Influence of clinical practice guidelines on pain management in german intenive care units – A state wide survey

Abstract

Systematic pain assessment in critically ill patients might reduce the number of days with mechanical ventilation as well as the length of hospital stay. Clinical practice guidelines recommend the use of standardized instruments as part of a structured pain assessment strategy for mechanically ventilated patients in intensive care units. Since it is unknown whether clinicians adhere to the recommendations, we conducted a survey focusing the main recommendation of pain and sedation assessment for critically ill patients with mechanical ventilation. A questionnaire consisting of eight items was developed, piloted and sent out to 457 intensive care units in North Rhine-Westphalia, Germany. Nursing directors were asked to forward the questionnaire to the ward nurses or the physicians in charge of the intensive care units. The response rate was 37.4% (n=171). Nurses from 68 out of 171 intensive care units indicated the use of a pain assessment tool; identified as n=39 used self-reporting tools or n=29 proxy rating tools; n=88 answered to use sedation assessment tools. A total of 801 physiological parameters for pain assessment were stated, most often blood pressure (19.5%), heart rate (18.6%), body language (16.7%), and respiratory rate (16.0%). Although recommended in the guidelines, our survey indicates that pain assessment tools are rarely used at German intensive care units. It remains unclear how nurses and physicians use pain assessment tools in combination with other parameters for systematic pain assessment. Further research is needed on the barriers of guideline implementation to intensive care units.