Improving assessment and treatment of pain in the critically ill
Improving assessment and treatment of pain in the critically ill
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DOI：
10.1093/intqhc/mzh010
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发表时间：
2004-02-01
影响因子：
2.6
通讯作者：
Pronovost, PJ
中科院分区：
文献类型：
--
作者：
Erdek, MA;Pronovost, PJ
目标。努力改善疼痛评估和治疗危重病人的研究很少，代表一个机会，以提高护理质量。本研究旨在改善某学术医疗中心外科重症监护病房患者的疼痛评估和治疗。2001年，我们在两个外科重症监护病房进行了一项疼痛评估和治疗的前瞻性研究。我们用视觉模拟量表测量患者疼痛的4小时间隔的百分比来测量疼痛评估。我们测量疼痛治疗的百分比，患者的疼痛评分在4小时的间隔小于或等于3。然后，我们实施了四个独立的“计划-执行-研究-行动”循环，以改善疼痛评估和治疗。主要结果测量。我们评估了干预前和干预后4小时患者护理间隔的百分比。我们评估了干预前和干预后患者疼痛评分小于或等于3的4小时患者护理间隔的百分比。此外，我们监测了纳洛酮的使用，以衡量与疼痛治疗相关的不良事件。我们对疼痛的基线评估为42%，基线治疗为59%。5周后，疼痛评估改善至71%，疼痛管理改善至97%。我们的干预措施与疼痛评估和治疗的显著改善相关，而与疼痛治疗相关的不良事件没有增加。我们的干预措施相对简单，可以广泛实施。我们的干预为复杂性理论在改进工作中的应用提供了见解。
Objective. Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center.Design. We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was less than or equal to3. We then implemented four separate 'plan-do-study-act' cycles to improve pain assessment and treatment.Main outcome measures. We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of less than or equal to3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment.Results. Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%.Conclusion. Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.