Abstract
The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. Therefore, the primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-guidelines in four ICUs. A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Proportion of nursing shifts with documented PAD-assessment (PAD-QIs) were retrieved from the electronical medical chart from included adult ICU patient-stays in four participating ICUs. Difference between the two time periods was assessed using generalised mixed model for repeated measures with unstructured covariance matrix, and presented as Beta (B) with 95% confidence interval (CI). Finally, 1049 ICU patient-stays were analysed; 534 in Before and 515 in Intervention. All three PAD-QIs significantly increased in Intervention by 31% (B=30.7, 95%CI [25.7 to 35.8]), 26% (B=25.8, 95%CI [19.4 to 32.2]) and 34% (B=33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively. A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, particularly as social distancing impacts clinical education and training and new approaches are needed.
Highlights
Health status of critically ill patients depends significantly on quality of care in the intensive care unit (ICU).[1,2] Optimisation of provided critical care according to evidence-based guidelines is of utmost importance.[1,2] Quality should be monitored and measured, and action must be taken if quality is found to be suboptimal.[2,3] Current practice for providing information and feedback about quality of care is mainly based on traditional communication methods such as international, national and local meetings, e-mails, web-pages and posters in the ICU
The impact on PAD are included within the scope of this study, because PAD-quality indicators (QI) are applicable to all patients, less influenced by specific diagnoses and circumstances, thereby clearly reflecting the impact of the intervention on adherence
All three PAD-QIs increased significantly in Intervention by 31% (B = 30.7, 95%confidence interval (CI) [25.7 to 35.8], 26% (B = 25.8, 95%CI [19.4 to 32.2]) and 34% (B = 33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively (Table 3)
Summary
Health status of critically ill patients depends significantly on quality of care in the intensive care unit (ICU).[1,2] Optimisation of provided critical care according to evidence-based guidelines is of utmost importance.[1,2] Quality should be monitored and measured, and action must be taken if quality is found to be suboptimal.[2,3] Current practice for providing information and feedback about quality of care is mainly based on traditional communication methods such as international, national and local meetings, e-mails, web-pages and posters in the ICU. The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. The primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-g uidelines in four ICUs. Methods: A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Conclusion: A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, as social distancing impacts clinical education and training and new approaches are needed
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