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Giovanni MISTRALETTI 1, 2, Michele UMBRELLO 2, Stefania ANANIA 2, Elisa ANDRIGHI 2, Alessandra DI CARLO 2, Federica MARTINETTI 2, Serena BARELLO 2, Giovanni SABBATINI 2, Paolo FORMENTI 2, Tommaso MARAFFI 1, Francesco MARRAZZO 1, Alessandra PALO 3, Giacomo BELLANI 4, Riccarda RUSSO 5, Silvia FRANCESCONI 6, Federico VALDAMBRINI 7, Marco CIGADA 8, Francesca RICCARDI 9, Egidio A. MOJA 10, Gaetano IAPICHINO 1,2 for the SedaICU investigators
1 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano; 2 U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo – Polo Universitario, Milano; 3 U.O. Anestesia e Rianimazione 1, I.R.C.C.S. San Matteo, Pavia; 4 Dipartimento di Scienze della Salute, Università degli Studi Milano Bicocca, A.O. San Gerardo, Monza (MI); 5 U.O.C. Rianimazione e Terapia Intensiva, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, Milano; 6 U.O.C. Anestesia e Rianimazione, A. O. Ospedale Civile di Desio (MI); 7 U.O. Anestesia e Rianimazione, A.O. Ospedale Civile di Legnano (MI); 8 U.O. Anestesia e Rianimazione, A.O. Fatebenefratelli e Oftalmico, Milano; 9 U.O. Anestesia e Rianimazione 2, I.R.C.C.S. San Matteo, Pavia; 10 Dipartimento di Scienze della Salute, Università degli Studi di Milano
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.