Cadogan Mary P, Schnelle John F, Al-Sammarrai Nahla R, Yamamoto-Mitani Noriko, Cabrera Georgina, Osterweil Dan, Simmons Sandra F
Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CA 90095, USA.
J Am Med Dir Assoc. 2005 Jan-Feb;6(1):1-9. doi: 10.1016/j.jamda.2004.12.002.
Assessment and management of pain for nursing home residents is frequently reported to be inadequate, yet few studies have used objective criteria to measure the quality of care related to pain.
Field test a standardized resident interview and medical record review protocol to assess and score quality indicators relevant to pain.
Descriptive.
Thirty nursing homes (NHs).
Seven hundred ninety-four residents met overall eligibility criteria. Quality indicators were scored for those residents who met specific eligibility requirements for each pain indicator.
Medical record reviews were completed for 542 participants, and data were used to score 12 indicators related to pain assessment, management, and response to treatment. A seven-item pain interview was attempted with all 794 participants and completed with 478 participants who were rated by NH staff as cognitively aware.
Quality indicators could be reliably scored. Physicians scored low on assessment of pain, performing targeted history and physical examinations, documenting risk factors for use of analgesics, and documenting response to treatment. Forty-eight percent of participants (227/478) reported symptoms of chronic pain during the interview, and 81% of this group reported a preference for a pain medication. However, nearly half had no physician assessment of pain in the past year and only 42% were receiving pain medication. Licensed nurse assessments of pain were documented weekly; but, more than 50% of those reporting symptoms of chronic pain on interview had nurse pain scores of 0 for 4 consecutive weeks prior to interview.
Infrequent or incomplete physician pain assessment and treatment and inaccurate documentation by licensed nurses limits evaluation of pain care quality based on medical record review alone. A brief resident interview identified participants reporting symptoms of chronic pain not documented in the medical record and those with a preference for medication. Initial targeting of residents with self-reported pain maximizes the efficiency of the standardized scoring system described in this study. Focusing on explicit process measures clearly identifies areas for improvement and represents an important step in assessing the quality of pain care in the NH.
据报道，养老院居民疼痛的评估与管理常常不足，但很少有研究使用客观标准来衡量与疼痛相关的护理质量。
实地测试标准化的居民访谈和病历审查方案，以评估与疼痛相关的质量指标并进行评分。
描述性研究。
30家养老院。
794名居民符合总体入选标准。对那些符合每个疼痛指标特定入选要求的居民的质量指标进行评分。
对542名参与者完成了病历审查，并使用数据对与疼痛评估、管理及治疗反应相关的12项指标进行评分。对所有794名参与者进行了一项包含7个条目的疼痛访谈，478名被养老院工作人员评定为认知清醒的参与者完成了访谈。
质量指标能够可靠地评分。医生在疼痛评估、进行针对性病史和体格检查、记录使用镇痛药的风险因素以及记录治疗反应方面得分较低。48%的参与者（227/478）在访谈中报告有慢性疼痛症状，该组中81%表示更喜欢使用止痛药物。然而，近一半的人在过去一年中没有医生对其疼痛进行评估，只有42%的人正在接受止痛药物治疗。有执照护士对疼痛的评估每周记录一次；但是，在访谈中报告有慢性疼痛症状的人中，超过50%的人在访谈前连续4周的护士疼痛评分为0。
医生对疼痛的评估和治疗不频繁或不完整，以及有执照护士的记录不准确，限制了仅基于病历审查对疼痛护理质量的评估。简短的居民访谈识别出了在病历中未记录有慢性疼痛症状报告的参与者以及更喜欢使用药物的参与者。以自我报告疼痛的居民为初始目标，可使本研究中描述的标准化评分系统的效率最大化。关注明确的过程指标能清楚地确定改进领域，是评估养老院疼痛护理质量的重要一步。
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