ICU Pain Management Needs Quality Improvement

Article faults outdated prescribing, poor quality monitoring, lack of accountability in ICUs
By Jeff Muise
HealthDay Reporter

MONDAY, June 8 (HealthDay News) -- Pain in critically ill patients is often undertreated and may even go unrecognized in intensive care units (ICU), pointing out the need for quality improvement in this important facet of care, according to an article in the June issue of Chest.

Chris Pasero, R.N., an independent pain management educator and clinical consultant in El Dorado Hills, Calif., and colleagues examined the barriers to pain management in critically ill patients and offered recommendations for an improvement process based on guidelines issued by the American Pain Society in 2005.

The researchers discovered an estimated 70 percent of critically ill patients experience at least moderate pain in the ICU. Among the barriers to pain management are failure to assess or acknowledge a patient's pain, outdated prescribing habits, inadequate quality monitoring, and a lack of accountability for poorly managed pain. The researchers fault the ICU clinicians' lack of knowledge about pain assessment and management, personal and cultural bias, and poor communication with the patient. The authors further advocate a process of improvement, including a review of prescribing practices, patient satisfaction surveys, clinician attitude surveys, and the adoption of evidence-based best practices.

"Despite decades of pain improvement initiatives, pain is common and often undertreated in the patients who are critically ill. The systematic and multidisciplinary implementation of evidence-based structured approaches and a rigorous continuous quality improvement plan are recommended to improve the way pain is managed in this vulnerable population." the authors conclude.

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