Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program

• Published in: Journal of critical care 2008-09, Vol.23 (3), p.359-371
• Main Authors: Diby, Marc, CNS, CCRN, Romand, Jacques-André, MD, FCCM, Frick, Sonia, MD, Heidegger, Claudia Paula, MD, Walder, Bernhard, MD
• Format: Article
• Language: English
• Subjects: Algorithms; Analgesics; Analgesics - therapeutic use; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Cardiac surgery; Cardiac Surgical Procedures; Clinical Protocols; Clinical trials; Critical Care; Dose-Response Relationship, Drug; Drug Utilization; Education; Female; Heart surgery; Hospitalization; Hospitals; Humans; Hypnotics and Sedatives - therapeutic use; Intensive care; Male; Middle Aged; Morphine - administration & dosage; Morphine - therapeutic use; Nurses; Pain management; Pain Measurement; Pain, Postoperative - drug therapy; Patient Satisfaction; Postoperative pain; Program Evaluation; Prospective Studies; Provider behavior change; Quality Assurance, Health Care - organization & administration; Quality improvement; Quality measurement; Sleep; Sleep - drug effects; Time Factors
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2007.11.005

Abstract Purpose The aim of this study was to test the effectiveness of a quality improvement postoperative pain treatment program after cardiac surgery. Materials and Methods This was a prospective, quasiexperimental study using nonequivalent groups comprising 3 periods: baseline (group baseline), implementation of the algorithm for acute pain management, and reassessment (group reassessment). Inclusion of 133 patients after elective cardiac surgery at an 18-bed surgical intensive care unit (SICU) at a Swiss university hospital. The algorithm was implemented by training, pocket guidelines, regular audits, and feedback. The implementation period was completed when the adherence to 2 of 3 process indicators attained at least 70% over 2 months. Visual analog scales (VAS) for pain, morphine consumption, pain perception, and sleep quality were assessed during stay in SICU and after 1 month and 6 months. Results The assessment included 79 patients at baseline and 54 in the reassessment periods. Pain intensity at rest decreased from 2.7 ± 1.4 to 2.2 ± 1.4 cm (VAS; P = .008). Retrospective perception of pain intensity at rest decreased from 3.8 ± 2.2 to 2.6 ± 1.8 ( P = .004). The proportion of patients with no pain or often without pain increased from 11% to 37% ( P = .005). The number of patients with sleep disturbances decreased from 68% to 35% ( P = .012). No differences were observed at 1 and 6 months postoperatively. Conclusions After algorithm implementation in the SICU, pain intensity at rest decreased and quality of sleep improved.