Impact of the Multidisciplinary ICU Daily Goals Checklist on quality of pain management in critically ill patients at a University Teaching Hospital of Kigali/Rwanda

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.