Implementation and maintenance of a pain management quality assurance program at intensive care units: 360 degree feedback of physicians, nurses and patients

Abstract

BackgroundPain management quality assurance programs (PMQP) have been successfully implemented in numerous hospitals across Europe. We aimed to evaluate the medium-term sustainability of a PMQP implemented at intensive care units (ICUs).MethodsTwo surveys, the first in 2012, immediately after introduction of the PMQP, and the second in 2015, were carried out amongst patients, physicians and nurses. Demographic parameters of all participants were assessed. Patients were asked after their pain levels during ICU stay. Staff members answered a questionnaire regarding familiarity with standards and processes of PMQP and self-perception of their knowledge as well as contentment with interdisciplinary communication.ResultsIn total (2012/2015), 267 (125/142) patients, 113 (65/48) physicians and 510 (264/246) members of the nursing staff participated. Minimum and maximum pain levels of patients did not differ between both surveys. Patients’ tolerance of pain 24 hours before the survey was better (p = 0.023), and vomiting occurred less often (p = 0.037) in 2015. Physicians’ and nurses’ contentment with the own knowledge about pharmacological pain treatment had increased from 2012 to 2015 (p = 0.002 and 0.004). Satisfaction with communication between nurses and physicians was better in 2015 (p<0.001 and p = 0.002). Familiarity with PMQP standards and processes remained stable in both collectives.ConclusionThe implementation of our PMQP achieved a high standard of care, guarantying a high patient and staff member satisfaction. Continuous education, ongoing training, regular updates and implementation of feedback-loops ensure continuity, in some parameters even an increase in knowledge and competencies. This is mirrored in high patient and staff member satisfaction.

Effect of Comprehensive Pain Management Training Program on Awareness and Attitude of ICU Nurses

“…According to another study by Machira et al, the training and implementation of a pain management program had a positive impact on the knowledge and attitude of Kenyan nurses (26). The results of studies by Smolle et al at Austrian hospitals, which were conducted to assess the sustainability of a pain management quality assurance program (PMQP), showed that the implementation of PMQP led to a high standard of care, and continuous education, ongoing training, regular courses, and implementing feedback loops would ensure the continuity and the increase of knowledge and competency in nurses and physicians (29). However, a study by Schreiber et al in Kentucky, USA, to assess the impact of training interventions on the nurses' knowledge of pain management in critically ill patients, showed that the nurses' awareness scores were not significantly different before and after the intervention (24).…”

“…Training in intensive care units should encourage critical care nurses (CCNs) to understand and confidently use pain assessment tools ( 16 ). Continuous training on pain management, regular feedback sessions ( 29 ), and implementation of pain management programs can also have a positive impact on increasing the nurses’ knowledge and attitude ( 26 - 30 ). Additionally, pain control guidelines can increase the effectiveness of nurses' clinical practice ( 31 ), but it should be noted that a comprehensive pain management program should consider not only prevention, but also all the three phases of pain management including diagnosis, treatment, and reassessment of pain ( 7 ).…”