Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.
Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.
复制标题
减少儿科医院围手术期阿片类药物过度镇静事件的质量改进项目。
DOI：
10.1136/bmjqs.2010.044065
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发表时间：
2011
影响因子：
5.4
通讯作者：
Conway,PatrickH
中科院分区：
文献类型：
--
作者：
Vermaire,Deborah;Caruso,MichelleC;Lesko,Anne;Kloppenborg,Elizabeth;Olivea,Jason;Pruett,Raymond;Paul,Marika;Schoettker,PamelaJ;Seid,Michael;Varadarajan,KartikR;Conway,PatrickH
BackgroundNarcotics负责许多不良药物事件的儿童和有增加阿片类药物过度镇静事件在住院patients.ObjectivesTo使用改进的方法，以防止围手术期阿片类药物过度镇静不良事件，同时继续提供适当的疼痛控制。麻醉医嘱单，以便处方者只能选择一种麻醉剂和一种剂量用于中度疼痛，一种麻醉剂和一种剂量用于重度疼痛，修改护理工具，以提供更客观的标准来评估患者镇静水平，并重组疼痛服务。急性疼痛服务的临床医生看到所有术后患者接受静脉病人自控镇痛或neuraxial麻醉剂在上午和下午和护士看到他们在工作日evening.ResultsThe阿片类药物相关的过度镇静事件的发生率下降，从0.15每1000患者日在基线的0.111在干预期间，在干预后的0.074。在同一时期，事件间隔天数从21.0天增加到27.5天再增加到48.8天。阿片类药物相关的过度镇静事件的数量下降，从22至17至5在这些时期，分别。ConclusionsOpioid相关的过度镇静事件在研究过程中下降。由于围手术期是阿片类药物过度镇静事件特别可能发生的时间，因此强调严格的阿片类药物处方实践，同时在围手术期保持充分的疼痛控制和改善镇静评估。重组疼痛服务和疼痛小组专家的访问增加也与过度镇静事件的减少有关。
BackgroundNarcotics are responsible for many adverse drug events in children and there has been an increase in opioid oversedation events in hospitalised patients.ObjectivesTo use improvement methods to prevent perioperative opioid oversedation adverse events while continuing to provide appropriate pain control.MethodsInterventions included revising the post-anaesthesia order form so that prescribers could choose only one narcotic and one dose for moderate pain and one narcotic and one dose for severe pain, modifying a nursing tool to provide more objective criteria for assessing patient sedation level, and restructuring the pain service. Clinicians on the Acute Pain Service saw all postoperative patients receiving intravenous patient-controlled analgesia or neuraxial narcotics in the mornings and afternoons and a nurse saw them on weekday evenings.ResultsThe rate of opioid-related oversedation events decreased from 0.15 per 1000 patient days at baseline to 0.111 during the intervention period to 0.074 in the post-intervention period. The days between events increased from 21.0 to 27.5 to 48.8 during the same periods. The number of opioid-related oversedation events decreased from 22 to 17 to 5 during these periods, respectively.ConclusionsOpioid-related oversedation events decreased over the course of the study. Because the perioperative period is an especially likely time for opioid oversedation events, strict opioid prescribing practices, while maintaining adequate pain control and improved sedation assessment during the perioperative period, were emphasised. The restructured pain service and increased visits by pain team experts were also associated with the reduction in oversedation events.