Abstract:
Background: In various resource settings, pain assessment and management modalities are often
limited by the lack of adequate health care resources, knowledge, the culture and the lack of
systematic approach to its management.
Aims: To investigate the impact of the Multidisciplinary ICU Daily Goals Checklist (MIDGC)
on quality of pain management in ICU patients in a variable resource environment at University
Teaching Hospital of Kigali, CHUK.
Methods: Data on pain assessment, management and pain intensity for 132 ICU adult patients
were collected on a same hour on odd days of the week for 8 weeks before the introduction of
the MIDGC at CHUK and for 135 patients after its implementation. We compared the frequency
and quality of pain assessment and management between the 2 periods by using the chi-square
test on Epi Info 7 software.
Results: Before the implementation of the checklist, there was no documented use of pain
assessment tool whereas after its implementation, the tool was used in all but one patients
(99.09%). There was also a reduction of pain scores during the post-implementation period:
proportions of patients with severe pain decreased from 34.8% (47 patients) to 8.3% (11
patients), corresponding to a reduction of 26.5% [95CI:4.2%-43.4%], p<0.0001; that of patients
with mild pain increased from 14.1% (19 patients) to 59.9% (79 patients), corresponding to an
increase of 45.8% [95CI:21.1%-68.2%], p<0.0001.
Conclusions: The use of the MIDGC is of great importance in improving the quality of pain
management among other interventions and may be used during ICU daily rounds. It has an
impact on use of pain assessment scales and improves pain management among critically ill
patients.
