title: Adherence to All Steps of a Pain Management Protocol in Intensive Care Patients after Cardiac Surgery Is Hard to Achieve.
abstract: Purpose.To investigate adherence to our pain protocol considering analgesics administration, number and timing of pain assessments, and adjustment of analgesics upon unacceptably high (NRS ≥ 4) and low (NRS ≤ 1) pain scores.Material and Methods.The pain protocol for patients in the intensive care unit (ICU) after cardiac surgery consisted of automated prescriptions for paracetamol and morphine, automated reminders for pain assessments, a flowchart to guide interventions upon high and low pain scores, and reassessments after unacceptable pain.Results.Paracetamol and morphine were prescribed in all 124 patients. Morphine infusion was stopped earlier than protocolized in 40 patients (32%). During the median stay of 47 hours [IQR 26 to 74 hours], 702/706 (99%) scheduled pain assessments and 218 extra pain scores were recorded. Unacceptably high pain scores accounted for 96/920 (10%) and low pain scores for 546/920 (59%) of all assessments. Upon unacceptable pain additional morphine was administered in 65% (62/96) and reassessment took place in 15% (14/96). Morphine was not tapered in 273 of 303 (90%) eligible cases of low pain scores.Conclusions.Adherence to automated prescribed analgesics and pain assessments was good. Adherence to nonscheduled, flowchart-guided interventions was poor. Improving adherence may refine pain management and reduce side effects.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands.
authors.forename: L
authors.identifier: 0000-0001-8603-5711
authors.initials: L
authors.lastname: van Gulik
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands; Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands.
authors.forename: S J G M
authors.initials: SJ
authors.lastname: Ahlers
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Bruins
authors.affiliation: Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands; Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands.
authors.forename: C A J
authors.initials: CA
authors.lastname: Knibbe
authors.affiliation: Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine