Comfort in pediatric critical care: a challenging new priority in the management of pediatric critical illness

Last modified by Logan Green on 2021/05/07 17:19

Historically children admitted to the Pediatric Intensive Care Unit (PICU) were deeply sedated throughout much of their PICU Stay. However, with the recognition of the presence of PICU delirium in 25-60% of children admitted to a pediatric critical care unit we have had to re-evaluate our use of sedating medications and deep sedation in the care of these children.

PICU delirium is associated with negative short and long term outcomes and one of the main contributors to PICU delirium is deep sedation and exposure to sedating medications such as benzodiazepines. Thus, one of the main methods to decrease rates of delirium has been the implementation of ICU bundles of care to minimize sedation and normalize care of children in the PICU. We now allow children to be more awake and participate in care more while in the PICU. This new practice comes with it a significant challenge. We must ensure that we continue to optimize children’s comfort while also minimizing their exposure to harmful analgesic and sedative medications.

In order to achieve this, the PICU at Alberta Children’s Hospital in collaboration with PICUs across Canada and adult ICUs across Alberta implemented a Pain, Agitation and Delirium program. This program was a bundle of care that followed the ABCDEF bundle set out by the Society of Critical Care Medicine and was adapted to our pediatric population.

One of the key components of this bundle was ensuring the comfort of our patients. This included the implementation of q4h pain scoring, and a pain-first comfort pathway with a focus on non pharmacologic therapy and targeted comfort management. Through implementation of this program we have significantly improved our assessment and management of comfort of children admitted to our PICU. We continue to grow our program adding to new initiatives regularly as evidence evolves in this rapidly changing area.

Learning Objectives:
1- Summarize what is known about the impact of the pandemic hospital policies on Canadian families of infants in the NICU.
2- Examine the evidence-based recommendations presented by the International Family Integrated care steering committee on how best to support parents of infants in the NICU during the pandemic.
3- Develop plans to evaluate their own NICU policies in light of the information provided

Social Media Hashtags:
#PedsICU #ComfortHolding #ItDoesntHavetoHurt #Delirium

Laurie Lee

Laurie is a PICU Nurse Practitioner and Clinician Scientist at the Alberta Children’s Hospital in Calgary, Alberta and Lead of the PICU’s Pain, Agitation and Delirium (PAD) Program. Laurie completed her BScN at the University of Alberta and her MN NP at the University of Toronto. She has over 20 years of experience in pediatric critical care. Laurie leads both quality improvement and research related to pain, agitation and delirium in pediatric critical care. She is passionate about ensuring all critically ill children are as comfortable as possible while receiving life saving therapy. She and her team have received awards for their pain and delirium work including the AHS President’s Excellence award, Alberta Children’s Hospital Champion award, the Health Quality Council of Alberta Patient Experience Award, and their work was instrumental in achieving a Child Kind Designation for the Alberta Children’s Hospital.

Stephanie Hall:
Stephanie is a Registered Nurse with 7 years experience in the Pediatric Intensive Care Unit at the Alberta Children’s Hospital. Stephanie completed her RNBN at Mount Royal University and went on to become a Certified Nurse in the Critical Care of Pediatrics with the CNA. Stephanie has been a part of the PICU PAD (Pain, Agitation and Delirium) Committee since its inception. As a “PAD Champion”, she has worked to educate bedside staff and promote exceptional care pertaining to the PAD principles. Stephanie has completed QI and Research projects around Delirium in the PICU, including work with the Provincial Delirium Initiative that led to the AHS President’s Excellence Award. She is passionate about the prevention of Delirium and has future goals for further unit wide initiatives focusing on the continuing improvement of sleep in the PICU.

Marie-Claire Shanahan - Family Representative:
Marie-Claire Shanahan is parent to an amazing kid with complex medical needs and a chronic pain patient herself. She has spent countless hours bedside in PICU and acute care settings as a primary caregiver. She is also a researcher studying public engagement with science and research consent processes. These two parts of her life have helped her understand the importance of shared goals and understanding between families and medical professionals. She's seen firsthand how understanding each others' values, intentions and goals is essential to create sustainable relationships for pain management in children.

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Created by Logan Green on 2021/04/14 22:33