Figure 1.

Study-design and quality method. This figure represents the quality-improvement process of pain and serious adverse events while moving ICU patients for turning and nursing care procedures. This 20-month process following the P-D-C-A steps was evaluated by four one-month studied phases separated by inter-study phases of four to six months. The present quality improvement process was the third quality process performed in the ICU regarding the management of sedation and analgesia. Consecutive improvement steps were followed according to the Plan-Do-Check-Adjust method for quality-improvement:

- P (Plan-step): Multidisciplinary ICU work group creation, choice of the studied procedure and design of the quality improvement process.

- D (Do-step): Beginning of the Nurse-Do study by a one-month baseline evaluation of pain management by nurse while moving the patients (studied Phase 1). Educational interventions for optimized pain management by nurse (Nurse-Do) started after the baseline studied phase.

- C (Check step): One-month evaluation (Check) of educational interventions (studied Phase 2).

- A (Adjust step): Adjustment of educational interventions implicating an increased multidisciplinary team collaboration, one-month evaluation (Check) of adjusted interventions (studied Phase 3).

- Consolidation step: one-month control audit of the PDCA quality improvement process (studied Phase 4).