Scientific article
English

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

Published inJournal of critical care, vol. 23, no. 3, p. 359-371
Publication date2008
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.

Keywords
  • Analgesics/therapeutic use
  • Analgesics, Opioid/administration & dosage/therapeutic use
  • Cardiac Surgical Procedures
  • Clinical Protocols
  • Dose-Response Relationship, Drug
  • Drug Utilization
  • Female
  • Humans
  • Hypnotics and Sedatives/therapeutic use
  • Male
  • Middle Aged
  • Morphine/administration & dosage/therapeutic use
  • Pain Measurement
  • Pain, Postoperative/drug therapy
  • Patient Satisfaction
  • Program Evaluation
  • Prospective Studies
  • Quality Assurance, Health Care/organization & administration
  • Sleep/drug effects
  • Time Factors
Citation (ISO format)
DIBY, Marc et al. Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program. In: Journal of critical care, 2008, vol. 23, n° 3, p. 359–371. doi: 10.1016/j.jcrc.2007.11.005
Main files (1)
Article (Accepted version)
accessLevelRestricted
Identifiers
ISSN of the journal1557-8615
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