Measuring quality indicators to improve pain management in critically ill patients

Marie José Roos-Blom, Wouter T. Gude, Jan Jaap Spijkstra, Evert de Jonge, Dave Dongelmans, Nicolette F. de Keizer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. Materials and methods: 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. Results: 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. Conclusions: 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.

LanguageEnglish
Pages136-142
Number of pages7
JournalJournal of Critical Care
Volume49
DOIs
StatePublished - 1 Feb 2019

Cite this

Roos-Blom, M. J., Gude, W. T., Spijkstra, J. J., de Jonge, E., Dongelmans, D., & de Keizer, N. F. (2019). Measuring quality indicators to improve pain management in critically ill patients. Journal of Critical Care, 49, 136-142. DOI: 10.1016/j.jcrc.2018.10.027
Roos-Blom, Marie José ; Gude, Wouter T. ; Spijkstra, Jan Jaap ; de Jonge, Evert ; Dongelmans, Dave ; de Keizer, Nicolette F./ Measuring quality indicators to improve pain management in critically ill patients. In: Journal of Critical Care. 2019 ; Vol. 49. pp. 136-142
@article{a0a9c75f15e84433b43d1e94a57ce793,
title = "Measuring quality indicators to improve pain management in critically ill patients",
abstract = "Purpose: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. Materials and methods: 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. Results: 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. Conclusions: 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.",
keywords = "Intensive care units, Pain, Pain assessment, Quality improvement, Quality indicator",
author = "Roos-Blom, {Marie Jos{\'e}} and Gude, {Wouter T.} and Spijkstra, {Jan Jaap} and {de Jonge}, Evert and Dave Dongelmans and {de Keizer}, {Nicolette F.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.jcrc.2018.10.027",
language = "English",
volume = "49",
pages = "136--142",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",

}

Roos-Blom, MJ, Gude, WT, Spijkstra, JJ, de Jonge, E, Dongelmans, D & de Keizer, NF 2019, 'Measuring quality indicators to improve pain management in critically ill patients' Journal of Critical Care, vol. 49, pp. 136-142. DOI: 10.1016/j.jcrc.2018.10.027

Measuring quality indicators to improve pain management in critically ill patients. / Roos-Blom, Marie José; Gude, Wouter T.; Spijkstra, Jan Jaap; de Jonge, Evert; Dongelmans, Dave; de Keizer, Nicolette F.

In: Journal of Critical Care, Vol. 49, 01.02.2019, p. 136-142.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Measuring quality indicators to improve pain management in critically ill patients

AU - Roos-Blom,Marie José

AU - Gude,Wouter T.

AU - Spijkstra,Jan Jaap

AU - de Jonge,Evert

AU - Dongelmans,Dave

AU - de Keizer,Nicolette F.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Purpose: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. Materials and methods: 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. Results: 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. Conclusions: 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.

AB - Purpose: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. Materials and methods: 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. Results: 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. Conclusions: 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.

KW - Intensive care units

KW - Pain

KW - Pain assessment

KW - Quality improvement

KW - Quality indicator

UR - http://www.scopus.com/inward/record.url?scp=85056232941&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2018.10.027

DO - 10.1016/j.jcrc.2018.10.027

M3 - Article

VL - 49

SP - 136

EP - 142

JO - Journal of Critical Care

T2 - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -

Roos-Blom MJ, Gude WT, Spijkstra JJ, de Jonge E, Dongelmans D, de Keizer NF. Measuring quality indicators to improve pain management in critically ill patients. Journal of Critical Care. 2019 Feb 1;49:136-142. Available from, DOI: 10.1016/j.jcrc.2018.10.027