Pain, Agitation & Delirium (2013) Immobility & Sleep (2018) Catherine Jones Practice Educator GICU October 2018
|
|
- Charlotte Cain
- 5 years ago
- Views:
Transcription
1 Pain, Agitation & Delirium (2013) Immobility & Sleep (2018) Catherine Jones Practice Educator GICU October
2 Plan for session Why Pain Agitation & Delirium are important considerations in critical care population? Describe assessment tools available for Pain CPOT Agitation/sedation RASS Delirium CAM-ICU Guidelines & Bundle(s) Specific management for PAD (IS). 2
3 WHY IS THIS IMPORTANT? 3
4 Pain Pain is a common memory for most ICU patients (Reade & Finfer, 2014) Critical care population may not be able to self-report their experience of pain so it may go undetected Consequences of uncontrolled pain Immunosuppression PTSD Delayed wound healing 4
5 Agitation & Sedation Early mechanical ventilation required deep sedation due to problems with patient synchrony & comfort Advances in vent technology & medications means this isn t always necessary now But common feature of ICU patients as they experience a frightening & stressful stimuli during their stay with us 5
6 Delirium Affects up to 80% of mechanically ventilated adult ICU patients Acute onset of cerebral dysfunction Characterised by Change/fluctuation from baseline mental status Inattention Either disorganised thinking or altered level of consciousness Barr(2013) 6
7 Barr(2013) 7
8 8
9 Causes & Interactions of PAD N Engl J Med 2014; 370:
10 ASSESSMENT TOOLS 10
11 Assessing pain at SGH: 1. Self Report (gold standard) Pain Assessment chart used by whole trust for patients able to tell us if it hurts 2. Continuous Pain Observation Tool (CPOT) Adult ICU patients who are unable to self report 3. Abbey Pain Scale Pain assessment chart used in trust for patients unable to self report such as LD 11
12 12
13 13
14 14
15 15
16 16
17 Assessing agitation at SGH: Richmond Agitation Sedation Score 17
18 Assessing delirium at SGH: Confusion assessment Method for the ICU CAM-ICU 18
19
20 Valeria Page cam icu assessment: tch?v=6wyj0zl7vki 3mins 30 secs 20
21 GUIDELINES & BUNDLES 21
22 PAD guidelines (Barr 2013) 22
23
24 PADIS guidelines (Devlin et al 2018) 24
25 ABCDEF Bundle 25
26 ecash: 26 Vincent et al (2016) Comfort & patient centred care without excessive sedation: the ecash concept Intensive care Medicine
27 SPECIFIC MANAGEMENT FOR PAD (IS). 27
28 Pain management in ICU: Consistent approach to pain assessment Analgesia first sedation or a analgesia based sedation IV opioids 1 st line BUT important considerations include: Sedation, Delirium, Resp despression, Ileus, immunosuppression SO.. Think about adjuncts to spare/minimise opioid use IV PARACETAMOL, low dose ketamine, Massage, music Gabapentin, Carbamazepine, Pregablin neuropathic pain Remember reduced morphine clearance in renal failure -?switch to Fentanyl Relative potency to morphine 28
29 Agitation management: Agitation is a feature of ICU admission Traditionally managed with deep sedation Paradigm shift to light sedation.. Titrated to Sedation Score Daily Sedation Hold (unless contraindicated) Sedation strategy that avoids benzo: Alfentenyl Propofol Dexdor Lorazepam Midazolam Haloperidol 29
30 Delirium management: Routine screening for delirium CAM-ICU Reduce modifiable risk factors Hearing aids & spectacles easy fix & quick win Re-orientation (Clocks), Cognitive stimulation Improve Sleep Increase wakefulness (reduce sedation) Early rehab/mobilsation ABCDEF Bundle Pharmacology? Restraint? 30
31 31
32 Immobility Management Early Mobilisation & rehabilitation Even on intubated patients! In bed activities eg Motomed 32
33 33
34 Sleep Management Ear Plugs & Eye Shades Relaxing music Reduction in night time light, noise, intervention? Melatonin,?dexdor 34
35 35
36 Summary Pain Agitation Delirium Immobility Sleep Disruption CAN ALL BE IMPROVED BY COMMITTED, HOLISTIC, PATIENT FOCUSED CARE 36
North Wales Critical Care Network
North Wales Critical Care Network SEDATION GUIDELINES FOR ADULTS IN CRITICAL CARE Approved 6.9.12 1 Sedation guidelines for intensive care Betsi Cadwaladr University Health Board (Adapted from guidelines
More informationDelirium in Critical Care. Recognition, Management, Research tasters. Dr Valerie Page Watford General Hospital
Delirium in Critical Care. Recognition, Management, Research tasters Dr Valerie Page Watford General Hospital What does it look like? Diagnosing delirium CAM-ICU CAM-ICU Feature 1: Acute onset of mental
More informationCritical Care Strategic Clinical Network Provincial ICU Delirium Framework
Pain assessed and documentation using validated tool (CPOT and NRS) Assess and document q4h and prn 100% of patients assessed for pain and documented q4h A: Assess, Prevent & Manage Pain Self Reporting
More informationCan Goal Directed Sedation Improve Outcomes?
