• M Binhas, F Roudot-Thoraval, A Alves, G D'Honneur, and B Plaud.
• 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
• Ann Fr Anesth Reanim. 2012 Oct 1;31(10):818-20.

ObjectivesTo evaluate the short medium and long-term impact of a quality-improvement program (QIP) in a university hospital using a validated reference tool.MethodsSeven 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.ResultsIn 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).ConclusionAudits 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.Copyright © 2012. Published by Elsevier SAS.

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