多方面教育计划对实施儿科姑息治疗指南的影响：一项试点研究。
Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study.
作者信息
Jagt-van Kampen Charissa Thari, Kremer Leontien C M, Verhagen A A Eduard, Schouten-van Meeteren Antoinette Y N
机构信息
Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis (code CA 72), Postbus 30.001, 9700, RB, Groningen, The Netherlands.
出版信息
BMC Med Educ. 2015 Nov 2;15:194. doi: 10.1186/s12909-015-0478-z.
BACKGROUND
A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline.
METHODS
We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning.
RESULTS
Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning.
CONCLUSIONS
The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be the more adequate assessment tool for future studies.
背景
2013年发布了一份关于儿童姑息治疗的国家临床实践指南。到目前为止，关于教育项目是否促进对该指南实施的依从性，仅有少数报告。我们旨在测试教育项目对实际依从性以及对指南依从性记录的影响。
方法
我们对一家儿童医院大学附属医院的儿童姑息治疗团队的护士专家进行了一项前瞻性研究，在干预前后评估其对病例管理指南的依从性。从儿童姑息治疗指南的192条建议中，基于频率、可测量性和相关性，选择了11项质量指标。多方面的教育项目包括电子学习和一次互动教育会议。四个电子学习模块涉及19个关于症状、诊断和治疗的患者案例以及一次图表记录练习。在互动教育会议期间，讨论了如何使用指南的患者案例。在电子学习完成前后，测量基于网络的患者图表中对指南的依从性记录以及通过每周基于网络的家长报告对指南的实际依从性。
结果
选择了11项质量指标。该教育项目并未使这些指标中的任何一项依从性得到显著改善。通过家长报告测量的“恶心治疗”“提前两步使用止痛药物”和“使用止痛药物48小时”指标，在电子学习前后的依从性得分均超过80%。其余测量依从性的指标以及通过图表审查测量记录情况的六项指标，在电子学习前后的依从性均低于80%。
结论
多方面的教育项目并未使对指南依从性的记录得到改善。家长报告的结果显示表现更好，可能是未来研究中更合适的评估工具。
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