Neitzel J J, Miller E H, Shepherd M F, Belgrade M
Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Orthop Nurs. 1999 Jul-Aug;18(4):37-45, 64.
To test the effects of implementing evidence-based postoperative pain management content and strategies on patient, provider (nurse and physician), and fiscal outcomes.
118 patients, 57 before and 61 after implementation, having total knee replacement (TKR) (54%) and total hip replacement (THR) (45%), and 28 orthopaedic nurses.
A research utilization approach with a pretest/posttest design was used. Independent variables (interventions) included evidence-based pain management content, education of care providers and patients, and system changes at the point of care. Dependent variables (outcomes) were patient perception of the postoperative pain experience, provider practice patterns, and length of stay (LOS).
The hypotheses of decreased provider use of meperidine and increased use of hydromorphone, i.v. route, pain plans of care, and nurse knowledge were supported. LOS was significantly reduced. The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported.
Methodical implementation of evidence-based pain management information changed practice and fiscal outcomes. Improvement in the patient perception of pain management was more difficult to achieve.
测试实施循证术后疼痛管理内容和策略对患者、医疗服务提供者（护士和医生）以及财务结果的影响。
118例患者，实施前57例，实施后61例，接受全膝关节置换术（TKR）（54%）和全髋关节置换术（THR）（45%），以及28名骨科护士。
采用前后测试设计的研究应用方法。自变量（干预措施）包括循证疼痛管理内容、对医护人员和患者的教育以及护理点的系统变革。因变量（结果）为患者对术后疼痛体验的感知、医护人员的实践模式以及住院时间（LOS）。
关于减少医护人员使用哌替啶以及增加使用氢吗啡酮、静脉途径、疼痛护理计划和护士知识的假设得到支持。住院时间显著缩短。关于患者疼痛强度降低、副作用减少以及满意度和功能提高的假设未得到支持。
循证疼痛管理信息的系统实施改变了实践和财务结果。改善患者对疼痛管理的认知则更难实现。
