAD symptoms, evidenced by an increase in patients receiving PRN benzodiazepines (38 vs. 59%, p=0.0001). Daily discussion of PAD assessment, goal, and interventions by the multidisciplinary team has improved coordination of care, as evidenced by a decrease in ICU and hospital LOS (4.79 vs. 4.24 days, p=0.02 and 13.96 vs. 12.82 days, p=0.03, respectively). Conclusions: Active participation of all disciplines in the planning phase created structure (defined roles, expectations, and workflows) and continued engagement of the team during implementation reinforced the practice changes. Multidisciplinary involvement with significant investment in planning and execution was essential in developing sustained practice change.