Limits...
Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project).

de Jong A, Molinari N, de Lattre S, Gniadek C, Carr J, Conseil M, Susbielles MP, Jung B, Jaber S, Chanques G - Crit Care (2013)

Bottom Line: Pain, SAE, patients' characteristics and analgesia were compared among the phases by a multivariate mixed-effects model for repeated-measurements, adjusted on severity index, age, admission type (medical/surgical), intubation and sedation status.Incidence of severe pain decreased significantly from 16% (baseline) to 6% in Phase 3 (odds ratio (OR) = 0.33 (0.11; 0.98), P = 0.04) and 2% in Phase 4 (OR = 0.30 (0.12; 0.95), P = 0.02).Incidence of SAE decreased significantly from 37% (baseline) to 17% in Phase 3 and 21% in Phase 4.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients.

Methods: The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning). Phase 1 was considered as the baseline. Implemented and adjusted quality-interventions were assessed at phases 2 and 3, respectively. An independent post-intervention control-audit was performed at Phase 4. Primary-endpoints were the incidence of severe pain defined by a behavioral pain scale > 5 or a 0 to 10 visual numeric rating scale > 6, and the incidence of serious adverse events (SAE): cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress. Pain, SAE, patients' characteristics and analgesia were compared among the phases by a multivariate mixed-effects model for repeated-measurements, adjusted on severity index, age, admission type (medical/surgical), intubation and sedation status.

Results: During the four studied phases, 630 care procedures were analyzed in 53, 47, 43 and 50 patients, respectively. Incidence of severe pain decreased significantly from 16% (baseline) to 6% in Phase 3 (odds ratio (OR) = 0.33 (0.11; 0.98), P = 0.04) and 2% in Phase 4 (OR = 0.30 (0.12; 0.95), P = 0.02). Incidence of SAE decreased significantly from 37% (baseline) to 17% in Phase 3 and 21% in Phase 4. In multivariate analysis, SAE were independently associated with Phase 3 (OR = 0.40 (0.23; 0.72), P < 0.01), Phase 4 (OR = 0.53 (0.30; 0.92), P = 0.03), intubation status (OR = 1.91 (1.28; 2.85), P < 0.01) and severe pain (OR = 2.74 (1.54; 4.89), P < 0.001).

Conclusions: Severe pain and serious adverse events are common and strongly associated while moving ICU patients for nursing procedures. Quality improvement of pain management is associated with a decrease of serious adverse events. Careful documentation of pain management during mobilization for nursing procedures could be implemented as a health quality indicator in the ICU.

Show MeSH

Related in: MedlinePlus

Incidence of severe pain, serious adverse events and analgesia. This figure shows that the incidence of severe pain and serious adverse events (SAE) decreased across the quality improvement study while the proportion of given analgesia increased. The difference was significant for severe pain (P = 0.04 and 0.02), SAE (P < 0.001 and P < 0.01) and analgesia (P = 0.01 and P < 0.01) between Phase 1 (baseline) and Phases 3 and 4, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672726&req=5

Figure 3: Incidence of severe pain, serious adverse events and analgesia. This figure shows that the incidence of severe pain and serious adverse events (SAE) decreased across the quality improvement study while the proportion of given analgesia increased. The difference was significant for severe pain (P = 0.04 and 0.02), SAE (P < 0.001 and P < 0.01) and analgesia (P = 0.01 and P < 0.01) between Phase 1 (baseline) and Phases 3 and 4, respectively.

Mentions: Incidence of severe pain, as well as at least one SAE (cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress), decreased over the quality improvement study, while the proportion of analgesia given for nursing care procedures increased (Figure 3). The difference was not significant between Phase 1 (baseline) and Phase 2 (first intervention P-D-C-A step) but became significant during Phase 3 (adjusted-intervention P-D-C-A step) and Phase 4 (consolidation P-D-C-A step).


Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project).

de Jong A, Molinari N, de Lattre S, Gniadek C, Carr J, Conseil M, Susbielles MP, Jung B, Jaber S, Chanques G - Crit Care (2013)

Incidence of severe pain, serious adverse events and analgesia. This figure shows that the incidence of severe pain and serious adverse events (SAE) decreased across the quality improvement study while the proportion of given analgesia increased. The difference was significant for severe pain (P = 0.04 and 0.02), SAE (P < 0.001 and P < 0.01) and analgesia (P = 0.01 and P < 0.01) between Phase 1 (baseline) and Phases 3 and 4, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672726&req=5

Figure 3: Incidence of severe pain, serious adverse events and analgesia. This figure shows that the incidence of severe pain and serious adverse events (SAE) decreased across the quality improvement study while the proportion of given analgesia increased. The difference was significant for severe pain (P = 0.04 and 0.02), SAE (P < 0.001 and P < 0.01) and analgesia (P = 0.01 and P < 0.01) between Phase 1 (baseline) and Phases 3 and 4, respectively.
Mentions: Incidence of severe pain, as well as at least one SAE (cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress), decreased over the quality improvement study, while the proportion of analgesia given for nursing care procedures increased (Figure 3). The difference was not significant between Phase 1 (baseline) and Phase 2 (first intervention P-D-C-A step) but became significant during Phase 3 (adjusted-intervention P-D-C-A step) and Phase 4 (consolidation P-D-C-A step).

Bottom Line: Pain, SAE, patients' characteristics and analgesia were compared among the phases by a multivariate mixed-effects model for repeated-measurements, adjusted on severity index, age, admission type (medical/surgical), intubation and sedation status.Incidence of severe pain decreased significantly from 16% (baseline) to 6% in Phase 3 (odds ratio (OR) = 0.33 (0.11; 0.98), P = 0.04) and 2% in Phase 4 (OR = 0.30 (0.12; 0.95), P = 0.02).Incidence of SAE decreased significantly from 37% (baseline) to 17% in Phase 3 and 21% in Phase 4.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients.

Methods: The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning). Phase 1 was considered as the baseline. Implemented and adjusted quality-interventions were assessed at phases 2 and 3, respectively. An independent post-intervention control-audit was performed at Phase 4. Primary-endpoints were the incidence of severe pain defined by a behavioral pain scale > 5 or a 0 to 10 visual numeric rating scale > 6, and the incidence of serious adverse events (SAE): cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress. Pain, SAE, patients' characteristics and analgesia were compared among the phases by a multivariate mixed-effects model for repeated-measurements, adjusted on severity index, age, admission type (medical/surgical), intubation and sedation status.

Results: During the four studied phases, 630 care procedures were analyzed in 53, 47, 43 and 50 patients, respectively. Incidence of severe pain decreased significantly from 16% (baseline) to 6% in Phase 3 (odds ratio (OR) = 0.33 (0.11; 0.98), P = 0.04) and 2% in Phase 4 (OR = 0.30 (0.12; 0.95), P = 0.02). Incidence of SAE decreased significantly from 37% (baseline) to 17% in Phase 3 and 21% in Phase 4. In multivariate analysis, SAE were independently associated with Phase 3 (OR = 0.40 (0.23; 0.72), P < 0.01), Phase 4 (OR = 0.53 (0.30; 0.92), P = 0.03), intubation status (OR = 1.91 (1.28; 2.85), P < 0.01) and severe pain (OR = 2.74 (1.54; 4.89), P < 0.001).

Conclusions: Severe pain and serious adverse events are common and strongly associated while moving ICU patients for nursing procedures. Quality improvement of pain management is associated with a decrease of serious adverse events. Careful documentation of pain management during mobilization for nursing procedures could be implemented as a health quality indicator in the ICU.

Show MeSH
Related in: MedlinePlus