Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit
| Autor: | Noreen Clarke, Devjit Srivastava, John MacKintosh, Michelle Beattie, Mairi Mascarenhas, Michelle Roxburgh |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Quality management Critical Care Leadership and Management medicine.drug_class medicine.medical_treatment Best practice Sedation quality measurement Audit quality improvement law.invention 03 medical and health sciences 0302 clinical medicine law Pain assessment medicine pain 030212 general & internal medicine Mechanical ventilation business.industry Health Policy Public Health Environmental and Occupational Health BMJ Quality Improvement report 030208 emergency & critical care medicine Intensive care unit Sedative Physical therapy Control charts/run charts medicine.symptom business |
| Zdroj: | BMJ Open Quality |
| ISSN: | 2399-6641 |
| Popis: | Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%. |
| Databáze: | OpenAIRE |
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