TY - JOUR
T1 - Neurological assessment with validated tools in general ICU: Multicenter, randomized, before and after, pragmatic study to evaluate the effectiveness of an e-learning platform for continuous medical education
AU - Mistraletti, Giovanni
AU - Umbrello, Michele
AU - Anania, Stefania
AU - Andrighi, Elisa
AU - Di Carlo, Alessandra
AU - Marti Netti, Federica
AU - Barello, Serena
AU - Sabbati Ni, Giovanni
AU - Formenti, Paolo
AU - Maraffi, Tommaso
AU - Marrazzo, Francesco
AU - Palo, Alessandra
AU - Bellani, Giacomo
AU - Russo, Riccarda
AU - Francesconi, Silvia
AU - Valdambrini, Federico
AU - Cigada, Marco
AU - Riccardi, Francesca
AU - Moja, Egidio A.
AU - Iapichino, Gaetano
PY - 2017
Y1 - 2017
N2 - BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study. The eight participating centers were randomized in two groups, and received training at different times. The use of validated tools (Verbal Numeric Rating or Behavioral Pain Scale for pain; Richmond Agitation-Sedation Scale for agitation; Confusion Assessment Method for the ICU for delirium) was evaluated from clinical data recorded in medical charts during a week, with follow-up up to six months after the training. All the operators were invited to complete a questionnaire, at baseline and after the training. RESULTS : Among the 374 nurses and physicians involved, 140 (37.4%) completed at least one of the three courses. The assessment of pain (38.1 vs. 92.9%, P<0.01) and delirium (0 vs. 78.6%, P<0.01) using validated tools significantly increased after training. Observation in the follow-up showed further improvement in delirium monitoring, with no signs of extinction for pain and sedation/agitation measurements. CONCLUSIONS: This e-learning program shows encouraging effectiveness, and the increase in the use of validated tools for neurological monitoring in critically ill patients lasts over time.
AB - BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study. The eight participating centers were randomized in two groups, and received training at different times. The use of validated tools (Verbal Numeric Rating or Behavioral Pain Scale for pain; Richmond Agitation-Sedation Scale for agitation; Confusion Assessment Method for the ICU for delirium) was evaluated from clinical data recorded in medical charts during a week, with follow-up up to six months after the training. All the operators were invited to complete a questionnaire, at baseline and after the training. RESULTS : Among the 374 nurses and physicians involved, 140 (37.4%) completed at least one of the three courses. The assessment of pain (38.1 vs. 92.9%, P<0.01) and delirium (0 vs. 78.6%, P<0.01) using validated tools significantly increased after training. Observation in the follow-up showed further improvement in delirium monitoring, with no signs of extinction for pain and sedation/agitation measurements. CONCLUSIONS: This e-learning program shows encouraging effectiveness, and the increase in the use of validated tools for neurological monitoring in critically ill patients lasts over time.
KW - Adult
KW - Clinical Competence
KW - Computer-Assisted Instruction
KW - Controlled Before-After Studies
KW - Critical Care
KW - Delirium
KW - Education, Distance
KW - Education, Medical, Continuing
KW - Education, distance-Education, medical, continuing-Neurophysiological monitoring-Pain-Delirium.
KW - Female
KW - Humans
KW - Intensive Care Units
KW - Male
KW - Middle Aged
KW - Neurologic Examination
KW - Pain Measurement
KW - Adult
KW - Clinical Competence
KW - Computer-Assisted Instruction
KW - Controlled Before-After Studies
KW - Critical Care
KW - Delirium
KW - Education, Distance
KW - Education, Medical, Continuing
KW - Education, distance-Education, medical, continuing-Neurophysiological monitoring-Pain-Delirium.
KW - Female
KW - Humans
KW - Intensive Care Units
KW - Male
KW - Middle Aged
KW - Neurologic Examination
KW - Pain Measurement
UR - http://hdl.handle.net/10807/160348
U2 - 10.23736/S0375-9393.16.11103-4
DO - 10.23736/S0375-9393.16.11103-4
M3 - Article
SN - 0375-9393
VL - 83
SP - 145
EP - 154
JO - Minerva Anestesiologica
JF - Minerva Anestesiologica
ER -