title: Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm.
abstract: OBJECTIVE
  To implement a pain management algorithm in intensive care units (ICU) and to evaluate nurses' level of adherence with the algorithm.
  
  
  BACKGROUND
  Many ICU patients experience pain. Therefore, an evidence-based algorithm for pain management was developed.
  
  
  METHODS
  A pain management algorithm was implemented in three units over three weeks. Nurses' level of adherence with the algorithm and associations between level of adherence and patient and unit characteristics over 22 weeks were evaluated using multivariate regression analysis.
  
  
  RESULTS
  Nurses' level of adherence was 74.6%. Adherence rates were lower on the evening and night shifts compared to the day shift. Males were assessed significantly less frequently than females. Patients with "injury, poisoning, or certain other consequences of external causes" were assessed significantly less frequently than patients with "diseases of the respiratory system."
  
  
  CONCLUSIONS
  ICU nurses can use a pain management algorithm consistently. Findings from this study suggest that a pain management algorithm is a useful tool to increase ICU nurses' adherence with pain assessment.
authors.affiliation: Østfold Hospital Trust, Fredrikstad, Norway; Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway. Electronic address: Brita.Fosser.Olsen@so-hf.no.
authors.forename: Brita F
authors.initials: BF
authors.lastname: Olsen
authors.affiliation: Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Rustøen
authors.affiliation: Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: Østfold Hospital Trust, Fredrikstad, Norway; Faculty of Medicine, University of Oslo, Norway; Norwegian University of Life Sciences, Aas, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Jacobsen
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Berit T
authors.initials: BT
authors.lastname: Valeberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003422:Critical Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000451:nursing*; D059408:Pain Management / Q000592:standards*; D057184:Practice Patterns, Nurses'; D055815:Young Adult
keywords: Acute pain; Critical care; Intensive care unit; Pain assessment; Pain management; Pain management algorithm