Can Goal Directed Sedation Improve Outcomes? Yahya SHEHABI, FANZCA, FCICM, EMBA Professor and Program Director Critical care Monash Health and Monash University - Melbourne School of Medicine, University
More informationManaging Delirium: The best way to achieve clarity (of mind) Tim Walsh. Professor of Critical Care, Edinburgh University
Managing Delirium: The best way to achieve clarity (of mind) Tim Walsh Professor of Critical Care, Edinburgh University Lecture Plan: a route to clarity What is delirium? Why is delirium important? Step
More informationComfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know
Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Sandy Staveski RN, PhD, CPNP-AC/PC, CNS; Cincinnati Children s Hospital Medical Center Mary Rummell,
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationClinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit January 2013 Volume 41 Number 1 Society of Critical Care Medicine 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時,
More informationSedation and Delirium Questions
Sedation and Delirium Questions TLC Curriculum William J. Ehlenbach, MD MSc Assistant Professor of Medicine Pulmonary & Critical Care Medicine Question 1 Deep sedation in ventilated critically patients
More informationComfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know
Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Sandy Staveski RN, MS, CPNP-AC/PC, CNS, CCRN Pediatric Intensive Care Nurse Practitioner Lucile Packard
More informationBPG 06: Sedation. Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects.
Statement of Best Practice BPG 06: Sedation Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects. 1: Introduction Indication for sedation will
More informationNYSPFP HIIN: VAE/Delirium Prevention. Operationalizing the Pain, Agitation and Delirium Assessments
NYSPFP HIIN: VAE/Delirium Prevention Operationalizing the Pain, Agitation and Delirium Assessments March 28, 2017 1 Agenda Topic Welcome and Introductions A Guide for Success: Implementing the Confusion
More informationKEY REFERENCES laying the foundation for A of ABCDEF bundle
KEY REFERENCES laying the foundation for A of ABCDEF bundle Puntillo K. Am J Crit Care (Response Procedural Pain) 2001;10:238-251 Payen J. Crit Care Med (Behavioral Pain Scale) 2001;29:2258-2263 Gelinas
More informationPHYSICIAN'S ORDERS Mark in for desired orders. If is blank, order is inactive. VENTILATOR SEDATION / ANALGESIC / DELIRIUM ORDER
Nursing Daily awakenings PHYSICIAN'S ORDERS Mark in for desired orders. If is blank, order is inactive. VENTILATOR SEDATION / ANALGESIC / DELIRIUM ORDER Do not perform daily awakenings: Rationale: Daily
More informationImproving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice
Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice Christine M. Groth, Pharm.D., BCCCP NYS Partnership for Patients September
More informationICU Liberation for the Pharmacist. A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center
ICU Liberation for the Pharmacist A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center Disclosure No conflicts of interest to disclose Objectives o Outline the elements of
More informationSleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc.
Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc. Conflicts of interest Member, SCCM Pain, Agitation and Delirium guidelines writing committee Vice-chair, SCCM Pain, Agitation, Delirium,
More informationCollaborative Regional Benchmarking Group (North of England, North Yorkshire & Humber and West Yorkshire)
Best Practice Guidance Sedation These recommendations are bound by the current evidence and best practice at the time of writing and so will be subject to change as further developments are made in this
More informationTest your Knowledge: Recognizing Delirium
The Ottawa Hospital Name: Unit: Profession: RN RPN PT OT SW Other Note: Each question has only one correct answer. 1. If a patient is identified as being at high risk for developing delirium, his/her mental
More information9/28/2016. Sedation Strategies in the ICU. Outline. ICU sedation. Recent clinical practice guidelines Top 10 myths A practical approach
Sedation Strategies in the ICU UW Medicine EMS and Trauma Conference Seattle, Washington September 26 th, 2016 C. Terri Hough, MD MSc Associate Professor of Medicine Division of Pulmonary and Critical
More informationKendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba
Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba Outline Sedation in ICU Purpose/Goals Common Drugs Sedation delivery strategies Mobility in the ICU Weakness with critical illness
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationDelirium in the ICU: Prevention and Treatment. Delirium Defined Officially. Delirium: Really Defined. S. Andrew Josephson, MD
Delirium in the ICU: Prevention and Treatment S. Andrew Josephson, MD Director, Neurohospitalist Service Medical Director, Inpatient Neurology June 2, 2011 Delirium Defined Officially (DSM-IV-TR) criteria
More informationImplementing the 2013 PAD Guidelines
1 of 20 8/11/2013 10:25 PM www.medscape.com Implementing the 2013 PAD Guidelines Top Ten Points to Consider Brenda T. Pun, MSN, RN, ACNP, Michele C. Balas, PhD, RN, APRN-NP, CCRN, Judy Davidson, DNP, RN,
More informationInteraction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico
Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Balance is not that easy! Weaning Weaning is the liberation of a patient from
More informationPRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist
PRESCRIBING PRACTICE IN DELIRIUM John Warburton Critical Care Pharmacist Learning outcomes Modifiable medication risk factors for delirium An appreciation of contributing factors modifiable with medicines
More informationFighting the Fog A Collaborative Approach to Decreasing ICU Delirium
Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium Kimberly Scherr NP Jennifer Barker RN Misericordia Hospital ICU Edmonton, AB CACCN Dynamics Sept 21, 2014 Delirium Delirium is an acute
More informationOverview of Presentation. Delirium Definition. Assessing & Managing ICU Delirium: What is the Evidence?
Assessing & Managing ICU Delirium: What is the Evidence? Dale Needham, MD, PhD Professor Pulmonary & Critical Care Medicine, and Physical Medicine & Rehabilitation Medical Director, Critical Care Physical
More informationVentilator-Associated Event Prevention: Innovations
Ventilator-Associated Event Prevention: Innovations Michael J. Apostolakos, MD Professor of Medicine Director, Adult Critical Care University of Rochester Mobility/Sedation in the ICU Old teaching: Keep
More informationDoug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network
Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network A paradigm shift (or revolutionary science) is, a change in the basic assumptions, or paradigms, within the ruling theory
More informationANALGESIA AND SEDATION IN MECHANICAL VENTILATION
ANALGESIA AND SEDATION IN MECHANICAL VENTILATION Erik Stoltenberg, MD Abbott Northwestern Hospital February 27, 2018 DISCLOSURE Nothing to disclose AllinaHealthSystem 1 OBJECTIVE To apply knowledge of
More informationManagement of Delirium in the ICU. Yahya Shehabi
Management of Delirium in the ICU Yahya Shehabi Hello! Doctor, your patient is CAM + ve Good morning Dr, Am one of the RC, Just examined Mr XXX he is CAM +ve Positive what? Sir replied RC: I meant he is
