Title: Construction of a thirst management program for ICU postoperative patients fasting from food and drink and its application
Abstract:
Background: The high incidence of thirst in postoperative ICU patients who fast from food and drink can cause much harm. Existing studies on thirst were large and rich in evidence. However, nurses often intervene with thirsty patients based on experience, which lacks scientific validity and comprehensiveness.
Objective: To construct a thirst management program for ICU postoperative patients who fast from food and drink through evidence-based and Delphi Expert Correspondence, and to explore its application effect. It can provide scientific and effective guidance for nurses to carry out the clinical practice of thirst management.
Methods: Practice guidelines, expert consensus, evidence summaries, recommended practices, and systematic reviews related to thirst were retrieved based on the "6S" pyramid model of evidence. Two researchers independently conducted literature screening, quality assessment, and evidence synthesis. Eighteen experts were invited to conduct two rounds of expert correspondence from May to June 2023. The best evidence was modified to form a formal program based on expert opinion. A before-after controlled trial was used, in which surgical patients admitted to the comprehensive ICU of a tertiary hospital in Shanghai from July to August 2023 were selected as the control group, and from September to October 2023 as the intervention group. The patients in the control group used routine care such as swabs dipped in water and spraying when they were thirsty; the intervention group utilized the thirst management program. The primary outcome was the Perioperative Thirst Discomfort Scale (PTDS), and the secondary outcomes were the Modified Beck Oral Assessment Scale (MBOAS), patient satisfaction, and nurse workload. The PTDS and MBOAS were measured from the time when the patients were admitted to the ICU and measured every 2 hours. Satisfaction was measured when patients were discharged from the ICU, and nurse workload was compared by frequency of intervention.
Results: A total of 18 articles were included in the literature search to extract 25 pieces of best evidence. The effective return rate of the questionnaire for both rounds of expert correspondence was 100%, and the authority coefficient was 0.92. The coefficients of variation for the importance and actionability scores after the second round of expert correspondence were 0.05∼0.23 and 0.06∼0.24, and the coefficients of Kendall's concordance were 0.166 and 0.154 (P<0.001). The final program consisted of 5 primary entries( pre-preparation, identification assessment, preoperative palliative strategies, postoperative interventions, and outcome evaluation) and 23 secondary entries. The invalid sample size of 6 cases in the implementation of the program. A total of 68 cases in the control group and 66 cases in the intervention group. Repeated measures ANOVA showed statistically significant differences in PTDS and MBOAS between the two groups. Patient satisfaction was better in the intervention group than in the control group, and nurse workload decreased compared with the control group (P<0.05).
Conclusions: The thirst management program for ICU postoperative patients constructed based on the evidence in this study is scientific, comprehensive, and effective. The application of this program can effectively improve patients thirst, oral condition, and satisfaction, and reduce nurses workload.
Audience Take Away Notes:
• ICU nurses can scientifically intervene with postoperative fasting patients based on the thirst management program constructed in the study
• Adopting a scientific thirst management program can reduce the frequency of nurse interventions and decrease workload
• Thirst management is currently under-recognized by nurses and needs to be included in the training curriculum
