title: Use of a validated reference tool to evaluate postoperative pain management through a quality-improvement program in a university hospital.
abstract: We audited the seven surgical departments of a university hospital before and after implementation of a program aiming to improve practices in postoperative pain management (POPM). Audits were conducted 2 years apart. During each evaluation, 10 medical charts from each surgical department (i.e., 70 charts) were analyzed for 9 quality criteria (five concerning anesthetist practices and four nursing practices). Two scores were calculated: one per department and the other per criteria. After the first audit, the seven departments received recommendations to improve their POPM. Targeted-training sessions were instituted for the three poorest performing departments (scores <4.5 out of 9 criteria). During the period between the two audits, all seven departments improved their scores; a statistically significant improvement was observed in five departments, including the three that had received targeted-training sessions. Moreover, overall scores for seven of the nine evaluated criteria improved, significantly for three criteria. Anesthetists significantly increased their overall score from 2.5 ± 0.8 to 3.7 ± 0.6 out of 5 points (p=.018), while surgical nurses' overall score did not change significantly from 2.3 ± 0.7 to 2.9 ± 0.7 out of 4 points (p=.128). In conclusion, using a standardized and validated instrument to evaluate POPM practices enables the identification of surgical departments requiring practice improvement and those quality criteria requiring reinforcement.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Committee Working against Pain; Hôpital Henri-Mondor, Université Paris XII, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. michele.binhas@hmn.aphp.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Binhas
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
authors.forename: Sabine
authors.initials: S
authors.lastname: Guerineau
authors.forename: Chantal
authors.initials: C
authors.lastname: Lory
authors.forename: Grégoire
authors.initials: G
authors.lastname: Jeanblanc
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kluger
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000458:organization & administration; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D058996:Quality Improvement; D018709:Statistics, Nonparametric; D013503:Surgery Department, Hospital / Q000458:organization & administration*