Table 3.
Summary of interventions to improve patient monitoring in the hospital inpatient setting (n = 10)
| Author, year, country | Study size (n; I = intervention, C = standard care) | Study design | Study population, Follow‐up duration | Interventiona | Outcomes | ||
|---|---|---|---|---|---|---|---|
| Health care professional education | Other | Prescribing | 2Clinical | ||||
| Pain monitoring | |||||||
| Muntlin et al., 2010, Sweden43 | 200 (I: 100 C: 100) | Quasi‐experimental study | ED 4 mo | ‐ Optional face‐to‐face nurse education to increase opioid analgesic use‐ Analgesic protocol‐ NRS pain evaluation | ↑ Analgesic use (46.0–65.0%*) | ↓ Pain intensity (NRS: 3.8 vs 2.9*) ↑ Patient satisfaction with pain management (Out of 10: 2.3 vs 3.6*)No changes in opioid‐related ADEs | |
| Chanques et al., 2006, France36 | 230 (I: 130 C: 100) | Pre–post intervention study | ICU 4 mo | ‐ Face‐to‐face nurse education to evaluate pain as ‘vital sign’ ‐ BPS and NRS pain evaluation | No change in morphine use↑ Tramadol use (15.0 vs 27.0%*) | ↓ Pain incidence (63.0 vs 42.0%*) and intensity (NRS > 6, 36.0 vs 16.0%*)↓ MV duration (120 [IQR 48–312] vs 65 [IQR 24–192] h*)No change in ICU LOS or mortality | |
| Duncan & Pozehl, 2000, USA31 | 240 (I: 121 C: 119) | Pre–post intervention study | Surgical 15 mo | ‐ Face‐to‐face nurse education of opioid use as ‘cornerstone’ pain treatment (according to Acute Pain Management: Operative or Medical Procedures and Trauma: Clinical Practice Guideline (Agency for Health Care Policy & Research. 1992)‐ NRS pain evaluation | ‐ Audit and feedback (daily) | ↑ Morphine use (OME: 12.70 vs 14.54 mg/d*) | ↓ Pain intensity (NRS: 3.58 vs 3.16*) |
| Olsen et al., 2016, Norway37 | 650 (I: 398 C: 252) | Pre–post intervention study | ICU 22 weeks | ‐ Face‐to‐face nurse education to encourage analgesic and nonpharmacologic pain management‐ Analgesia protocol ‐ NRS and BPS pain evaluation | ↑ Fentanyl use as epidural (median 223 vs 310 μg*) | ↓ Agitation events (3.0 vs 6.0%*) ↓ MV duration (median 46 vs 79 h*)↓ ICU LOS (median 2.6 vs 3.0 d, P = 0.04) | |
| Pierik et al., 2016, Netherlands44 | 660 (I: 156 C: 504) | Pre–post intervention study | ED 6 mo | ‐ Education to encourage nonopioid use before opioid analgesia (Pain management for trauma patients in the chain of emergency care) ‐ Analgesia protocol‐ NRS pain evaluation ‐ Leaflet material | ↑ Analgesic use (95% CI 11.5–30.9*) ↓ Time to opioid administration (37 vs 15 min*) | ↑ Pain relief (95% CI 1.8–18.5*)No changes in ED LOS or patient satisfaction | |
| Cui et al., 2017, China32 | 148 (I: 71 C: 77) | Separate sample pre–post intervention study | Surgical 24 mo | ‐ Mandatory nurse education encouraging nonpharmacological pain management‐ Analgesic protocol‐ Hard copy guidelines (Acute Pain Management Handbook for Nurses developed by Professor Ramani Vijayan, Department of Anaesthiology, University of Malaya, Malaysia)‐ NRS pain evaluation | ↑ Nonopioids and opioid combination use (38.8 vs 66.2%*)No change in the opioid use alone↑ Nonpharmacological pain management (60.0 vs 96.0%*) | ↑ Pain relief (53.0 vs 78.0%*) | |
| Manias et al., 2011, Australia45 | 192 (I: 96 C: 96) | Non‐equivalent control pre–post intervention study | Geriatric ≥65 years 3 mo | ‐ Face‐to‐face nurse education to appropriately manage pain using nonpharmacological and pharmacological methods ‐ Pain evaluation using 8 scales (including NRS and VAS) | ‐ Audit and feedback (daily)‐ Case study discussion | ↓ Oxycodone use (Odds reduction by 1.2 times at baseline, 4 times following intervention*) | ↓ Pain intensity both at rest and on movement (VASrest 6.05 vs 4.40* and VASmovement 7.42 vs 5.27*) |
| Patient controlled analgesia safety monitoring | |||||||
| Paul et al., 2010, Canada53 | 25 198(I: 12 193 C: 13 005) | Longitudinal cohort study | Inpatients receiving PCA36 mo | ‐ Nurse face‐to‐face PCA education for safe use and ADE monitoring | ‐ Mandatory computerised incident reporting‐ Policy change requiring review of PCA settings during shifts and upon handover‐ Purchase of new PCA pumps | ↓ PCA error rate (OR: 0.28 [95% CI = 0.14, 0.53] vs 0.05 [95% CI = 0.001, 0.30]*) | |
| Ferguson et al., 2010, USA54 | 3732 (I: 1979 C: 1753) | Pre–post intervention study | Inpatients receiving PCA 4 mo | ‐ Nurse face‐to‐face PCA education for safe use and ADE monitoring‐ Practical competency demonstration‐ Online module | ↓ PCA error rate (0.46 vs 0.05%*) | ||
| Whipple et al., 1994, USA55 | 4669 | Retrospective cross‐sectional study | Inpatients receiving PCA | ‐ Computerised PCA ADE monitoring | ↓ PCA overdose events (11 vs 6 of 294 potential events detected) | ||
Sorted in descending order of intervention complexity, as assessed by the iCAT_SR Tool,19 and subclassified in descending order of study design.68
*
Denotes statistical significance (P < 0.05).
ED = Emergency department; ICU = intensive care unit; VAS = visual analogue scale; NRS = numeric rating scale; BPS = Behavioural pain scale; PCA = patient‐controlled analgesia; LOS = length of stay; ADE = adverse drug event; MV = mechanical ventilation; OR = odds ratio; CI = confidence interval; IQR = interquartile range