Jenna L Morris1, Francis Bernard2, Mélanie Bérubé3,4, Jean-Nicolas Dubé5,6, Julie Houle7,8, Denny Laporta9, Suzanne N Morin10, Marc Perreault11,12, David Williamson11,13, Céline Gélinas14,15. 1. Ingram School of Nursing, McGill University, Montréal, QC, Canada. 2. Faculty of Medicine, Université de Montréal, Neuro Intensive Care Unit and Research Centre, Hôpital du Sacré-Coeur de Montréal, CIUSSS Nord-Ile-Montréal, Montréal, QC, Canada. 3. Faculty of Nursing, Université Laval, Québec City, QC, Canada. 4. CHU de Québec - Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Practices Research Unit, Québec City, QC, Canada. 5. Faculty of Medicine (campus Mauricie), Université de Montréal, Montréal, QC, Canada. 6. Department of Specialized Medicine, CIUSSS Mauricie-Centre-du-Québec, Centre hospitalier affilié universitaire régional, Trois-Rivières, QC, Canada. 7. Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada. 8. Medical and Clinical Research, CIUSSS Mauricie-Centre-du-Québec, Trois-Rivières, QC, Canada. 9. Faculty of Medicine, Respiratory Division, McGill University, Department of Medicine, Division of Adult Critical Care, Jewish General Hospital, CIUSSS West-Central-Montreal, Montréal, QC, Canada. 10. Department of Medicine, Center for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada. 11. Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. 12. Department of Pharmacy, McGill University Health Center, Montréal, QC, Canada. 13. Department of Pharmacy and Research Centre, Hôpital du Sacré-Cœur de Montréal, CIUSSSS Nord-Ile-Montréal, Montréal, QC, Canada. 14. Ingram School of Nursing, McGill University, Montréal, QC, Canada. celine.gelinas@mcgill.ca. 15. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS West-Central-Montreal, Montréal, QC, Canada. celine.gelinas@mcgill.ca.
Abstract
PURPOSE: The underassessment of pain is a major barrier to effective pain management, and the lack of pain assessment documentation has been associated with negative patient outcomes. This study aimed to 1) describe the contextual factors related to pain assessment and management in five Québec intensive care units (ICUs); 2) describe their pain assessment documentation practices; and 3) identify sociodemographic and clinical determinants related to pain assessment documentation. METHODS: A descriptive-correlational retrospective design was used. Sociodemographic data (i.e., age, sex), clinical data (i.e., diagnosis, mechanical ventilation, level of consciousness, severity of illness, opioids, sedatives), and pain assessments were extracted from 345 medical charts of ICU admissions from five teaching hospitals between 2017 and 2019. Descriptive statistics and multiple linear regression were performed. RESULTS: All sites reported using the 0-10 numeric rating scale, but the implementation of a behavioural pain scale was variable across sites. A median of three documented pain assessments were performed per 24 hr, which is below the minimal recommendation of eight to 12 pain assessments per 24 hr. Overall, pain assessment was present in 70% of charts, but only 20% of opioid doses were followed by documented pain reassessment within one hour post-administration. Higher level of consciousness (β = 0.37), using only breakthrough doses (β = 0.24), and lower opioid doses (β = -0.21) were significant determinants of pain assessment documentation (adjusted R2 = 0.25). CONCLUSION: Pain assessment documentation is suboptimal in ICUs, especially for patients unable to self-report or those receiving higher opioid doses. Study findings highlight the need to implement tools to optimize pain assessment and documentation.
PURPOSE: The underassessment of pain is a major barrier to effective pain management, and the lack of pain assessment documentation has been associated with negative patient outcomes. This study aimed to 1) describe the contextual factors related to pain assessment and management in five Québec intensive care units (ICUs); 2) describe their pain assessment documentation practices; and 3) identify sociodemographic and clinical determinants related to pain assessment documentation. METHODS: A descriptive-correlational retrospective design was used. Sociodemographic data (i.e., age, sex), clinical data (i.e., diagnosis, mechanical ventilation, level of consciousness, severity of illness, opioids, sedatives), and pain assessments were extracted from 345 medical charts of ICU admissions from five teaching hospitals between 2017 and 2019. Descriptive statistics and multiple linear regression were performed. RESULTS: All sites reported using the 0-10 numeric rating scale, but the implementation of a behavioural pain scale was variable across sites. A median of three documented pain assessments were performed per 24 hr, which is below the minimal recommendation of eight to 12 pain assessments per 24 hr. Overall, pain assessment was present in 70% of charts, but only 20% of opioid doses were followed by documented pain reassessment within one hour post-administration. Higher level of consciousness (β = 0.37), using only breakthrough doses (β = 0.24), and lower opioid doses (β = -0.21) were significant determinants of pain assessment documentation (adjusted R2 = 0.25). CONCLUSION:Pain assessment documentation is suboptimal in ICUs, especially for patients unable to self-report or those receiving higher opioid doses. Study findings highlight the need to implement tools to optimize pain assessment and documentation.
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