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

Abstract

IntroductionA quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients.MethodsThe 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.ResultsDuring 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).ConclusionsSevere 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.

Pengkajian Nyeri pada Pasien Kritis dengan Menggunakan Critical Pain Observation Tool(CPOT) di Intensive Care Unit(ICU)

“…Tidak adekuatnya pengkajian nyeri dapat menyebabkan tidak dikenalinya masalah nyeri sehingga nyeri tidak tertangani. Nyeri yang tidak ditangani secara optimal dapat menimbulkan dampak yang buruk terhadap fungsi fisiologis (fluktuasi tandatanda vital, nosokomial infeksi), meningkatkan waktu rawat inap di ICU, meningkatkan waktu penggunaan ventilator (Canques et al, 2006, De Jong et al, 2013, Sessler et al, 2008, Payen et al, 2009, Futier et al, 2012. Selain hal tersebut, nyeri yang tidak tertangani juga bisa menyebabkan peningkatan tekanan intra kranial (Bor Seng et al, 2013), pada level yang tinggi juga memiliki konsekuensi menimbukan post traumatic stres disorder (Myhren et al,2010) Manajemen yang tepat dari nyeri tergantung pada pengkajian nyeri yang sistematis dan akurat (Herr et al, 2006).…”

Pain Perception of Nurses and Pain Expression of Patients in Critical Care Units

“…www.kan.or.kr 배경희·정인숙 환자가 경험하는 통증은 주요한 스트레스원으로 다양한 부정적 인 영향을 줄 수 있다 [5][6][7]. 통증은 부정맥, 빈맥, 서맥, 고혈압, 저혈 압, 호흡장애 [5]와 혈당조절장애 [6]와 같은 생리적 문제를 초래하며, 지속적이고 완화되지 않은 통증은 수면장애의 원인이 되어 [7], 환 자의 삶의 질을 저하시킬 수 있다.…”

“…통증은 부정맥, 빈맥, 서맥, 고혈압, 저혈 압, 호흡장애 [5]와 혈당조절장애 [6]와 같은 생리적 문제를 초래하며, 지속적이고 완화되지 않은 통증은 수면장애의 원인이 되어 [7], 환 자의 삶의 질을 저하시킬 수 있다. 따라서, 의료인은 환자가 경험하 는 통증을 정확히 사정하여 인식하고, 이를 감소시키기 위한 적절 한 중재를 강구할 필요가 있다.…”

Optimizing safe, comfortable ICU care through multi-professional quality improvement: just DO it

“…In this issue of Critical Care , de Jong and colleagues report on a quality improvement (QI) project (NURSE-DO) that led to a decrease in severe pain and serious adverse events during nursing care procedures in their ICU [1]. In this commentary we describe three aspects of this QI study that we think contributed to the overall success of the NURSE-DO project: the hospital environmental and culture; multi-professional partnerships; and a structured approach.…”