Pain Management, Critical Care, Quality Improvement
Conditions
Brief summary
This study evaluates the addition of a quality improvement toolbox to an online audit and feedback intervention in Dutch intensive care units. The toolbox comprises for each quality indicator (e.g., percentage of patients per shift whose pain is measured) a list of potential bottlenecks in the care process (e.g., staff is unaware of the prevailing guidelines for measuring pain every shift), associated recommendations for actions to solve mentioned bottlenecks (e.g., organize an educational training session), and supporting materials to facilitate implementation of the actions (e.g., a slide show presentation discussing the importance and relevance of measuring pain every shift). Half of the participating intensive care units will only receive online feedback, while the other half will additionally gain access to the integrated toolbox to facilitate planning and executing actions.
Interventions
BEHAVIORALAudit and Feedback
An online dashboard that provides insight into clinical performance on pain management quality indicators. It also incorporates an empty action plan, in which participating intensive care units can define potential bottlenecks in the care process and what actions they intend to undertake to improve.
BEHAVIORALToolbox
A quality improvement toolbox, incorporated within the action plan, that comprises for each pain management quality indicator (e.g., percentage of patients per shift whose pain is measured) a list of potential bottlenecks in the care process (e.g., staff is unaware of the prevailing guidelines for measuring pain every shift), associated recommendations for actions to solve mentioned bottlenecks (e.g., organize an educational training session), and supporting materials to facilitate implementation of the actions (e.g., a slide show presentation discussing the importance and relevance of measuring pain every shift).
Sponsors
National Intensive Care Evaluation Foundation
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ICUs treating adult (18 years and above) patients * ICUs willing and able to submit data monthly * ICUs with a local quality improvement team of at least 1 intensivist and 1 nurse
Exclusion criteria
* Nil
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from proportion of patient shifts during which pain has been adequately managed | 9 months | Adequately managed is defined: pain measured AND (acceptable pain score OR (unacceptable pain score AND normalized within 1 hour)). The primary outcome measure is a composite score of four quality indicators (= secondary outcome measures).The measure is limited to only patients' first 12 shifts to prevent bias from patients with a long stay. There are 3 shifts in 1 day. |
Secondary
| Measure | Time frame |
|---|---|
| Change from proportion of patient shifts during which pain was measured at least once | 9 months |
| Change from proportion of patient shifts during which pain was measured and no unacceptable pain scores were observed | 9 months |
| Change from proportion of patient shifts during which an unacceptable pain score was measured, and pain was timely re-measured | 9 months |
| Change from proportion of patient shifts during which an unacceptable pain score was measured, and pain was timely re-measured indicating that the pain score was normalized | 9 months |
Countries
Netherlands
Outcome results
None listed