Measuring quality indicators to improve pain management in critically ill patients

J Crit Care. 2019 Feb:49:136-142. doi: 10.1016/j.jcrc.2018.10.027. Epub 2018 Oct 30.


Purpose: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement.

Materials and methods: We used a modified RAND method to develop pain assessment indicators. We measured performance on the indicators using retrospectively collected pain measurement data from Dutch ICUs, which are all mixed medical - surgical, of three months within October 2016-May 2017. We assessed the room for improvement, feasibility of data collection, and reliability of the indicators.

Results: We defined four pain assessment indicators. We analyzed 45,688 patient-shift observations from 15 ICUs. In 69.2% (IQR 58.7-84.9) of the patient-shifts pain was measured at least once (indicator 1); in 56.7% (IQR 49.6-73.5) pain scores were acceptable (indicator 2); in 11.7% (IQR 5.6-26.4) pain measurements with unacceptable scores were repeated within 1 h (indicator 3); and in 10.9% (IQR 5.1-20.1) unacceptable scores normalized within 1 h (indicator 4). We found data collection feasible because data were available for >79.3% of the admissions, and all indicators reliable as they produced consistent performance scores.

Conclusions: There is substantial variation in pain assessment across Dutch ICUs, and ample room for improvement. With this study we took a first step towards quality assurance of pain assessment in Dutch ICUs.

Keywords: Intensive care units; Pain; Pain assessment; Quality improvement; Quality indicator.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Critical Care / standards*
  • Critical Illness / therapy*
  • Data Collection
  • Feasibility Studies
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Pain / prevention & control*
  • Pain Management / standards
  • Pain Measurement / standards*
  • Quality Improvement
  • Quality Indicators, Health Care
  • Reproducibility of Results
  • Retrospective Studies