The hidden error of mismanaged pain: A systems approach
The hidden error of mismanaged pain: A systems approach
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DOI：
10.1016/j.jpainsymman.2003.11.005
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发表时间：
2004-07-01
影响因子：
4.7
通讯作者：
Starck, PL
中科院分区：
文献类型：
--
作者：
McNeill, JA;Sherwood, GD;Starck, PL
尽管有针对性的改善方法，但导致生理、心理和经济后果的疼痛治疗不足仍在继续。斯塔克等人提出了一个用于研究疼痛管理错误的系统框架。该次要分析检查了住院患者的疼痛结局，以确定预测适当疼痛管理的因素。数据收集自美国西南部964名住院成人患者。采用美国疼痛学会患者结局问卷和表情和图表审计表收集数据。计算所有参与者的疼痛管理指数（PMI）。结果显示，30%的患者的疼痛治疗不足，67.5%的患者报告了严重的最差疼痛评级（0-10级评分为7）。非白人、老年人和女性的疼痛评分明显更高，消极PMI评分的比例也更高。Logistic回归预测充分的疼痛管理的基础上镇痛等级，种族，年龄和教育水平与0.89的准确性。研究结果支持将疼痛管理不善概念化为医疗错误。干预模型描述了使用系统方法来识别高风险患者并确保所有人的有效疼痛管理实践。(C)2004年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck. et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a emographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30 % of patients were undertreated for pain, with 67.5 % reporting severe worst, pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all. (C) 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.