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Benchmarking as a tool of continuous quality improvement in postoperative pain management

Published online by Cambridge University Press:  20 January 2006

W. Meissner ,
K. Ullrich  and
S. Zwacka
W. Meissner
Affiliation:
Friedrich-Schiller-University, Department of Anaesthesiolgy and Intensive Care, Jena, Germany
K. Ullrich
Affiliation:
Friedrich-Schiller-University, Department of Anaesthesiolgy and Intensive Care, Jena, Germany
S. Zwacka
Affiliation:
Friedrich-Schiller-University, Department of Nursing, Jena, Germany
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Extract

Summary

Background and objective: Quality of acute pain management is far from being satisfactory. These deficits are not caused by the complexity of the medical problem but by difficulties in organization and hospital structures, sand procedures. Continuous quality improvement is a recommended tool to overcome such difficulties and to increase quality in the long run. This study reports the implementation of benchmarking-based continuous quality improvement to improve postoperative pain management at a university hospital. Methods: A specialised pain nurse interviewed patients of three surgical departments on the first day after surgery, and continuously assessed process and outcome quality parameters. A multidisciplinary team of anaesthetists, surgeons, nurses and pharmacists implemented a regular procedure of data analysing and internal benchmarking. Results and suggested improvements were fed back to the healthcare teams. Results: From 1998 to 2002, 6756 patients were assessed. Average pain on ambulation and maximal pain were 3.7 ± 2.4 and 5.0 ± 2.5 (mean ± SD) on a 11-point numeric rating scale. Pain intensity at rest was 1.9 ± 1.8. Over time, pain intensity on ambulation decreased (P = 0.022) whereas maximal pain and pain at rest remained unchanged. There was an increase in the number of patients who received non-opioid analgesia (P < 0.001). Conclusions: A continuous quality improvement process could be established and is now successfully used in clinical routine. Cornerstones of this project were frequent assessments of process and outcome parameters, regular benchmarking and implementation of feedback mechanisms. Changes in organization of medical management and multidisciplinary teamwork seem to be more important than medical or technical aspects.

Keywords

QUALITY ASSURANCE, health careBENCHMARKINGPAIN POSTOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 2 , February 2006 , pp. 142 - 148
Copyright
© 2006 European Society of Anaesthesiology

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References

Kehlet H. Effect of postoperative pain treatment on outcome–current status and future strategies. Langenbecks Arch Surg 2004; 389: 244–249.Google Scholar
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534–540, table of contents.Google Scholar
Rawal N. Acute pain services revisited– good from far, far from good? Reg Anesth Pain Med 2002; 27: 117–121.Google Scholar
Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89: 409–423.Google Scholar
Rawal N, Berggren L. Organization of acute pain services: a low-cost model. Pain 1994; 57: 117–123.Google Scholar
American Pain Society Quality of Care Committee. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA 1995; 274: 1874–1880.
Lack JA, White LA, Thoms GM, Rollin AM. Raising the Standard: The Royal College of Anaesthetists, 2000.Google Scholar
Allcock N. The use of different research methodologies to evaluate the effectiveness of programmes to improve the care of patients in postoperative pain. J Adv Nurs 1996; 23: 32–38.Google Scholar
Meissner W, Ullrich K, Zwacka S, Schreiber T, Reinhart K. [Quality management in postoperative pain therapy.] Anaesthesist 2001; 50: 661–670.Google Scholar
Rawal N, Allvin R. Acute pain services in Europe: a 17-nation survey of 105 hospitals. The EuroPain Acute Pain Working Party. Eur J Anaesthesiol 1998; 15: 354–363.Google Scholar
Coleman SA, Booker-Milburn J. Audit of postoperative pain control. Influence of a dedicated acute pain nurse. Anaesthesia 1996; 51: 1093–1096.Google Scholar
Tighe SQ, Bie JA, Nelson RA, Skues MA. The acute pain service: effective or expensive care? Anaesthesia 1998; 53: 397–403.Google Scholar
Bardiau FM, Taviaux NF, Albert A, Boogaerts JG, Stadler M. An intervention study to enhance postoperative pain management. Anesth Analg 2003; 96: 179–185.Google Scholar
McNeill JA, Sherwood GD, Starck PL, Thompson CJ. Assessing clinical outcomes: patient satisfaction with pain management. J Pain Symptom Manage 1998; 16: 29–40.Google Scholar
Miaskowski C, Nichols R, Brody R, Synold T. Assessment of patient satisfaction utilizing the American Pain Society's Quality Assurance Standards on acute and cancer-related pain. J Pain Symptom Manage 1994; 9: 5–11.Google Scholar
Shayer M. Problems and issues in intervention studies. In: Demetriou A, Shayer M, Efklides A (eds). Neo-Piagetian Theories of Cognitive Development: Implications and Applications for Education. London: Routledge, 1992: 107–121.
Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995; 274: 700–705.Google Scholar
Deming WE. Out of the Crisis. Cambridge, MA: MIT Press, 1986.
Ward S, Donovan M, Max MB. A survey of the nature and perceived impact of quality improvement activities in pain management. J Pain Symptom Manage 1998; 15: 365–373.Google Scholar
Aubrun F, Paqueron X, Langeron O, Coriat P, Riou B. What pain scales do nurses use in the postanaesthesia care unit? Eur J Anaesthesiol 2003; 20: 745–749.Google Scholar
Jensen MP, Chen C, Brugger AM. Postsurgical pain outcome assessment. Pain 2002; 99: 101–109.Google Scholar
Crowley B, Lubesnick K, Sylwestrak ML. Clinical indicators: a tool for improving pain management documentation. J Nurs Care Qual 1991; 6: 40–46.Google Scholar
Dietrick-Gallagher M, Polomano R, Carrick L. Pain as a quality management initiative. J Nurs Care Qual 1994; 9: 30–42.Google Scholar
Gould TH, Crosby DL, Harmer M et al. Policy for controlling pain after surgery: effect of sequential changes in management. BMJ 1992; 305: 1187–1193.Google Scholar
Gordon DB, Pellino TA, Miaskowski C et al. A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures. Pain Manag Nurs 2002; 3: 116–130.Google Scholar
Joint Commission on Accreditation of Healthcare Organizations. Improving the Quality of Pain Management through Measurement and Action. Oakbrook Terrace, IL: JCAHO, 2003.