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Abstract PCCLB-47: A QUALITY IMPROVEMENT PROJECT TO STANDARDIZE PAIN, AGITATION, AND WITHDRAWAL ASSESSMENTS REDUCES USAGE OF MORPHINE AND MIDAZOLAM IN THE PEDIATRIC INTENSIVE CARE UNIT

Kongkiattikul, L.1; Dagenais, M.2; Ruo, N.3; Di Genova, T.2; Fontela, P.2,4; Zavalkoff, S.2

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 257
doi: 10.1097/01.pcc.0000538132.46292.07
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1Chulalongkorn University, Pediatrics, bangkok, Thailand

2McGill University, Pediatrics, Montreal, Canada

3McGill University Health Centre, Pharmacy, Montreal, Canada

4McGill University, Epidemiology- Biostatistics- and Occupational Health, Montreal, Canada

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Aims & Objectives:

To assess the impact of a quality improvement (QI) initiative to increase assessments of pain, agitation, and withdrawal on the use and cost of sedative and analgesic medication in a pediatric intensive care unit (PICU)

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Methods

Retrospective pre- and post- quality improvement study in eighteen-bed medical-surgical-cardiac tertiary PICU in an academic center. PICU patients (0 - 18 years) consecutively admitted from October 1, 2015 to March 31, 2016 (pre- period) and from October 1, 2016 to March 31, 2017 (post- period) who were mechanically ventilated (MV) for more than 48 hours. QI initiative developed by a multidisciplinary team, including a family advisor, and implemented using rapid “Plan-Do-Study-Act cycles”, that 1) standardized assessment of pain and sedation, 2) standardized sedation goal setting, and 3) implemented the use of non-pharmacological strategies to manage pain and sedation. No specific sedation protocol was implemented. We used audit and feedback to reinforce change.

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Results

Forty-five patients were included in each group. The groups were similar in age, weight, sex, PRISM III, and MV-day, but different in PICU stay (8 vs. 12 days, p 0.047). The cumulative dose of midazolam equivalent was significantly lower in the post-implementation period (3.71 vs 2.65 mg/kg/MV-day, p 0.009). There were no significant pre-post differences in the use of other sedative agents, rate of withdrawal, or medication cost

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Conclusions

A multi-faceted QI project to standardize formal assessments of pain and agitation resulted in a significant reduction in midazolam use. We also observed a decrease in morphine use without increasing rates of iatrogenic withdrawal syndrome

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies