Dataset Information

Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative.

ABSTRACT:

Introduction

As survival has improved in the Neonatal Intensive Care Unit (NICU), there has been a 10-fold increase in the proportion of infants requiring a tracheostomy. At our institution, we observed a wide variation in the duration of opioid use posttracheostomy from 6 to 148 days. We aimed to decrease the duration of opioid exposure in postoperative tracheostomy patients in the NICU from a baseline average of 24 days to 7 days by December 31, 2017.

Methods

We established a multidisciplinary team to develop change ideas to implement in 3 Plan-Do-Study-Act cycles that focused on enhanced care plan standardization and communication in patient care rounds with subsequent documentation in the medical record and the timely addition of dexmedetomidine to the postoperative care plan.

Results

Baseline population was from October 2014 to December 2016. The mean posttracheostomy opioid duration was 24.6 days (range, 6-148 days); neuromuscular blockade was 2.89 days (range, 0-9 days), and benzodiazepine exposure was 20.9 days (range, 1-114 days). Following our interventions, the mean duration of posttracheostomy opioid duration was 5.4 days (range, 4-21 days); neuromuscular blockade was 3.14 days (range, 1-5 days), benzodiazepine duration was 8.88 days (range, 4-25 days), and dexmedetomidine was 4.6 days (range, 0-32 days).

Conclusions

We utilized quality improvement methodology to standardize posttracheostomy management and demonstrate that we could significantly reduce the duration of opioid and benzodiazepine use after tracheostomy with the timely addition of dexmedetomidine, a structured written daily care plan, and clarification of roles and responsibilities.

SUBMITTER: Puthoff TD

PROVIDER: S-EPMC6221593 | biostudies-literature | 2018 Sep-Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative.

Puthoff Teresa D TD Shah Hevil H Slaughter Jonathan L JL Bapat Roopali R

Pediatric quality & safety 20180928 5

<h4>Introduction</h4>As survival has improved in the Neonatal Intensive Care Unit (NICU), there has been a 10-fold increase in the proportion of infants requiring a tracheostomy. At our institution, we observed a wide variation in the duration of opioid use posttracheostomy from 6 to 148 days. We aimed to decrease the duration of opioid exposure in postoperative tracheostomy patients in the NICU from a baseline average of 24 days to 7 days by December 31, 2017.<h4>Methods</h4>We established a mu ...[more]

PMID: 30584633

Similar Datasets

Project description:BackgroundWe aimed to examine current bedside analgesia/sedation (A/S) and pain assessment (PA) practices in Italian neonatal intensive care units (NICUs) in relation to the findings of an epidemiological European study and recently-introduced national guidelines.MethodsWe analyzed the Italian data from the EUROPAIN (EUROpean-Pain-Audit-In-Neonates) prospective observational study on A/S practices that involved 6680 newborns admitted to tertiary-level NICUs in 18 European countries. Demographics, type of assisted ventilation, type and mode of A/S administration and PA were analyzed. Multivariate linear regression models were used to identify factors predicting A/S and PA practices.ResultsFrom October 1st, 2012 to June 30th, 2013, thirty Italian NICUs gathered data on 422 newborn: 131 on invasive ventilation (IV); 150 on noninvasive ventilation (NIV); and 141 on spontaneous ventilation (SV). A/S was documented for 35.3% of all infants admitted (86.3% IV; 17.3% NIV; 7.1% SV [p = 0.0001]), and varied considerably between NICUs (as reported in other European countries). Strong analgesics were used in 32.5% of cases, sedatives in 10.2%, mild analgesics in 3.8%. Fentanyl was used in 78.6% of cases, morphine in 8.4%, neuromuscular blockers in 5.3%, midazolam in 22.1%. The performance of PA was documented in 67.5% of all newborn (85.5% IV; 67.3% NIV; 51.1% SV [p = 0.001]). Illness severity, type of ventilation, bedside PA, and number of NICU beds were all factors associated with A/S use on multivariate analysis, while gestational age ≤ 32 weeks, and type of ventilation and presence of a pain team were associated with PA.ConclusionsWe documented a generally widespread, but still highly variable use of A/S and PA at Italian NICUs, despite the diffusion of national guidelines. There is an urgent need to improve routine PA to enable customized pain and stress control (and prevention) in all infants.Trial registrationClinical Trials.gov # NCT01694745 .