More informationDisclosure. Hospira Pharmaceuticals. Unrestricted research funding Honoraria for CME education administered via France Foundation
Disclosure Hospira Pharmaceuticals Unrestricted research funding Honoraria for CME education administered via France Foundation Economics in Sedation: Responsible Use of the ICU Budget John W. Devlin,
More informationJennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University
Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University Hospital Objectives Review pertinent pharmacotherapy common
More informationSarah V. Cogle, PharmD, BCCCP Assistant Clinical Professor Auburn University Harrison School of Pharmacy Auburn, AL ALSHP Annual Clinical Meeting
Sarah V. Cogle, PharmD, BCCCP Assistant Clinical Professor Auburn University Harrison School of Pharmacy Auburn, AL ALSHP Annual Clinical Meeting 2018 I have no actual or potential conflict of interest
More informationDELIRIUM IN ICU: Prevention and Management. Milind Baldi
DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Page VJ, Casarin A, Ely EW, et al. Evaluation
More informationPOST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier
POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures,
More informationEarly Goal Directed Sedation In Critically Ill Patients
Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationSedation and delirium- drugs and clinical management
Sedation and delirium- drugs and clinical management Shannon S. Carson, MD Associate Professor and Chief Division of Pulmonary and Critical Care Medicine University of North Carolina Probability of transitioning
More informationSedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe )
PROTOCOL Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe ) Page 1 of 6 Scope: Population: Outcome: Critical care clinicians and providers. All ICU patients intubated or mechanically
More informationSedation of the Critically Ill Patient
Buffalo theory of sedation It s a well known fact that a herd of buffalo can only move as fast as the slowest buffalo. And when the herd is hunted, it s the slowest and weakest ones at the back that are
More informationDelirium. Quick reference guide. Issue date: July Diagnosis, prevention and management
Issue date: July 2010 Delirium Diagnosis, prevention and management Developed by the National Clinical Guideline Centre for Acute and Chronic Conditions About this booklet This is a quick reference guide
More informationICU Delirium in Infants & Children: Cause for Concern or False Alarm. Objectives
ICU Delirium in Infants & Children: Cause for Concern or False Alarm Peter (Pete) N. Johnson, Pharm.D., BCPS, BCPPS, FPPAG Associate Professor of Pharmacy Practice University of Oklahoma College of Pharmacy
More informationExecutive Sponsorship of Delirium Initiatives Lessons from ICU Liberation
Executive Sponsorship of Delirium Initiatives Lessons from ICU Liberation J. Matthew Aldrich, MD Co-Chair, SCCM ICU Liberation Committee Associate Professor Medical Director, Critical Care Medicine UCSF
More informationAnalgesia, Sedation and Delirium The Latest Evidence in Assessment & Treatment
Analgesia, Sedation and Delirium The Latest Evidence in Assessment & Treatment Julie Miller, RN, BSN, CCRN How many of you routinely assess for delirium in your patients? 2013 SCCM Guidelines Pain Recommend
More informationICU LIBERATION: IMPLEMENTING THE ABCDEF BUNDLE AND IMPROVING THE LIVES OF ICU PATIENTS
ICU LIBERATION: IMPLEMENTING THE ABCDEF BUNDLE AND IMPROVING THE LIVES OF ICU PATIENTS J. MATTHEW ALDRICH, MD ASSOCIATE CLINICAL PROFESSOR OF ANESTHESIA AND PERIOPERATIVE CARE UNIVERSITY OF CALIFORNIA
More informationWhat is delirium? not know they are in hospital. think they can see animals who are about to attack them. think they have been kidnapped
It is common for patients who are critically ill to experience delirium, usually called ICU delirium. This information sheet will explain what it is, what causes it, and what might help patients with delirium.
More informationICU Updates: Delirium in Hospitalized Patients
Outline James A. Frank, MD Associate Professor Pulmonary and Critical Care UCSF Dept. of Medicine Director, MICU San Francisco VAMC ICU Updates: in Hospitalized Patients Recognizing and preventing delirium
More informationKEY REFERENCES Laying the foundation for D of ABCDEF bundle
KEY REFERENCES Laying the foundation for D of ABCDEF bundle Ely E. JAMA. 2001;286:2703-2710 (CAM-ICU) Bergeron N. Intensive Care Med. 2001;27:859-864 (ICDSC) Dubois M. Intensive Care Med. 2001;27:1297-1304
More informationJuliana Barr, MD, FCCM
Juliana Barr, MD, FCCM Staff Anesthesiologist and Intensivist, VA Palo Alto Health Care System Associate Professor, Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine
More informationAnalgosedation: What Strategy is Best? Guillermo Castorena MD Fundación Clínica Médica Sur México
Analgosedation: What Strategy is Best? Guillermo Castorena MD Fundación Clínica Médica Sur México The facts Despite the efforts to optimize sedation and comfort of ICU s patients: More than 50% of patients
More informationDelirium. Dr. Lesley Wiesenfeld. Deputy Psychiatrist in Chief, Mount Sinai Hospital. Dr. Carole Cohen
Delirium Dr. Lesley Wiesenfeld Deputy Psychiatrist in Chief, Mount Sinai Hospital Dr. Carole Cohen Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre Case Study Mrs B
More informationICU Updates: Delirium in Hospitalized Patients
ICU Updates: Delirium in Hospitalized Patients James A. Frank, MD Associate Professor Pulmonary and Critical Care UCSF Dept. of Medicine Director, MICU San Francisco VAMC Recognizing and preventing delirium
More informationSEDATION, AGITATION, DELIRIUM Daniel Lollar, MD
SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD OVERVIEW Correctable causes of agitation Pain assessment opioids Agitation assessment BZNs, propofol, precedex comparisons Delirium haldol, antipsychotics
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationDelirium Screening and Prevention Faculty Disclosures
Delirium Screening and Prevention Faculty Disclosures I have nothing to disclose Kathleen Puntillo RN, PhD, FAAN, FCCM Professor Emeritus School of Nursing, UCSF Objectives Discuss prevalence, risk factors
More informationDelirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018
Three most common cognitive problems in adults 1. (acute confusion) 2. Dementia 3. Depression These problems often occur together Can you think of common stimuli for each? 1 1 State of temporary but acute
More informationCanadian Practices for the Treatment of Delirium. Lisa Burry, BScPharm, PharmD
Canadian Practices for the Treatment of Delirium Lisa Burry, BScPharm, PharmD Disclosures & Acknowledgements Conflicts of interest: None Acknowledgements: our patients and the clinical staff that supported
More informationDelirium Screening and Prevention. Faculty Disclosures. Objectives 5/13/2014. I have nothing to disclose
Delirium Screening and Prevention Kathleen Puntillo RN, PhD, FAAN, FCCM Professor Emeritus School of Nursing, UCSF Faculty Disclosures I have nothing to disclose Objectives Discuss prevalence, risk factors
More informationDelirium in the hospitalized patient
Delirium in the hospitalized patient Jennifer A. Tarin, M.D. Department of Hospital Medicine Geriatric Health Safety Chair Colorado Permanente Medical Group UCLA Reynolds Scholar Delirium Preventing delirium
More informationExtreme arousal, irritability, excess motor activity driven by internal sense of discomfort such as disease, pain, anxiety and delirium
Agitated patient in ICUapproach & management Arjun Srinivasan Agitation Extreme arousal, irritability, excess motor activity driven by internal sense of discomfort such as disease, pain, anxiety and delirium
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationKICU Spontaneous Awakening Trial (SAT) Questionnaire
KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director
More informationSedation in The ICU: The Biological Cost of the Depression of Consciousness
Sedation in The ICU: The Biological Cost of the Depression of Consciousness Michael Ramsay MD FRCA Chairman Department of Anesthesia Baylor University Medical Center Professor Texas A&M University Clinical
More informationPalliative Care and Delirium. Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care
Palliative Care and Delirium Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care Disclosures I have no personal or professional financial relationships
More informationABCs of ICU Delirium Marian Maxwell, Pharm.D., BCCCP January 6, 2018
ABCs of ICU Delirium Marian Maxwell, Pharm.D., BCCCP January 6, 2018 Disclosures I do not have any financial/non-financial relationships to disclose. Learning Objectives Define delirium and discuss the
More informationDelirium Assessment and management in relation to falls risk in hospital
Delirium Assessment and management in relation to falls risk in hospital A house call - Mrs JM 95-year-old lady Normally cognitively intact Multiple medical problems, including falls Housebound, mobile
More informationWAKE UP AND TREAT DELIRIUM : PITFALLS OF THE PAD GUIDELINES
WAKE UP AND TREAT DELIRIUM : PITFALLS OF THE PAD GUIDELINES Tudy Hodgman, Pharm D, FCCM, BCPS The goal of this discussion will be to review the literature published since the PAD guidelines were released
More informationDelirium. Assessment and Management
Delirium Assessment and Management Goals and Objectives Participants will: 1. be able to recognize and diagnose the syndrome of delirium. 2. understand the causes of delirium. 3. become knowledgeable about
More informationSimple measures to promote sleep can reduce delirium in intensive care patients
Delirium can lead to short- and long-term confusion and memory problems Simple measures to promote sleep can reduce delirium in intensive care patients Baltimore, Maryland, USA (February 20, 2013) - A
More informationPart A of this guideline covers the structured assessment and management of pain and sedation.
