• Marc Diby, Jacques-André Romand, Sonia Frick, Claudia Paula Heidegger, and Bernhard Walder.
• Nursing Directorate, University Hospitals of Geneva, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.
• J Crit Care. 2008 Sep 1;23(3):359-71.

PurposeThe aim of this study was to test the effectiveness of a quality improvement postoperative pain treatment program after cardiac surgery.Materials And MethodsThis was a prospective, quasiexperimental study using nonequivalent groups comprising 3 periods: baseline (group baseline), implementation of the algorithm for acute pain management, and reassessment (group reassessment). Inclusion of 133 patients after elective cardiac surgery at an 18-bed surgical intensive care unit (SICU) at a Swiss university hospital. The algorithm was implemented by training, pocket guidelines, regular audits, and feedback. The implementation period was completed when the adherence to 2 of 3 process indicators attained at least 70% over 2 months. Visual analog scales (VAS) for pain, morphine consumption, pain perception, and sleep quality were assessed during stay in SICU and after 1 month and 6 months.ResultsThe assessment included 79 patients at baseline and 54 in the reassessment periods. Pain intensity at rest decreased from 2.7 +/- 1.4 to 2.2 +/- 1.4 cm (VAS; P = .008). Retrospective perception of pain intensity at rest decreased from 3.8 +/- 2.2 to 2.6 +/- 1.8 (P = .004). The proportion of patients with no pain or often without pain increased from 11% to 37% (P = .005). The number of patients with sleep disturbances decreased from 68% to 35% (P = .012). No differences were observed at 1 and 6 months postoperatively.ConclusionsAfter algorithm implementation in the SICU, pain intensity at rest decreased and quality of sleep improved.

33 keywords...

hide…