Late Breaking Abstracts
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)
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.
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
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