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Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain 2023; 17:400-407. [PMID: 37538941 PMCID: PMC10395392 DOI: 10.1177/20494637231172496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.
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Affiliation(s)
- Maysoon S Abdalrahim
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Khaldoun M Hamdan
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Herranz Prinz L, de Castro I, de Cesar Pontes Azevedo L, Mauro Vieira J. Uncontrolled pain in critically ill patients and acute kidney injury: a hypothesis-generating cohort study. BMC Nephrol 2022; 23:202. [PMID: 35659594 PMCID: PMC9166653 DOI: 10.1186/s12882-022-02810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In critically ill patients, acute pain occurs frequently, causes sympathetic activation, release of inflammatory mediators, and potential organ dysfunction, with the kidneys potentially sensitive to inflammation-mediated injury. This study aimed to explore the association between acute pain in critically ill patients and the occurrence of acute kidney injury (AKI).
Methods
Data from a retrospective cohort of adult patients admitted between June 2013 and June 2016 to the Intensive Care Unit (ICU) of a tertiary hospital in São Paulo, Brazil, were analyzed. The main exclusion criteria were ICU length of stay < 48 h, coma, and prior kidney dysfunction. The outcome (AKI) was defined as an elevation in the baseline serum creatinine level of ≥ 0.3 mg/dl and/or > 50% at any time after the first 48 h in the ICU. Multivariable logistic regression and hierarchical cluster analysis were performed.
Results
The isolated incidence of pain was 23.6%, and the incidence of pain duration > 5 days was 10.6%. AKI occurred in 31.7% of the cohort. In multivariable logistic analysis, duration of pain > 5 days (OR 5.25 CI 2.19–12.57 p < 0.01) and mechanical ventilation (MV) ≥ 3 days (OR 5.5 CI 2.3–13.5 p < 0.01) were the variables with positive association with AKI. The hierarchical cluster analysis reinforced the relation between AKI, MV and duration of pain.
Conclusions
Pain is an especially important issue in critically ill patients and in this exploratory study it appears to be associated with AKI development. The search for more rigorous pain control in ICU is crucial and can influence organ dysfunction.
Graphical Abstract
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Ushe T, Lakhan SE, Locklear T, Muthukattil R, Whitehead P, Benson A, Ladak AA, Carter KF. Pain management consultation for acute pancreatitis: impact on length of stay and opioid utilization. Pain Manag 2021; 12:159-166. [PMID: 34420404 DOI: 10.2217/pmt-2021-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: The purpose of the study was to understand the impact of a pain management consult for acute pancreatitis patients on their inpatient length of stay, morphine milligram equivalences (MMEs) and pancreatitis severity. Materials & methods: Adult patient data were extracted from the electronic health records from 1 October 2016 to 31 December 2018. Results & conclusion: Of 277 patients with a single acute pancreatitis hospitalization, 23 had a pain consultation (treatment group), whereas 254 did not (control group). There were statistically significant differences in median length of stay, median MME total and median MME per day between the treatment and control groups with comparable severity and pain scores (6.8 vs 3.1 days, 196.5 vs 33.8 MMEs, 30.9 vs 12.1 MMEs, respectively, p < 0.0001). This study emphasizes the complexity of pain management and the importance of further research in the field.
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Affiliation(s)
- Tendai Ushe
- Pain Management, Carilion Clinic (at time of study data collection), Roanoke, VA 24014, USA
| | - Shaheen E Lakhan
- Pain Management, Carilion Clinic (at time of study data collection), Roanoke, VA 24014, USA.,Biosciences, Global Neuroscience Initiative Foundation, Boston, MA 02127, USA
| | - Tonja Locklear
- Health Analytics Research Team, Carilion Clinic, Roanoke, VA 24014, USA
| | - Ronex Muthukattil
- Health Analytics Research Team, Carilion Clinic, Roanoke, VA 24014, USA
| | - Phyllis Whitehead
- Palliative Medicine, Carilion Clinic & Virginia Tech Carilion School of Medicine, Roanoke, VA 24014, USA
| | - Andrew Benson
- Research & Development, Carilion Clinic, Roanoke, VA 24014, USA
| | - Asma Akbar Ladak
- Medical College, Aga Khan University, Hospital, Karachi, Sindh, 74800, Pakistan
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Benjenk I, Messing J, Lenihan MJ, Hernandez M, Amdur R, Sirajuddin S, Davison D, Schroeder ME, Sarani B. Authorized Agent-Controlled Analgesia for Pain Management in Critically Ill Adult Patients. Crit Care Nurse 2021; 40:31-36. [PMID: 32476024 DOI: 10.4037/ccn2020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent-controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults. OBJECTIVE To evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients. METHODS A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent-controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent-controlled analgesia. Authorized agent-controlled analgesia was administered by nurses only. RESULTS The mean (SD) change in pain score was -3.4 (2.0) (95% CI, -4.0 to -2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent-controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent-controlled analgesia initiation on pain scores remained significant (P < .001). CONCLUSIONS Use of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.
