Improving assessment and treatment of pain in the critically ill.

OBJECTIVE: Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. DESIGN: We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was < or =3. We then implemented four separate "plan-do-study-act" cycles to improve pain assessment and treatment. MAIN OUTCOME MEASURES: We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment. RESULTS: Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%. CONCLUSION: Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.