title: [Postoperative pain management on surgical wards; impact of using a validated reference tool in a short, medium and long term].
abstract: OBJECTIVE
  To evaluate the short medium and long-term impact of a quality-improvement program (QIP) in a university hospital using a validated reference tool.
  
  
  METHODS
  Seven surgical departments were audited before and after implementation of a QIP in postoperative pain management. Audits were conducted in 2005, 2007, 2009 and 2012. In each audit, 10 medical charts from each surgical department were analyzed for 9 quality criteria. A surgical department score (SDS) was calculated for each department (maximum score=90). The surgical departments with a SDS<45 received targeted training sessions.
  
  
  RESULTS
  In 2005, three surgical departments had a SDS<45. After the first audit, a targeted training sessions was conducted in the three surgical departments, all seven departments improved their scores with a SDS>45 in 2007. Between 2007 and 2009, all seven departments improved their scores. Conversely, between 2009 and 2012, the SDS diminished in six of the seven surgical departments and four of the nine evaluated quality criteria decreased significantly: right detailed order for postoperative pain analgesia (prescriber identifier, agent used, unit doses, mode of administration; 100% versus 53; P=0.027), appropriate dosing of steps I and II analgesics (96% versus 80%; P=0.041), morphine (90% versus 76%; P=0.039), based on corresponding physician orders and monitor morphine side effects (87% versus 29; P=0.027).
  
  
  CONCLUSIONS
  Audits should be performed regularly (at least every two years) for detecting postoperative pain management degradation. Lack of targeted training sessions can explain partially this degradation.
authors.affiliation: Service d'anesthésie et réanimations chirurgicales, université Paris-Est Créteil, GHU Albert-Chenevier-Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France. michele.binhas@hmn.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Binhas
authors.forename: F
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: A
authors.initials: A
authors.lastname: Alves
authors.forename: G
authors.initials: G
authors.lastname: D'Honneur
authors.forename: B
authors.initials: B
authors.lastname: Plaud
mesh_terms: D000465:Algorithms; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D017408:Guidelines as Topic; D006785:Hospitals, University; D006801:Humans; D008485:Medical Audit; D018710:Pain Clinics / Q000592:standards*; D059408:Pain Management / Q000379:methods / Q000592:standards*; D010149:Postoperative Pain / Q000188:drug therapy / Q000628:therapy*; D058996:Quality Improvement
chemical_list: D000700:Analgesics