Use of a validated reference tool to evaluate postoperative pain management through a quality-improvement program in a university hospital.

We audited the seven surgical departments of a university hospital before and after implementation of a program aiming to improve practices in postoperative pain management (POPM). Audits were conducted 2 years apart. During each evaluation, 10 medical charts from each surgical department (i.e., 70 charts) were analyzed for 9 quality criteria (five concerning anesthetist practices and four nursing practices). Two scores were calculated: one per department and the other per criteria. After the first audit, the seven departments received recommendations to improve their POPM. Targeted-training sessions were instituted for the three poorest performing departments (scores <4.5 out of 9 criteria). During the period between the two audits, all seven departments improved their scores; a statistically significant improvement was observed in five departments, including the three that had received targeted-training sessions. Moreover, overall scores for seven of the nine evaluated criteria improved, significantly for three criteria. Anesthetists significantly increased their overall score from 2.5 ± 0.8 to 3.7 ± 0.6 out of 5 points (p=.018), while surgical nurses' overall score did not change significantly from 2.3 ± 0.7 to 2.9 ± 0.7 out of 4 points (p=.128). In conclusion, using a standardized and validated instrument to evaluate POPM practices enables the identification of surgical departments requiring practice improvement and those quality criteria requiring reinforcement.
(© 2010 National Association for Healthcare Quality.)