Protocolo de analgesia, sedação e delirium em Unidade de Terapia Intensiva como instrumento de melhoria da qualidade

Abstract

Introduction: The protocols of analgesia, sedation and delirium in the Intensive Care Units promote comfort, reduce stress and errors of clinical evaluation, with quality in the treatment, adjusting the use of the drugs, providing patient safety. Objective: to implant protocol of analgesia, sedation and delirium in the Intensive Care Unit of a regional hospital in the Brazilian Northeast using a quality improvement cycle. Methodology: a quasi-experimental quantitative study, before and after, without control group, and intervention, for quality improvement, developed with the multiprofessional team of the Adult Intensive Care Unit of the Deoclécio Marques de Lucena Regional Hospital, Parnamirim- RN, in the period from March to August 2018. The intervention covered the implementation of the assistance protocol in a participatory manner, with permanent education and changes in work processes. A total of 15 criteria and six indicators were added to measure the quality of care and daily measurements were made in the pre- and post-intervention period. Noncompliance data were analyzed in the before-and-after Pareto chart. Absolute and relative improvement values and statistical significance were estimated using the unilateral Z-value test for p <0.05. Results: The charts of 40 patients in each phase of the study were analyzed, and there were no statistical differences in relation to the demographic data and severity criteria (APACHE II) of the two phases of the study. Of the 43 caregivers who were trained in the intervention phase, 74% stated that they did not have previous knowledge of the scales used, but all reported safety in their use after the intervention. There was a significant improvement (p <0.001) in 12 of the 15 criteria, but no difference in quality indicators. Conclusions: The protocols of analgesia, sedation and delirium in an intensive care unit, implanted with the use of quality improvement tools (cycles of improvement), are easy to handle, low cost and effective in patient safety.