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Table 3 Unique actions (n = 29) grouped by practice domain with the percentage of ICUs that planned (and completed) these actions

From: Facilitating action planning within audit and feedback interventions: a mixed-methods process evaluation of an action implementation toolbox in intensive care

Unique actions grouped by practice domain % of ICUs that planned (completed) the action
Feedback with toolbox (n = 10) Feedback only (n = 11)
Guideline (e.g. clarity of the recommendation, accessibility) 60 (40) 36.4 (27.3)
 Revise pain protocol about pain monitoring (e.g. frequency, triggers) 40 (20) 9.1 (0)
 Workflow redesign; introduce routine to measuring pain 20 (20) 9.1 (9.1)
 Increase protocol accessibility (e.g. electronically, flow chart, pocket card) 20 (10) 9.1 (9.1)
 Develop pain protocol 20 (10)
 Revise pain protocol about pain medication (e.g. drug choice, dosage choice) 10 (10) 27.3 (18.2)
 Workflow redesign; check contraindications to pain medications at admission 10 (0)
Individual health professional (e.g. knowledge and skills; cognitions) 90 (70) 81.8 (63.6)
 Digital newsletter or email 70 (60) 27.3 (27.3)
 Educational meeting 70 (50) 9.1 (9.1)
 Individual feedback if pain has not been measured 60 (20) 9.1 (9.1)
 Promotional poster or message board 40 (30) 36.4 (27.3)
 Announcement about pain monitoring during regular staff meeting* 10 (0) 72.7 (63.6)
 Quiz about ICU pain management knowledge* 9.1 (9.1)
Professional interactions (e.g. communication and influence; team processes) 30 (10) 9.1 (9.1)
 Include information on pain status to hand-over moments during shift change 20 (0) 9.1 (9.1)
 Collaborate with Acute Pain Service about pain medication after surgery* 10 (10)
Incentives and resources (e.g. availability of resources; information system) 100 (80) 63.6 (36.4)
 Build or adapt reminder system in the EHR 80 (50) 36.4 (18.2)
 Increase completeness of pain measurement data recording in the local EHR 50 (30)
 Expand order set in EHR (e.g. add pain measurement order at admission)* 40 (40) 18.2 (9.1)
 Provide validated pain measurement tools (i.e. NRS, VAS, BPS, CPOT) 30 (20)
 Adapt EHR form to facilitate pain measurement recording* 10 (10) 18.2 (9.1)
 Create performance monitoring tool/dashboard* 10 (0) 9.1 (0)
 Nonfinancial incentives (e.g. edible treat) if targets are achieved* 9.1 (9.1)
 Keep patient-controlled analgesia (PCA) pumps in stock locally at ICU* 9.1 (0)
Capacity for organisational change (e.g. mandate, authority, accountability) 40 (40) 27.3 (18.2)
 Assign or involve a pain coordinator 40 (40) 18.2 (9.1)
 Workflow redesign; increase efficiency to allow more time for measuring pain 10 (10)
 Expand pain management QI team* 10 (10)
 Monitoring and feedback on (recording of) pain measurements each shift* 10 (0) 9.1 (9.1)
 Monitoring and feedback on appropriateness of prescribed pain medication 10 (0)
Patient (e.g. patient needs; preferences) 30 (10)
 Workflow redesign; monitor/manage factors (e.g. fear) that may worsen pain 20 (0)
 Workflow redesign; measure pain on patients’ indication 10 (10)
  1. *A self-defined action that did not match any toolbox action