The incidence from of at least one SAE (cardiac arrest, arrhythmias, tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea or ventilatory distress) is strongly associated with severe pain in multivariate analysis. A healthcare quality improvement project of pain management, while moving ICU patients, is associated with a decrease in both severe pain and SAE.Being moved for nursing care procedures is one of the most painful procedures experienced by the patient during the ICU stay, whatever the type of admission (medical, surgical or trauma) [3,13,16,33]. Nevertheless, except for trauma and surgical patients, moving is currently not considered a painful procedure by ICU healthcare workers and physicians [34].

Similarly, to our knowledge, no study has reported yet whether pain might be a barrier for active mobilization in ICU patients and if a specific analgesia given to decrease pain while moving ICU patients would be associated with a greater chance to achieve rehabilitation objectives in the ICU setting [35,36].One of the reasons not to treat pain is that ICU physicians may be uncomfortable ordering analgesic drugs [37] because of frequent organ dysfunction, altered pharmacokinetics and pharmacodynamics, and impaired mental status in critically ill patients [38]. Indeed, adverse events have been reported in critically ill patients even with non-opioid WHO’s step-1 analgesics, such as acetaminophen [39] and nefopam [40]. In the present study, analgesics were administered upon nurse discretion but were chosen among eligible analgesics ordered by physicians according to the context and for each patient.

Decreased incidence of severe pain and increased rate of analgesic administration observed during adjusted and consolidated steps of the quality project suggests that collaboration between nurses and physicians, which was the aim of educational intervention at the adjusted step, improved regarding appreciation of patients’ pain and analgesics needs. A multidisciplinary discussion involving nurses and physicians/pharmacists is recommended regarding AV-951 the complex management of pain in ICU patients [41]. To better define a rational plan for a given patient, it is important for physicians to assess nursing issues as it should be important for nurses to understand the benefit and risks associated with every analgesic ordered by physicians.Tramadol was the only drug that’s use significantly increased through the study. Except in the case of severe renal impairment, tramadol is an opioid associated with a minimal risk of ventilatory depression [42].