Michael A Erdek1, Peter J Pronovost. 1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 842, Baltimore, MD 21287, USA. merdek@jhmi.edu
Abstract
OBJECTIVE: Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. DESIGN: We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was < or =3. We then implemented four separate "plan-do-study-act" cycles to improve pain assessment and treatment. MAIN OUTCOME MEASURES: We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment. RESULTS: Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%. CONCLUSION: Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.
OBJECTIVE: Efforts to improve pain assessment and treatment in critically illpatients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. DESIGN: We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was < or =3. We then implemented four separate "plan-do-study-act" cycles to improve pain assessment and treatment. MAIN OUTCOME MEASURES: We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment. RESULTS: Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%. CONCLUSION: Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.
Authors: Judith E Nelson; Kathleen A Puntillo; Peter J Pronovost; Amy S Walker; Jennifer L McAdam; Debra Ilaoa; Joan Penrod Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
Authors: Judith E Nelson; Rick Bassett; Renee D Boss; Karen J Brasel; Margaret L Campbell; Therese B Cortez; J Randall Curtis; Dana R Lustbader; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; David E Weissman Journal: Crit Care Med Date: 2010-09 Impact factor: 7.598
Authors: David S Thompson; Xavier Fazio; Erika Kustra; Linda Patrick; Darren Stanley Journal: BMC Health Serv Res Date: 2016-03-12 Impact factor: 2.655
Authors: Kathleen Puntillo; Judith Eve Nelson; David Weissman; Randall Curtis; Stefanie Weiss; Jennifer Frontera; Michelle Gabriel; Ross Hays; Dana Lustbader; Anne Mosenthal; Colleen Mulkerin; Daniel Ray; Rick Bassett; Renee Boss; Karen Brasel; Margaret Campbell Journal: Intensive Care Med Date: 2013-11-26 Impact factor: 17.440