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通过提供定期培训和更新的疼痛治疗理念来改善儿童术后疼痛管理。

Improving postoperative pain management in children by providing regular training and an updated pain therapy concept.

作者信息

Heinrich M, Mechea A, Hoffmann F

机构信息

Department of Pediatric Surgery, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.

Department of Pediatrics, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.

出版信息

Eur J Pain. 2016 Apr;20(4):586-93. doi: 10.1002/ejp.770. Epub 2015 Aug 27.

Abstract

BACKGROUND

In recent years, children's hospitals have increasingly implemented postoperative pain management protocols to reduce postoperative pain and improve patient satisfaction. The effectiveness and long-term sustainability of such protocols have rarely been studied. Therefore, we conducted a prospective intervention study to assess the impact of regular training and improvement of clinical processes on the quality of postoperative pain management.

METHODS

We conducted an initial assessment of the status quo of postoperative pain management (Audit 1) followed by repeated training and improvement of clinical processes (analgesic pocket card, parents' brochure, modification of the patient chart, bimonthly advanced trainings sessions) and a follow-up review after 3 years (Audit 2). We used a data entry form, a patient survey, and an anonymous questionnaire for the nursing staff as measurement tools.

RESULTS

Our analysis included a total of 93 and 85 patients in the initial and final audits. The return rates of the nursing staff questionnaire were 83% (Audit 1) and 77% (Audit 2). The training and process improvements resulted in significant improvement in the administration of analgesics for pain requiring treatment, the control of pain measurement after the administration of analgesics and the use of non-pharmacological pain therapies. The patients reported faster administration of analgesics for acute pain and improved pain relief following the intervention.

CONCLUSIONS

Repeated training and improvement of clinical processes can significantly improve the long-term quality of postoperative pain management in children with a tolerable amount of effort on the part of health care professionals and institutions.

摘要

背景

近年来,儿童医院越来越多地实施术后疼痛管理方案,以减轻术后疼痛并提高患者满意度。此类方案的有效性和长期可持续性鲜有研究。因此,我们开展了一项前瞻性干预研究,以评估定期培训和临床流程改进对术后疼痛管理质量的影响。

方法

我们首先对术后疼痛管理现状进行了初步评估(审核1),随后对临床流程进行了反复培训和改进(镇痛口袋卡、家长宣传册、修改患者病历、每两个月进行一次高级培训课程),并在3年后进行了随访复查(审核2)。我们使用数据录入表、患者调查问卷和针对护理人员的匿名问卷作为测量工具。

结果

我们的分析在初次审核和最终审核中分别纳入了93例和85例患者。护理人员问卷的回收率分别为83%(审核1)和77%(审核2)。培训和流程改进使需要治疗的疼痛的镇痛药物给药、镇痛药物给药后的疼痛测量控制以及非药物性疼痛治疗的使用有了显著改善。患者报告称,干预后急性疼痛的镇痛药物给药更快,疼痛缓解情况有所改善。

结论

反复培训和临床流程改进能够显著提高儿童术后疼痛管理的长期质量,而医疗保健专业人员和机构只需付出适度努力。

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