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Affiliation(s)
- Ivy Benjenk
- Ivy Benjenk is a senior clinical analyst, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Jonathan Messing
- Jonathan Messing is lead nurse practitioner for trauma services, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Megan J Lenihan
- Megan J. Lenihan and Madelyn Hernandez are medical students, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Madelyn Hernandez
- Megan J. Lenihan and Madelyn Hernandez are medical students, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Richard Amdur
- Richard Amdur is a statistician, George Washington University Medical Faculty Associates, Washington, DC
| | - Sarah Sirajuddin
- Sarah Sirajuddin is a surgical resident, George Washington University Hospital
| | - Danielle Davison
- Danielle Davison is an attending physician, Department of Anes-thesiology and Critical Care, George Washington University
| | - Mary E Schroeder
- Mary E. Schroeder is an attending physician, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Babak Sarani
- Babak Sarani is an attending physician and medical director of trauma services, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
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Olsen BF, Valeberg BT, Jacobsen M, Småstuen MC, Puntillo K, Rustøen T. Pain in intensive care unit patients-A longitudinal study. Nurs Open 2021; 8:224-231. [PMID: 33318830 PMCID: PMC7729640 DOI: 10.1002/nop2.621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
Aim To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient-related variables. Design A longitudinal study. Methods Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient-related variables were modelled using multiple logistic regression. Results When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self-report pain, compared with patients not able to self-report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.
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Affiliation(s)
- Brita F. Olsen
- Intensive and Post Operative UnitØstfold Hospital TrustGrålumNorway
- Faculty of Health and WelfareØstfold University CollegeHaldenNorway
| | - Berit T. Valeberg
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
- Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Morten Jacobsen
- Medical DepartmentØstfold Hospital TrustGrålumNorway
- Faculty of MedicineUniversity of OsloOsloNorway
- Norwegian University of Life SciencesÅsNorway
| | | | - Kathleen Puntillo
- Department of Physiological NursingUniversity of California San Francisco School of NursingSan FranciscoCAUSA
| | - Tone Rustøen
- Faculty of MedicineUniversity of OsloOsloNorway
- Division of Emergencies and Critical CareOslo University HospitalOsloNorway
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6
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Olsen BF, Rustøen T, Valeberg BT. Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units. Pain Manag Nurs 2020; 21:543-548. [PMID: 32651048 DOI: 10.1016/j.pmn.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. AIM Evaluate the feasibility and clinical utility of this algorithm. DESIGN A descriptive survey. SETTINGS One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. PARTICIPANTS/SUBJECTS Nurses working at the three units. METHODS A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. RESULTS Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). CONCLUSIONS Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients' pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients' pain is needed.
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Affiliation(s)
- Brita F Olsen
- Intensive and Postoperative Unit, Østfold Hospital Trust, Grålum, Norway; Faculty of Health and Welfare, Østfold University College, Halden, Norway.
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Berit T Valeberg
- Department of Nursing, Oslo Metropolitan University, Oslo, Norway; University of South-Eastern Norway, Kongsberg, Norway
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Gosselin É, Richard-Lalonde M. Role of Family Members in Pain Management in Adult Critical Care. AACN Adv Crit Care 2020; 30:398-410. [PMID: 31951660 DOI: 10.4037/aacnacc2019275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This review describes family member involvement in intensive care unit pain assessment and management and generates implications for clinical practice, education, and future research. A literature review was performed in MEDLINE, PubMed, EMBASE, Cochrane, and CINAHL databases from their inception until April 30, 2019. Only 11 studies addressing the topic were identified, and the current quality of evidence is low. Family members can be involved in pain assessment by describing patients' pain behaviors and in pain management by selecting and delivering nonpharmacological interventions tailored to patients' needs, if the family members feel comfortable with this role. More-rigorous research is required to describe the role of family members in patients' pain assessment and management. Advancing knowledge in this field could improve patients' and family members' experiences with pain assessment and management in the intensive care unit.
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Affiliation(s)
- Émilie Gosselin
- Émilie Gosselin is a Postdoctoral Research Fellow, Ingram School of Nursing, McGill University, and Center for Nursing Research, Jewish General Hospital of Montreal, 680 Sherbrooke St West, Room 1838, Montreal, QC H3A 2M7, Canada . Mélissa Richard-Lalonde is a Doctoral Student, Ingram School of Nursing, McGill University
| | - Mélissa Richard-Lalonde
- Émilie Gosselin is a Postdoctoral Research Fellow, Ingram School of Nursing, McGill University, and Center for Nursing Research, Jewish General Hospital of Montreal, 680 Sherbrooke St West, Room 1838, Montreal, QC H3A 2M7, Canada . Mélissa Richard-Lalonde is a Doctoral Student, Ingram School of Nursing, McGill University
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Gélinas C, Joffe AM, Szumita PM, Payen JF, Bérubé M, Shahiri T S, Boitor M, Chanques G, Puntillo KA. A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults. AACN Adv Crit Care 2020; 30:365-387. [PMID: 31951666 DOI: 10.4037/aacnacc2019952] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.
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Affiliation(s)
- Céline Gélinas
- Céline Gélinas is Associate Professor, Ingram School of Nursing, McGill University, 680 Sherbrooke West, Room 1838, Montréal, Québec, Canada, H3A 2M7; and Researcher, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Aaron M Joffe
- Aaron M. Joffe is Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Paul M Szumita
- Paul M. Szumita is Clinical Pharmacy Practice Manager and Program Director - PGY2 Critical Care Pharmacy Practice Residency, Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Francois Payen
- Jean-Francois Payen is Professor, Department of Anesthesiology and Critical Care, and Researcher, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Bérubé
- Mélanie Bérubé is Assistant Professor, Faculty of Nursing, Université Laval; and Researcher, CHU de Québec, Université Laval Research Center (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Shiva Shahiri T
- Shiva Shahiri T is a PhD Student, Ingram School of Nursing, McGill University
| | - Madalina Boitor
- Madalina Boitor is a Student, Faculty of Dentistry, McGill University
| | - Gerald Chanques
- Gerald Chanques is Professor, Department of Anesthesia & Critical Care Medicine, Montpellier University Hospital Saint Eloi, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Kathleen A Puntillo
- Kathleen A. Puntillo is Professor of Nursing Emeritus, University of California San Francisco School of Nursing, San Francisco, California
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9
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Sandvik RK, Olsen BF, Rygh L, Moi AL. Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review. J Clin Nurs 2020; 29:1488-1498. [DOI: 10.1111/jocn.15194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Reidun K. Sandvik
- Departement of Health and Caring Sciences Faculty of Health and Social Sciences Western Norway University of Applied Sciences Bergen Norway
- Department of Global Public Health and Primary Care Centre for Elderly and Nursing Home Medicine University of Bergen Bergen Norway
| | - Brita F. Olsen
- Intensive and Post‐operative Unit Østfold Hospital Trust Sarpsborg Norway
- Faculty of Health and Welfare Østfold University College Fredrikstad Norway
| | - Lars‐Jørgen Rygh
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Asgjerd Litlere Moi
- Departement of Health and Caring Sciences Faculty of Health and Social Sciences Western Norway University of Applied Sciences Bergen Norway
- Department of Plastic, Hand and Reconstructive Surgery National Burn Centre Haukeland University Hospital Bergen Norway
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10
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Liu S, Gnjidic D, Nguyen J, Penm J. Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review. Br J Clin Pharmacol 2020; 86:210-243. [PMID: 31863503 DOI: 10.1111/bcp.14203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. METHODS Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). RESULTS Of 398 full-text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty-one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard-copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient-controlled analgesia reduced medication errors by up to 89.1%. CONCLUSION Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.
