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The intervention consisted of a multifaceted implementation of the Pain, Agitation and Delirium guidelines.
The implementation of the pain assessment method was problematic in many studies, especially as far as time frame of pain assessment (70%), administration modalities (46%), and use of non-validated measurement methods (10%).
To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents.
In contrast, Williams et al. [ 14] reported more prolonged use of sedatives after implementation of the pain assessment protocol.
In the study by Rose et al. [ 9], implementation of the pain assessment tool had different effects on opioid and benzodiazepine administration in the two participating ICUs.
Only one study reported no difference in the type of opioid analgesics administered or the amount of medication (morphine equivalents) after implementation of the pain assessment tool [ 13].
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Patient acceptability assessment of iPACT-E-Trauma led to the tailoring of key intervention features, based on determinants such as pain intensity and the implementation of self-management behaviors between intervention sessions.
Main topics of the focus groups discussion guideline were the evaluation of the chest pain guideline and its key recommendations, suggestions for improvement, key factors that influence the implementation of the chest pain guideline in a negative or positive way, and intended behaviour changes as a result of the chest pain guideline.
Williams et al. [ 14] used a before-and-after design to evaluate results of implementation of the Behavioral Pain Scale and the Richmond Agitation-Sedation Scale for patients receiving mechanical ventilation.
The heterogeneous feedback concerning the perceived additional diagnostic value by the guideline and the physicians' behaviour change in consequence of the guideline knowledge reveals that agreement alone is not a sufficient precondition for a lasting implementation of the chest pain guideline [ 10, 12, 25].
Arbour et al. [ 11] performed a pilot before-and-after study to explore the impact of the implementation of the CPOT on pain management among mechanically ventilated trauma intensive care unit patients.
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