Adult Critical Care Pain, Agitation and Delirium (PAD) Guideline ITAPS CMG: Adult Critical Care May 2018 Trust Ref: C24/2018 1. Introduction & Scope The management of analgesia and sedation is pivotal
More informationDELIRIUM DR S A R A H A B D E L A T I S A S DR H I L A R Y W O L F E N D A L E S T 4
DELIRIUM DR S A R A H A B D E L A T I S A S DR H I L A R Y W O L F E N D A L E S T 4 AIMS Define delirium Identify: Different types of delirium Risk factors Preventable causes Screening tools Management
More informationDo benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry
Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry Delirium in the ICU Occurs in up to 85% of MICU/SICU MV patients 20-50% of lower severity ICU patients develop delirium Hypoactive
More information5 older patients become delirious every minute
Management of Delirium: Nonpharmacologic and Pharmacologic Approaches Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationPain & Sedation Management in PICU. Marut Chantra, M.D.
Pain & Sedation Management in PICU Marut Chantra, M.D. Pain Diseases Trauma Procedures Rogers Textbook of Pediatric Intensive Care, 5 th ed, 2015 Emotional Distress Separation from parents Unfamiliar
More informationSupporting Last Days of Life Symptom Control Medication Guidance: Algorithm. Agitation & Anxiety
Agitation & Anxiety (Exclude or treat REVERSIBLE causes*) Patient is anxious / frightened, but lucid Patient is confused, agitated and / or hallucinating MIDAZOLAM 2.5-5mg s/c (Max total 24 hour dose of
More informationImproving Pain Management: The UCSF Journey
Improving Pain Management: The UCSF Journey April 2014 Adam Cooper, RN, MSN Clinical Nurse Educator Institute for Nursing Excellence UCSF Medical Center After this discussion, learners will be able to:
More informationPain Assessment. Cathy Murray MSN RN OCNS-C Clinical Nurse Specialist December /21/2014 1
Pain Assessment Cathy Murray MSN RN OCNS-C Clinical Nurse Specialist December 2013 3/21/2014 1 Objectives Articulate pain assessment strategies. Identify appropriate assessment tools for patients. Describe
More informationDrug induced delirium
Drug induced delirium Knut Erik Hovda, MD, PhD, FACMT, FEAPCCT The Norwegian CBRNe Centre of Medicine Department of Acute Medicine Oslo University hospital Content 1. Introduction 2. Risk factors 3. Prevalence
More informationPathway to Pain Control
Pathway to Pain Control Assessing, Preventing, and Managing Pain in the Intensive Care Unit Caitlin S. Brown, PharmD Brianne M. Ritchie, PharmD, MBA, BCCCP, BCPS Pharmacy Grand Rounds November 21, 2017
More information7/6/ ANNUAL MEETING BRINGING THE ABC(DEF) S TO THE ICU ICU TRIAD DISCLOSURE ICU TRIAD SEDATION AND ANALGESIA OBJECTIVES
ICU TRIAD BRINGING THE ABC(DEF) S TO THE ICU GINA RIGGI, PHARMD, BCPS, BCCCP CLINICAL HOSPITAL PHARMACIST- TRAUMA INTENSIVE CARE UNIT JACKSON MEMORIAL HOSPITAL MIAMI, FLORIDA Figure 1. Reade M and Finfer
More informationSedation and Analgesia in the Critically Ill
12th Congress of the World Federation of Societies of Intensive and Critical Care Medicine August 29 (Sat.) September 1 (Tue.), 2015 COEX, Seoul, Korea ONE STEP FURTHER: THE PURSUIT OF EXCELLENCE IN CRITICAL
More informationDelirium Prevalence in Acute Care Hospitalized Patients
Delirium Prevalence in Acute Care Hospitalized Patients Linda Cason DNP, CNS, RN-BC, NE-BC, CNRN Brittany Farmer MSN, CNS, ACCNS-AG, CCRN Kim Salee MSN, RN, AGCNS-BC, CWOCN Abby Schmitt MSN, RN-BC Objectives
More informationGeneral Anesthesia. Mohamed A. Yaseen
