Indicator development for the assessment of pain management: a practical approach

Background Analgesics represent one of the most frequently administered drugs during hospital stay. It is estimated that 40–80% of inpatients suffer from intermittent pain during their stay. In the current literature, indicators are considered an efficient, targeted method for the assessment of drug therapy quality. However, little is known about useful methods of identifying indicators for the quality of pharmacological therapy for pain. Purpose The aim of this work was to design an indicator development method and subsequent indicator set for the assessment of pharmacological pain management quality with a primary focus on safety, and secondarily efficacy, in the inpatient setting. Indicator development process The following strategies were used: (i) a systematic literature review (PubMed, Embase and Scopus); (ii) analysis of a critical incident reporting system, encompassing 1557 reports from 37 hospitals; and (iii) semistructured expert interviews. A list of 172 pain related indicators was compiled. The 56 most pain specific indicators were subsequently evaluated in a Delphi panel. The final set consisted of 15 indicators: nine were chosen based on the risk priority number, seven according to expert rating of their overall relevance. The three highest rated indicators were: (1) patients treated with non-steroidal anti-inflammatory drugs AND creatinine clearance <60 ml/min; (2) standard use of a visual analogue scale for pain assessment; and (3) paracetamol >4 g/day. Conclusion A combination of literature search, analysis of a critical incident reporting system and expert interviews was useful for the indicator development. Although indicators could be well rated based on risk priority number, process and structure indicators were better assessed based on their attributed relevance.