In February 2009, the British Columbia Ministry of Health mandated the Clinical Care Management initiative to improve health outcomes through implementation and standardization of evidence-based clinical guidelines across various clinical populations—including the critically ill. Additionally, the Critical Care Working Group, a collection of clinically expert physicians and nurses, identified the assessment and management of pain, agitation, and delirium (PAD) as a significant clinical area for improvement. The occurrence of PAD among critically ill patients is positively associated with numerous undesirable outcomes, such as higher mortality rates, longer stays, increased costs, and low health-related quality of life.

Given the negative consequences associated with PAD, and the recent improvement initiatives proposed by the British Columbia Ministry of Health and the Critical Care Working Group, the authors of this EBR article sought to document the practice variations in assessing and managing PAD within critically ill adults....

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