Ask an answerable question (PICO)：
Effect of cold water with bundle care on thirst patients in adult intensive care units.
PICO-P: adult intensive care unit, I: patient care bundles, O: thirst
The Method and Analysis of Literature Review：
Through Boolean logic, the study keywords and synonyms of PICO were searched on Cochrane library, Embase, PubMed and CEPS. Keywords include: P(ICU, Intensive Care Units, Critical Care), I(Patient Care Bundles, Intervention*, bundle*, cold water, Spray*, lip moisturizer*, moisturizer*, menthol), O(Thirst, Thirst, Distress, Thirst Intensity, Thirst relief*, Numeric rating scales); and MeSH terms and truncation are combined with OR, and P, I, and O are combined with AND to search for documents in multiple combinations.
Critical Appraisal：
Totally 13 literatures were obtained. After screening, one randomized controlled trial study was selected. These one research evidences were critically appraised for validity, importance, and practicability through the appraising tool of CASP in the version of 2020.
Clinical Application of Evidence：
Using 7 steps of empirical knowledge translation to improve the question. The acceptance period is from October 1, 2020 to November 15, 2020. The subjects are patients in the intensive care unit of a northern medical center. Randomized pre-test/post-test design are conducted. Intervention measures are modular modules: use 3.5~4.1° C The combined care of cold water cotton sticks to wipe the mouth, cold water spray bottle sprayed to the oropharynx, tongue area, and menthol lip moisturizer.
Evaluation of Effectiveness：
From October 01 to November 15, 2020, 9 cases were admitted. Thirst intensity scale (on a numeric rating scale [NRS] of 1-10), dropped from 6.10 before intervention to 3.16 after intervention. The average score of thirst distress increased from before the intervention, 5.66 dropped to 2.83 after the intervention. In addition, after the intervention, the average time for patients to express thirst again was about 54 minutes. The intervention can be combined with regular hourly inspections without adding extra care burden, It shows that the use of bundle care has a relief effect on the degree of thirst and the degree of thirst distress of patients in the intensive care unit.
Conclusions and Recommendations：
Multiple intervention measures: routinely give cold water sponge sticks to moisten the mouth, cold water spray and apply mint moisturizing lip balm as a combination, which is very simple and convenient, and can be easily applied to reduce critically ill units, combined with hourly care and treatment, to calculate cost-effectiveness: An oral sponge swab is 3 yuan, a mint moisturizing lip balm is NT$ 100 , and a spray bottle is NT$10. The total total is less than NT$200. It is an easy-to-reach safe and economical measure that does not use drugs indirectly. There are no special safety issues, and 4 of the 9 cases are clearly conscious intubation of patients, showing measures can be applied to patients of endotracheal tube intubation, so we will continue to track patients of endotracheal tube intubation in the future. I hope to use this experience sharing to provide multiple empirical applications to improve the quality of critical care.
