Measuring quality indicators to improve pain management in critically ill patients

To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. We used a modified RAND method to develop pain assessment indicators. We measured performance on the indicators using retrospectively collected pain measurement data from Dutch ICUs, which are all mixed medical –...

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Bibliographic Details
Published in:	Journal of critical care 2019-02, Vol.49, p.136-142
Main Authors:	Roos-Blom, Marie-José, Gude, Wouter T., Spijkstra, Jan Jaap, de Jonge, Evert, Dongelmans, Dave, de Keizer, Nicolette F.
Format:	Article
Language:	eng
Subjects:	Clinical outcomes Critical care Critical Care - standards Critical Illness - therapy Data Collection Feasibility Studies Humans Intensive care Intensive care units Intensive Care Units - statistics & numerical data Nursing care Pain Pain - prevention & control Pain assessment Pain management Pain Management - standards Pain Measurement - standards Patients Quality control Quality Improvement Quality indicator Quality Indicators, Health Care Quality of care Quality standards Reproducibility of Results Retrospective Studies
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Summary:	To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. We used a modified RAND method to develop pain assessment indicators. We measured performance on the indicators using retrospectively collected pain measurement data from Dutch ICUs, which are all mixed medical – surgical, of three months within October 2016–May 2017. We assessed the room for improvement, feasibility of data collection, and reliability of the indicators. We defined four pain assessment indicators. We analyzed 45,688 patient-shift observations from 15 ICUs. In 69.2% (IQR 58.7–84.9) of the patient-shifts pain was measured at least once (indicator 1); in 56.7% (IQR 49.6–73.5) pain scores were acceptable (indicator 2); in 11.7% (IQR 5.6–26.4) pain measurements with unacceptable scores were repeated within 1 h (indicator 3); and in 10.9% (IQR 5.1–20.1) unacceptable scores normalized within 1 h (indicator 4). We found data collection feasible because data were available for >79.3% of the admissions, and all indicators reliable as they produced consistent performance scores. There is substantial variation in pain assessment across Dutch ICUs, and ample room for improvement. With this study we took a first step towards quality assurance of pain assessment in Dutch ICUs. •There is substantial variation in pain assessment in Dutch ICUs•Clinical performance scores on pain assessment are far below desired practice•The developed and validated four pain assessment indicators are a first step towards quality assurance of pain management
ISSN:	0883-9441 1557-8615