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  • Measure Summary
  • NQMC:008505
  • Mar 2011

Sedation and analgesia: percentage of mechanically ventilated patients evaluated for the presence of delirium.

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of mechanically ventilated patients evaluated for the presence of delirium.

Rationale

The aim of intensive care medicine is to provide critical patients with the healthcare that they need, ensuring the quality and safety of care. Intensive care medicine is one of the principal components of modern healthcare systems. There is an increasing demand for this resource, which involves high costs.

The quality of care has gradually come to be the central focus of healthcare, and in recent years patient safety has come to represent one of the key aspects of quality. In the case of intensive care medicine, this interest in quality is even more evident, not only because of its social and economic impact, but also because some of the dimensions involved in the quality of care of critical patients take on greater importance: critical patients are more vulnerable, access to critical care is more limited so efforts to distribute resources equitably are more important, scant scientific evidence is available, and the efficiency is limited.

Delirium has a high incidence; it is associated with significant morbidity and increased costs in critical patients. It can be difficult to identify and the use of systems that allow it to be identified and treated appropriately is recommended. The Confusion Assessment Method for the intensive care unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are useful for diagnosing delirium in critical patients.

Evidence for Rationale

Celis-Rodriguez E, Besso J, Birchenall C, de la Cal MA, Carrillo R, Castorena G, Ceraso D, Duenas C, Gil F, Jimenez E, Meza JC, Munoz M, Pacheco C, Palizas F, Pinilla D, Raffan F, Raimondi N, Rubiano S, Suarez M, Ugarte S, Federacion Panamericana e Iberica de Sociedades de Medicina Critica y Cuidados. [Clinical practice guideline based on the evidence for the management of sedoanalgesia in the critically ill adult patient]. Med Intensiva. 2007 Nov;31(8):428-71. [284 references] PubMed External Web Site Policy

Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001 Jul;29(7):1370-9. PubMed External Web Site Policy

Palencia Herrejon E. [Diagnosis of delirium in the critical ill]. Med Intensiva. 2010 Jan-Feb;34(1):1-3. PubMed External Web Site Policy

Palencia-Herrejon E, Romera MA, Silva JA, Grupo de Trabajo de Analgesia y Sedacion de la SEMICYUC. [Delusion in the critical patient]. Med Intensiva. 2008 Feb;32 Spec No:77-91. [120 references] PubMed External Web Site Policy

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Toro AC, Escobar LM, Franco JG, Diaz-Gomez JL, Munoz JF, Molina F, Bejarano J, Yepes D, Navarro E, Garcia A, Wesley Ely E, Esteban A. [Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation]. Med Intensiva. 2010 Jan-Feb;34(1):14-21. PubMed External Web Site Policy

Primary Health Components

Sedation; analgesia; mechanical ventilation (MV); delirium

Denominator Description

Number of patients undergoing mechanical ventilation (MV) greater than 48 hours (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of mechanically ventilated patients evaluated for the presence of delirium (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Nurses

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients undergoing mechanical ventilation (MV) greater than 48 hours

Population: All patients undergoing MV greater than 48 hours during the period reviewed.

Exclusions
Richmond Agitation Sedation Scale less than -2 or the equivalent score on another validated scale

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of mechanically ventilated patients evaluated for the presence of delirium

Evaluated for the presence of delirium: Daily assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC).

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Confusion Assessment Method for the Intensive Care Unit (CAM-ICU); Intensive Care Delirium Screening Checklist (ICDSC); Richmond Agitation Sedation Scale

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Prescriptive standard

Prescriptive Standard

Standard: 90%

Evidence for Prescriptive Standard

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Original Title

Identification of delirium.

Measure Collection Name

Quality Indicators in Critically Ill Patients

Measure Set Name

Sedation and Analgesia

Submitter

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Developer

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Funding Source(s)

Boehringer Laboratories

Composition of the Group that Developed the Measure

Work Group for Sedation and Analgesia

  • José Luis Martínez Melgar
  • José Manuel Borrallo Pérez
  • Carlos Chamorro Jambrina

Scientific Coordination:

  • Maria Cruz Martín Delgado
  • Jesús Blanco Varela
  • Lluís Cabré Pericas
  • Pedro Galdos Anuncibay
  • Federico Gordo Vidal

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2011 Mar

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2016 Jul

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Source(s)

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Measure Availability

Source available in English External Web Site Policy and Spanish External Web Site Policy from the Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC) Web site.

For more information, contact SEMICYUC at Paseo de la Reina Cristina, 36, 4o D, Madrid, Spain; Phone: +34-91-502-12-13; Fax: +34-91-502-12-14; Web site: www.semicyuc.org External Web Site Policy; E-mail: secretaria@semicyuc.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 8, 2014. The information was verified by the measure developer on February 26, 2014.

The information was reaffirmed by the measure developer on May 10, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

The Quality Indicators in Critically Ill Patients update 2011 can be used by any private or public body only for the purposes of research, clinical management, teaching and education, and will not be used for any other purpose. In all cases, full credit to the Spanish Society of Intensive Care Medicine (SEMICYUC) will be granted. The commercial use of the Quality Indicators in Critically Ill Patients update 2011 is explicitly forbidden.

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