title: Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project).
abstract: BACKGROUND
  A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients.
  
  
  METHODS
  The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning). Phase 1 was considered as the baseline. Implemented and adjusted quality-interventions were assessed at phases 2 and 3, respectively. An independent post-intervention control-audit was performed at Phase 4. Primary-endpoints were the incidence of severe pain defined by a behavioral pain scale > 5 or a 0 to 10 visual numeric rating scale > 6, and the incidence of serious adverse events (SAE): cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress. Pain, SAE, patients' characteristics and analgesia were compared among the phases by a multivariate mixed-effects model for repeated-measurements, adjusted on severity index, age, admission type (medical/surgical), intubation and sedation status.
  
  
  RESULTS
  During the four studied phases, 630 care procedures were analyzed in 53, 47, 43 and 50 patients, respectively. Incidence of severe pain decreased significantly from 16% (baseline) to 6% in Phase 3 (odds ratio (OR) = 0.33 (0.11; 0.98), P = 0.04) and 2% in Phase 4 (OR = 0.30 (0.12; 0.95), P = 0.02). Incidence of SAE decreased significantly from 37% (baseline) to 17% in Phase 3 and 21% in Phase 4. In multivariate analysis, SAE were independently associated with Phase 3 (OR = 0.40 (0.23; 0.72), P < 0.01), Phase 4 (OR = 0.53 (0.30; 0.92), P = 0.03), intubation status (OR = 1.91 (1.28; 2.85), P < 0.01) and severe pain (OR = 2.74 (1.54; 4.89), P < 0.001).
  
  
  CONCLUSIONS
  Severe pain and serious adverse events are common and strongly associated while moving ICU patients for nursing procedures. Quality improvement of pain management is associated with a decrease of serious adverse events. Careful documentation of pain management during mobilization for nursing procedures could be implemented as a health quality indicator in the ICU.
authors.forename: Audrey
authors.initials: A
authors.lastname: de Jong
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Sylvie
authors.initials: S
authors.lastname: de Lattre
authors.forename: Claudine
authors.initials: C
authors.lastname: Gniadek
authors.forename: Julie
authors.initials: J
authors.lastname: Carr
authors.forename: Mathieu
authors.initials: M
authors.lastname: Conseil
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Susbielles
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Gérald
authors.initials: G
authors.lastname: Chanques
mesh_terms: D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D055805:Moving and Lifting Patients / Q000009:adverse effects / Q000379:methods*; D009732:Nursing Care / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index