Lehmkuhl D, Meissner W, Neugebauer E A M
Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin, Fakultät für Medizin der Universität Witten/Herdecke, Campus Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
Schmerz. 2011 Sep;25(5):508-15. doi: 10.1007/s00482-011-1054-z.
Demonstration of improved postoperative pain management by implementation of the S3 guidelines on treatment of acute perioperative and posttraumatic pain, by the integrated quality management concept "quality management acute pain" of the TÜV Rheinland or by participation in the benchmark project "Quality improvement in postoperative pain management" (QUIPS).
A prospective controlled study (pre-post design) was carried out in hospitals with various levels of care comparing three hospital groups (n = 17/7/3, respectively). Group 1: participation in the QUIPS project (intraclinic and interclinic comparison of outcome data of postoperative pain treatment), group 2: participation in the quality management acute pain program (certified by TÜV Rheinland), group 3: control group with no involvement in either of the two concepts. In all three groups, an anonymous data collection was performed consisting of patient-reported pain intensity, side effects, pain disability and patient satisfaction. Pain therapy intervention was carried out only in group 2 by an integrated quality management concept (certification project: Quality management acute pain) with a package of measures to improve structure, process and outcome quality.
The TÜV Rheinland certified clinics (group 2) showed a significant improvement in the pre-post comparison (before versus after certification) in the areas maximum pain (from visual analogue scale VAS 4.6 to 3.7), stress pain (5.3 to 3.9), pain-related impairment (proportion of patients with pain-linked decreased mobility and movement 26% to 16.1%, coughing and breathing 23.1% to 14.3%) and patient satisfaction (from 13.2 to 13.7; scale 0 completely unsatisfied, 15 very satisfied). The clinics with participation in QUIPS for 2 years also showed a significant improvement in stress pain (numeric rating scale NRS for pain 4.5 to 4.2), pain-linked-limitation of coughing and breathing (28% to 23.6%), and patient satisfaction (from 11.9 to 12.4). There were no differences in postoperative nausea and vomiting between any of the groups.
The main objective of the certification concept quality management acute pain as a tool for the successful implementation of the S3 guidelines on treatment of acute perioperative and posttraumatic pain, led to a significant improvement in patient outcome. Participation in QUIPS is an ideal supplement to TÜV Rheinland certification and can be recommended as a benchmarking tool to evaluate outcome.
通过实施S3急性围手术期和创伤后疼痛治疗指南、采用莱茵兰技术监督协会的“急性疼痛质量管理”综合质量管理理念或参与“术后疼痛管理质量改进”(QUIPS)基准项目,来证明术后疼痛管理得到改善。
在不同护理水平的医院开展一项前瞻性对照研究(前后设计),比较三个医院组(分别为n = 17/7/3)。第1组:参与QUIPS项目(术后疼痛治疗结果数据的院内和院际比较);第2组:参与急性疼痛质量管理项目(由莱茵兰技术监督协会认证);第3组:未参与上述两种理念的对照组。在所有三组中,进行了匿名数据收集,内容包括患者报告的疼痛强度、副作用、疼痛残疾和患者满意度。仅在第2组通过综合质量管理理念(认证项目:急性疼痛质量管理)实施了疼痛治疗干预,该理念包含一系列旨在改善结构、过程和结果质量的措施。
莱茵兰技术监督协会认证的诊所(第2组)在最大疼痛(从视觉模拟量表VAS的4.6降至3.7)、应激性疼痛(从5.3降至3.9)、疼痛相关损害(疼痛导致活动能力下降的患者比例从26%降至16.1%,咳嗽和呼吸方面从23.1%降至14.3%)以及患者满意度(从13.2升至13.7;量表0表示完全不满意,15表示非常满意)等方面的前后比较(认证前与认证后)显示出显著改善。参与QUIPS项目两年的诊所,在应激性疼痛(疼痛数字评定量表NRS从4.5降至4.2)、咳嗽和呼吸的疼痛相关限制(从28%降至23.6%)以及患者满意度(从11.9升至12.4)方面也有显著改善。各组之间术后恶心和呕吐情况无差异。
作为成功实施S3急性围手术期和创伤后疼痛治疗指南的工具,急性疼痛质量管理认证理念使患者结局得到显著改善。参与QUIPS是莱茵兰技术监督协会认证的理想补充,可作为评估结局的基准工具推荐。