Quality Improvement in an Anaesthesiology and Intensive Care Unit Through Pain Assessment and Control

Abstract

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)—60 patients and a prospective group (PG)—91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG—50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.