Project description:Introduction: Tracheostomy-related adverse events are a global problem, requiring coordinated approach for care of tracheostomised patients. The concept of ‘collaborative tracheostomy care’ was introduced by Global Tracheostomy Collaborative in 2012. For successful post tracheostomy outcome, nursing care is vital. Data on their knowledge, attitude and skills regarding tracheostomy care including outcome of a structured interventional workshop is not available from India. Methods: A validated questionnaire with items pertaining to knowledge, attitude and skills regarding tracheostomy care was administered to nurses working in intensive care units and wards. Following this, a workshop was conducted for hands-on training in tracheostomy care using didactic lectures, videos and simulation-based training. The participants took a post-test immediately and after three months. Skills were assessed before and three months after the workshop using a checklist. Results: Among 386 participants who attended the pre-test and workshop, 285 (74.2%) underwent post-test immediately and three months later. Overall mean knowledge score (± SD) of the participants in pre-workshop was 6.8 ± 3.5, immediate post-test score was 15.9 ± 2.7 and three months later was 11.6 ± 3.5 (p < 0.001) out of total score 20. The baseline score was significantly higher among ICU nurses. Three months post workshop skill assessment revealed no statistically significant increase in the proportion of participants who performed skills related to suctioning procedure. Conclusion: Knowledge, attitude and practice regarding tracheostomy care is inadequate among nurses. Otolaryngologists-driven structured intervention with didactic lectures, videos and hands-on training can improve all three domains to positively impact outcomes in post tracheostomy patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03682-9.

Project description:BackgroundInternationally, one in three children develop delirium during their intensive care stay. International guidelines strongly recommend twice-daily screening for paediatric delirium using validated instruments. In the United Kingdom and Ireland, delirium was assessed only when suspected and few intensive care units (ICUs) used validated instruments.AimThis initiative aimed to implement a national screening strategy in 28 paediatric intensive care units (PICUs) across the United Kingdom and Ireland.Study designThe strategy involved: (a) rapidly reviewing, evaluating and ranking paediatric screening instruments for sensitivity, specificity, appropriateness and acceptability for national implementation; (b) achieving national agreement to implement a common tool; (c) creating and disseminating training materials while supporting training personnel in implementation; and (d) integrating delirium monitoring within the Paediatric Intensive Care Audit Network national database.ResultsAmong seven validated instruments, the top ranked options (from 1, most applicable to 7, least applicable) were the Cornell Assessment of Pediatric Delirium (average rank 1.25) and the Sophia Observation withdrawal Symptoms-Paediatric Delirium scale (1.5). Twenty-three units voted for their preferred choice of instrument: fifteen preferred the Cornell instrument, eight favoured the Sophia instrument and five did not respond. Training and implementation began in November 2021 and by March 2023 18 of the 28 units (64%) had successfully implemented screening. The national database began actively collecting delirium data from units in January 2024.ConclusionsThis initiative outlined critical steps for implementing and maintaining practice of delirium screening in PICUs. We provided clinicians with validated screening tools for detecting paediatric delirium and the necessary support and infrastructure to maintain screening. Embedding and sustaining screening is an ongoing challenge.Relevance to clinical practiceUndertaking routine screening for all intensive care patients from admission to discharge using validated instruments will provide earlier detection and treatment for critically ill children. This strategy offers a model for standardized and effective implementation in clinical practice in ICUs.

Dataset Information

Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative.

Introduction

Methods

Results

Conclusions

Publications

Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets