Investigation And Countermeasure Research On Cognition And Clinical Practice Of Quenching Analgesia In ICU Medical Staff

Objective The study was to explore the cognitive level and practice Status on the ABCDE Bundle for analgosedation in Qingdao top three hospitals’ intensive care units,and analyze the influence factors of clinical doctors ’ and nurses’ cognitive level and Practice Status on the ABCDE Bundle for Analgosedation. The survey was designed for the clinical manager to improve the level of clinical doctors and nurses, the correct understanding and dealing with the happening of the pain, agitation and delirium in ICU and to provide reliable theory basis.Methods A convenience sample of 300 doctors and nurses in the intensive care units of the top three hospitals in Qing Dao was accessed with a self-designed questionnaireResults Of 300 members who accessed the survey, 256(85.3%)completed all sections.(1)The knowledge scores of the doctors and nurses were(6.37 ± 1.25) points and(3.98± 1.60) points(total score=10)and the difference was statistically significant(t =9.55, P < 0.05).And the practice scores of the doctors and nurses were(46.13±5.53) points and(47.42±8.40)points(total score=76) and the difference was not statistically significant.(2)There were significant differences between different titles, working ages in ICU,and departments of ICU about the knowledge scores. And There was significant difference between different departments of ICU about the practice scores.(3)The investigation of ICU Doctors’ and nurses’ cognition for the management of pain,agitation and delirium displayed the below 3 which were " pain management", "pain and agitation assessment scale " and "risk factors of delirium ".( 4) The use of pain assessment tools,the use of sedation assessment tools and the manager of the delirium were the worst 3 dimensions.The pain assessment tools were rarely used by most respondents. While delirum assessment tools, such as ICDSC and CAM-ICU were also rarely used. The Ramsay was the most commonly used sedation assessment tool(60.9%).70.3% respondents used Sedative Awakening Test and 64.9% used Spontaneous Breathing Test for the mostly patients. But just50.3% used the Awakening and Breathing Coordination. Fentanyl 、 propofol 、midazolam、and dexmedetomidine were the most commonly used medicines.40.2%respondents used haloperidol to reduce the severity and duration of delirium once it has occurred. Very few physicians will participate in rehabilitation exercises of the ICU patients(only 5.1%).The stand up training(94.5%) and Passive Range of Motion exercise(72.4%) were the most commonly accepted early mobilization and exercises.(5) "Exchanges of the clinical experiences between colleagues" 、 " lecture from the department " and "self-study " were considered to be their main source of knowledge about the management of pain, agitation and delirium in ICU.(6)Factors affecting the clinical practice mainly included:1)lack of standardized guidance and training(4.43 ± 1.50 points), 2) knowledge deficits(4.23 ± 1.85points), and 3)fear of aggravating the clinical workload(3.53±1.39 points).Conclusion ICU doctors and nurses in Qingdao have less knowledge on the management of pain, agitation and delirium in ICU, and they have less chance of continuing education.And there was till some distance between the current practice situation and evidence-based strategies,the compliance of criterions was low. So there is an ongoing need for improvements in education and effective implementation strategies.While ICU managers should combine with the the native culture and available resources, to establish a scientific and standardized management model to improve the management quality of patients in ICUs.