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