Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program.
OBJECTIVE
The aim of this study was to test the effectiveness of a quality improvement postoperative pain treatment program after cardiac surgery.


METHODS
This was a prospective, quasiexperimental study using nonequivalent groups comprising 3 periods: baseline (group baseline), implementation of the algorithm for acute pain management, and reassessment (group reassessment). Inclusion of 133 patients after elective cardiac surgery at an 18-bed surgical intensive care unit (SICU) at a Swiss university hospital. The algorithm was implemented by training, pocket guidelines, regular audits, and feedback. The implementation period was completed when the adherence to 2 of 3 process indicators attained at least 70% over 2 months. Visual analog scales (VAS) for pain, morphine consumption, pain perception, and sleep quality were assessed during stay in SICU and after 1 month and 6 months.


RESULTS
The assessment included 79 patients at baseline and 54 in the reassessment periods. Pain intensity at rest decreased from 2.7 +/- 1.4 to 2.2 +/- 1.4 cm (VAS; P = .008). Retrospective perception of pain intensity at rest decreased from 3.8 +/- 2.2 to 2.6 +/- 1.8 (P = .004). The proportion of patients with no pain or often without pain increased from 11% to 37% (P = .005). The number of patients with sleep disturbances decreased from 68% to 35% (P = .012). No differences were observed at 1 and 6 months postoperatively.


CONCLUSIONS
After algorithm implementation in the SICU, pain intensity at rest decreased and quality of sleep improved.
Diby
Marc
M
Nursing Directorate, University Hospitals of Geneva, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.
Romand
Jacques-André
JA
Frick
Sonia
S
Heidegger
Claudia Paula
CP
Walder
Bernhard
B
D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002985:Clinical Protocols; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012890:Sleep / Q000187:drug effects; D013997:Time Factors
D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine