Structured approaches to pain management in the ICU.
Pain in patients who are critically ill remains undertreated despite decades of research, guideline development and distribution, and intense educational efforts. By nature of their complex medical conditions, these patients present unique challenges to the delivery of optimal pain treatment. Outdated clinical practices and faulty systems, such as a formulary that allows dangerous prescriptions, present additional obstacles. A multidisciplinary and patient-centered continuous quality improvement process is essential to identifying barriers and implementing evidence-based solutions to the problem of undertreated pain in hospital ICUs. This article addresses barriers common to the ICU setting and presents a number of structured approaches that have been shown to be successful in improving pain treatment in patients who are critically ill.
Pasero
Chris
C
Independent Pain Management Educator and Clinical Consultant, El Dorado Hills, CA. Electronic address: cpasero@aol.com.
Puntillo
Kathleen
K
Critical Care/Trauma Program Department of Physiological Nursing, University of California, San Francisco, CA.
Li
Denise
D
Department of Nursing and Health Sciences, College of Science, California State University, East Bay, Hayward, CA.
Mularski
Richard A
RA
The Center for Health Research, Kaiser Permanente Northwest and Oregon Health and Science University, Portland, OR.
Grap
Mary Jo
MJ
Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, VA.
Erstad
Brian L
BL
The University of Arizona College of Pharmacy, Department of Pharmacy Practice and Science, Tucson, AZ.
Varkey
Basil
B
Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Gilbert
Hugh C
HC
Northwestern University Department of Anesthesiology, Feinberg School of Medicine, Chicago, IL.
Medina
Justine
J
Professional Practice and Programs, American Association of Critical Care Nurses, Aliso Viejo, CA.
Sessler
Curtis N
CN
Virginia Commonwealth University Health System, Richmond, VA.
D000698:Analgesia / Q000592:standards* / Q000639:trends; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003422:Critical Care / Q000592:standards; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D010148:Intractable Pain / Q000175:diagnosis / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D018570:Risk Assessment; D014481:United States
D000701:Analgesics, Opioid