Association between organizational characteristics and adequate pain management at the intensive care unit

Marie-José Roos-Blom, Dave Dongelmans, Willemke Stilma, Jan Jaap Spijkstra, Evert de Jonge, Nicolette de Keizer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: Half of the patients experience pain during their ICU stay which is known to influence their outcomes. Nurses and physicians encounter organizational barriers towards pain assessment and treatment. We aimed to evaluate the association between adequate pain management and nurse to patient ratio, bed occupancy rate, and fulltime presence of an intensivist. Materials and methods: We performed unadjusted and case-mix adjusted mixed-effect logistic regression modeling on data from thirteen Dutch ICUs to investigate the association between ICU organizational characteristics and adequate pain management, i.e. patient-shift observations in which patients' pain was measured and acceptable, or unacceptable and normalized within 1 h. All ICU patients admitted between December 2017 and June 2018 were included, excluding patients who were delirious, comatose or had a Glasgow coma score < 8 at the first day of ICU admission. Results: Case-mix adjusted nurse to patient ratios of 0.70 to 0.80 and over 0.80 were significantly associated with adequate pain management (OR [95% confidence interval] of respectively 1.14 [1.07–1.21] and 1.16 [1.08–1.24]). Bed occupancy rate and intensivist presence showed no association. Conclusion: Higher nurse to patient ratios increase the percentage of patients with adequate pain management especially in medical and mechanically ventilated patients.
Original languageEnglish
Pages (from-to)1-5
JournalJournal of Critical Care
Volume56
DOIs
Publication statusPublished - 2020

Cite this

Roos-Blom, Marie-José ; Dongelmans, Dave ; Stilma, Willemke ; Spijkstra, Jan Jaap ; de Jonge, Evert ; de Keizer, Nicolette. / Association between organizational characteristics and adequate pain management at the intensive care unit. In: Journal of Critical Care. 2020 ; Vol. 56. pp. 1-5.
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abstract = "Purpose: Half of the patients experience pain during their ICU stay which is known to influence their outcomes. Nurses and physicians encounter organizational barriers towards pain assessment and treatment. We aimed to evaluate the association between adequate pain management and nurse to patient ratio, bed occupancy rate, and fulltime presence of an intensivist. Materials and methods: We performed unadjusted and case-mix adjusted mixed-effect logistic regression modeling on data from thirteen Dutch ICUs to investigate the association between ICU organizational characteristics and adequate pain management, i.e. patient-shift observations in which patients' pain was measured and acceptable, or unacceptable and normalized within 1 h. All ICU patients admitted between December 2017 and June 2018 were included, excluding patients who were delirious, comatose or had a Glasgow coma score < 8 at the first day of ICU admission. Results: Case-mix adjusted nurse to patient ratios of 0.70 to 0.80 and over 0.80 were significantly associated with adequate pain management (OR [95{\%} confidence interval] of respectively 1.14 [1.07–1.21] and 1.16 [1.08–1.24]). Bed occupancy rate and intensivist presence showed no association. Conclusion: Higher nurse to patient ratios increase the percentage of patients with adequate pain management especially in medical and mechanically ventilated patients.",
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Association between organizational characteristics and adequate pain management at the intensive care unit. / Roos-Blom, Marie-José; Dongelmans, Dave; Stilma, Willemke; Spijkstra, Jan Jaap; de Jonge, Evert; de Keizer, Nicolette.

In: Journal of Critical Care, Vol. 56, 2020, p. 1-5.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - de Jonge, Evert

AU - de Keizer, Nicolette

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