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Affiliation(s)
- Shania Liu
- Sydney Pharmacy School, The University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Nguyen
- Sydney Pharmacy School, The University of Sydney, Camperdown, NSW, Australia
| | - Jonathan Penm
- Sydney Pharmacy School, The University of Sydney, Camperdown, NSW, Australia
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García-Sánchez M, Caballero-López J, Ceniceros-Rozalén I, Giménez-Esparza Vich C, Romera-Ortega M, Pardo-Rey C, Muñoz-Martínez T, Escudero D, Torrado H, Chamorro-Jambrina C, Palencia-Herrejón E. Prácticas de analgosedación y delirium en Unidades de Cuidados Intensivos españolas: Encuesta 2013-2014. Med Intensiva 2019; 43:225-233. [DOI: 10.1016/j.medin.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 01/17/2023]
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12
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Smolle C, Sendlhofer G, Sandner-Kiesling A, Herbert MK, Jantscher L, Pichler B, Kamolz LP, Brunner G. Implementation and maintenance of a pain management quality assurance program at intensive care units: 360 degree feedback of physicians, nurses and patients. PLoS One 2018; 13:e0208527. [PMID: 30566446 PMCID: PMC6300320 DOI: 10.1371/journal.pone.0208527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Pain management quality assurance programs (PMQP) have been successfully implemented in numerous hospitals across Europe. We aimed to evaluate the medium-term sustainability of a PMQP implemented at intensive care units (ICUs). Methods Two surveys, the first in 2012, immediately after introduction of the PMQP, and the second in 2015, were carried out amongst patients, physicians and nurses. Demographic parameters of all participants were assessed. Patients were asked after their pain levels during ICU stay. Staff members answered a questionnaire regarding familiarity with standards and processes of PMQP and self-perception of their knowledge as well as contentment with interdisciplinary communication. Results In total (2012/2015), 267 (125/142) patients, 113 (65/48) physicians and 510 (264/246) members of the nursing staff participated. Minimum and maximum pain levels of patients did not differ between both surveys. Patients’ tolerance of pain 24 hours before the survey was better (p = 0.023), and vomiting occurred less often (p = 0.037) in 2015. Physicians’ and nurses’ contentment with the own knowledge about pharmacological pain treatment had increased from 2012 to 2015 (p = 0.002 and 0.004). Satisfaction with communication between nurses and physicians was better in 2015 (p<0.001 and p = 0.002). Familiarity with PMQP standards and processes remained stable in both collectives. Conclusion The implementation of our PMQP achieved a high standard of care, guarantying a high patient and staff member satisfaction. Continuous education, ongoing training, regular updates and implementation of feedback-loops ensure continuity, in some parameters even an increase in knowledge and competencies. This is mirrored in high patient and staff member satisfaction.
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Affiliation(s)
- Christian Smolle
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- * E-mail:
| | - Andreas Sandner-Kiesling
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Michael K. Herbert
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Bernd Pichler
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Azevedo-Santos IF, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res 2018; 11:2969-2980. [PMID: 30538536 PMCID: PMC6255280 DOI: 10.2147/jpr.s151169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Procedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional’s routine, and studies have been developed to show the relevance of measuring pain in critically ill patients. Objective This review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published. Method Systematic literature search was performed on PubMed and Google Scholar. Keywords “pain”, “pain measurement”, “intensive care units” and “respiration, artificial” were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review. Results Objective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods. Conclusion This review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals’ knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.
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Affiliation(s)
- Isabela Freire Azevedo-Santos
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
| | - Josimari Melo DeSantana
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
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Fuchs ME, Beecroft N, McLeod DJ, Dajusta DG, Ching CB. Intraoperative Onabotulinumtoxin-A Reduces Postoperative Narcotic and Anticholinergic Requirements After Continent Bladder Reconstruction. Urology 2018; 118:183-188. [DOI: 10.1016/j.urology.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Damico V, Cazzaniga F, Murano L, Ciceri R, Nattino G, Dal Molin A. Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study. Pain Manag Nurs 2018; 19:256-266. [DOI: 10.1016/j.pmn.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/17/2022]
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Nowak T, Neumann-Podczaska A, Deskur-Śmielecka E, Styszyński A, Wieczorowska-Tobis K. Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia. Clin Interv Aging 2018; 13:1045-1051. [PMID: 29872283 PMCID: PMC5973322 DOI: 10.2147/cia.s157246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia. Patients and methods The research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed. Results Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia. Conclusion Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential.
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Affiliation(s)
- Tomasz Nowak
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Ewa Deskur-Śmielecka
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Arkadiusz Styszyński
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Wieczorowska-Tobis
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Wynne R, Lui N, Tytler K, Koffsovitz C, Kirwa V, Riedel B, Ryan S. The Trajectory of Postoperative Pain Following Mastectomy with and without Paravertebral Block. Pain Manag Nurs 2017; 18:234-242. [PMID: 28601480 DOI: 10.1016/j.pmn.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/21/2016] [Accepted: 03/08/2017] [Indexed: 11/18/2022]
Abstract
Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy.
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Affiliation(s)
- Rochelle Wynne
- School of Nursing & Midwifery, Deakin University, Geelong, Australia.
| | - Natalie Lui
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kristen Tytler
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Carol Koffsovitz
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victor Kirwa
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shane Ryan
- Department of Anaesthesia, Peter MacCallum Cancer Centre, Melbourne, Australia
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