QUALITY IMPROVEMENT GUIDELINES FOR THE TREATMENT OF ACUTE PAIN AND CANCER PAIN
QUALITY IMPROVEMENT GUIDELINES FOR THE TREATMENT OF ACUTE PAIN AND CANCER PAIN
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DOI：
10.1001/jama.1995.03530230060032
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发表时间：
1995-12-20
影响因子：
120.7
通讯作者：
EDWARDS, T
中科院分区：
文献类型：
--
作者：
MAX, MB;DONOVAN, M;EDWARDS, T
目标。-制定质量改善（QI）指南和项目，以改善急性疼痛和癌症疼痛患者的治疗效果。美国疼痛学会（APS）的24名成员参与了这份声明的编写，其中包括15名护士（肿瘤学、普通内科外科护理、儿科和QI研究）、7名医生（临床药理学、神经学、麻醉学、放射肿瘤学和物理学）、一名心理学家和一名统计学家。参与者是从美国科学学会的3000名成员中自行挑选出来的，该学会支持这一进程，并从1988年开始每年举行公开委员会会议和科学专题讨论会。检索-MEDLINE（1980 - 1995）以确定所有关于疼痛评估、急性疼痛或癌性疼痛治疗以及与疼痛相关的QI或教育的文章。达成共识的过程。在小组讨论之后，一名成员（M.B.M.）准备了连续的草案，并将其分发给小组和APS成员以征求意见。1991年出版了一个原型版本后，14名小组成员在三个医疗中心对准则的执行情况进行了正式研究。本文是基于这项研究，一篇新的文献综述，以及50位疼痛临床医生和研究人员的建议而编写的。-改善急性疼痛和癌症疼痛治疗的质量改进计划应包括五个关键要素：(1)确保未缓解疼痛的报告提出“危险信号”，引起临床医生的注意；(2)在开具处方的地方方便提供镇痛药信息；(3)向患者承诺反应性镇痛护理，督促患者沟通疼痛；(4)实施使用现代镇痛技术的政策和保障措施；(5)协调和评估这些措施的实施情况。几项短期研究表明，这种QI方法可以提高患者满意度，促进对最佳疼痛治疗的制度性障碍的认识，但它不是治疗不足的疼痛的灵丹妙药。通过使问题的严重性变得明显，并使机构做出改变，疼痛治疗QI项目可以为多方面的方法提供基础，包括对临床医生和患者的教育，设计信息工具以尽量减少处方中的错误，以及改进评估和治疗疼痛过程的协调。
Objective.-To develop quality improvement (QI) guidelines and programs to improve treatment outcomes for patients with acute pain and cancer pain.Participants.-Twenty-four members of the American Pain Society (APS) participated in preparing the statement, including 15 nurses (oncology, general medical-surgical nursing, pediatrics, and QI research), seven physicians (clinical pharmacology, neurology, anesthesiology, radiation oncology, and physiatry), one psychologist, and one statistician. Participants were self-selected from the 3000 members of the APS, which supported the process and held annual open committee meetings and scientific symposia beginning in 1988.Evidence.-MEDLINE was searched (1980 to 1995) to identify all articles on pain assessment, treatment of acute pain or cancer pain, and QI or education related to pain.Consensus Process.-Following panel discussions, one member (M.B.M.) prepared successive drafts and circulated them to the panel and APS membership for comments. After publication of a prototype version in 1991, 14 panelists carried out formal studies of implementation of the guidelines at three medical centers. This article was prepared based on this research, a new literature review, and suggestions from 50 pain clinicians and researchers.Conclusions.-Quality improvement programs to improve treatment of acute pain and cancer pain should include five key elements: (1) Assuring that a report of unrelieved pain raises a ''red flag'' that attracts clinicians' attention; (2) making information about analgesics convenient where orders are written; (3) promising patients responsive analgesic care and urging them to communicate pain; (4) implementing policies and safeguards for the use of modem analgesic technologies, and (5) coordinating and assessing implementation of these measures. Several short-term studies suggest that this QI approach may improve patient satisfaction and facilitate recognition of institutional obstacles to optimal pain treatment, but it is not a panacea for undertreated pain. By making the magnitude of the problem apparent and committing the institution to change, pain treatment QI programs can provide a foundation for a multifaceted approach that includes education of clinicians and patients, design of informational tools to minimize errors in prescribing, and improved coordination of the process of assessing and treating pain.