General Anesthesia Mohamed A. Yaseen M.S,c Surgery Before Anesthesia General Anesthesia ( GA ) Drug induced absence of perception of all sensation allowing surgery or other painful procedure to be carried
More informationDelirium Screening Tools: Just- In- Time Education and Evaluation Using the EMR
Delirium Screening Tools: Just- In- Time Education and Evaluation Using the EMR Implementation of an EMR based protocol for detection of delirium in elderly Medical and palliative care patients Parul Goyal,
More informationAnalgesia in patients with impaired renal function Formulary Guidance
Analgesia in patients with impaired renal function Formulary Guidance Approved by Trust D&TC: January 2010 Revised March 2017 Contents Paragraph Page 1 Aim 4 2 Introduction 4 3 Assessment of renal function
More informationSleep deprivation. Delirium
acknowledgements Colleagues at BRI Delirium project group- Sam Heaton SSN (light therapy), Bex Russell Acting sister (this is me), Louise Sherratt- SSN (music therapy), Lucy Alford (RN) diaries) CIS team
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More informationDelirium assessment and management. Dr Kim Jeffs Northern Health
Delirium assessment and management Dr Kim Jeffs Northern Health What do you need to know? Epidemiology How big is the problem? Who is at risk? Assessment Tools for diagnosis Prevention Evidence base Management
More informationOptimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS)
Optimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS) Georgios Dadoudis Anesthesiologist ICU DIRECTOR INTERBALKAN MEDICAL CENTER Optimal performance requires:
More informationSymptom Management Pocket Guides: DELIRIUM
Symptom Management Pocket Guides: DELIRIUM August 2010 DELIRIUM Page Considerations. 1 Assessment 2 Diagnosis. 3 Non-Pharmacological treatment 3 Pharmacological treatment. 5 Mild Delirium... 6 Moderate
More informationnicheprogram.org 16th Annual NICHE Conference Forging New Paths and Partnerships 1
Improving Patient Outcomes in Geriatric Post-Operative Orthopedic Patients: Translating Research into Practice Tripping into The CAM Presented by: Diana LaBumbard, RN, MSN, ACNP/GNP-BC, CWOCN Denise Williams,
More informationManaging Delirium in Hospitalized Older Adults
Marquette University e-publications@marquette College of Nursing Faculty Research and Publications Nursing, College of 10-1-2015 Managing Delirium in Hospitalized Older Adults Margaret J. Bull Marquette
More informationCare of the Dying. For dosing in severe renal impairment see separate guidance for care of the dying in severe renal failure.
Care of the Dying Early diagnosis of the dying process allows for adequate preparation of the patient, the family and the carers. This clinical guidance covers the prescribing and management of patients
More informationThe Quebec Palliative Sedation Guidelines. Rose DeAngelis, N, MSc(A), CHPCN (C)
The Quebec Palliative Sedation Guidelines Rose DeAngelis, N, MSc(A), CHPCN (C) CHPCA Conference September 2017 Conflict of Interest Statements There is no financial or in-kind support for this presentation.
More informationNEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES
NEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES GENERAL PRINCIPLES Neuropathic pain may be relieved in the majority of patients by multimodal management A careful history and examination are essential.
More informationImproving the quality of care of patients with delirium
Improving the quality of care of patients with delirium Alasdair MacLullich MRCP(UK), PhD Professor of Geriatric Medicine University of Edinburgh Scotland How are we doing now? We are doing badly. Difficult
More information