title: Improvement of Postoperative Pain Control Processes and Outcomes in Veterans of a Surgical Intensive Care Unit.
abstract: Postoperative pain remains undertreated in critically ill patients. We hypothesized that the adequacy of pain control in our Surgical Intensive Care Unit (SICU) was above the reported average of 71 % in the literature and that the introduction of the critical care pain observation tool (CPOT) could improve it. We used a Lean Six Sigma methodology to improve our processes and quantify our improvement.
  
  
  
  We retrospectively review 713 consecutive veterans admitted to our SICU. Between December 2014 and February 2015, postoperative pain was assessed every 2 h and rated "acceptable," "unacceptable," or "unable to assess". Between March 2015 and October 2015, postoperative pain was assessed with CPOT. Concurrently, we implemented a postoperative pain education program and documented this activity in the electronic medical record.
  
  
  
  The baseline adequacy of pain control was 78 %, which improved to 99 % after the introduction of CPOT. We concurrently achieved a 100 % median documentation of postoperative pain education in the electronic medical record. The introduction of CPOT improved the process σ from 2.3 to 3.8. The process of documenting pain education achieved a process σ of 3.1.
  
  
  
  The proportion of veterans with acceptable pain control in our SICU is higher than that reported in the literature and the application of a Six Sigma methodology that involved the introduction of the CPOT has allowed us to improve the perception of pain control and comply with the newest regulatory directives.
authors.affiliation: Nursing Service, Veterans Health Administration, Boston Healthcare System, Boston, MA, USA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: D'Andrea
authors.affiliation: Department of Surgery, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA, 02132, USA. piero.fisichella@va.gov.
authors.forename: P Marco
authors.initials: PM
authors.lastname: Fisichella
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D016638:Critical Illness; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies