van Gulik L, Ahlers S J G M, Bruins P, Tibboel D, Knibbe C A J, van Dijk M
Department of Anaesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands.
Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands; Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands.
Pain Res Manag. 2017;2017:7187232. doi: 10.1155/2017/7187232. Epub 2017 Feb 16.
To investigate adherence to our pain protocol considering analgesics administration, number and timing of pain assessments, and adjustment of analgesics upon unacceptably high (NRS ≥ 4) and low (NRS ≤ 1) pain scores. The pain protocol for patients in the intensive care unit (ICU) after cardiac surgery consisted of automated prescriptions for paracetamol and morphine, automated reminders for pain assessments, a flowchart to guide interventions upon high and low pain scores, and reassessments after unacceptable pain. Paracetamol and morphine were prescribed in all 124 patients. Morphine infusion was stopped earlier than protocolized in 40 patients (32%). During the median stay of 47 hours [IQR 26 to 74 hours], 702/706 (99%) scheduled pain assessments and 218 extra pain scores were recorded. Unacceptably high pain scores accounted for 96/920 (10%) and low pain scores for 546/920 (59%) of all assessments. Upon unacceptable pain additional morphine was administered in 65% (62/96) and reassessment took place in 15% (14/96). Morphine was not tapered in 273 of 303 (90%) eligible cases of low pain scores. Adherence to automated prescribed analgesics and pain assessments was good. Adherence to nonscheduled, flowchart-guided interventions was poor. Improving adherence may refine pain management and reduce side effects.
为了研究在镇痛药物给药、疼痛评估的次数和时间，以及根据不可接受的高疼痛评分（数字评分法≥4）和低疼痛评分（数字评分法≤1）调整镇痛药物方面对我们疼痛方案的依从性。心脏手术后重症监护病房（ICU）患者的疼痛方案包括对乙酰氨基酚和吗啡的自动处方、疼痛评估的自动提醒、指导高疼痛评分和低疼痛评分时干预措施的流程图，以及不可接受疼痛后的重新评估。124例患者均开具了对乙酰氨基酚和吗啡。40例患者（32%）的吗啡输注比方案规定的时间提前停止。在中位住院时间47小时[四分位间距26至74小时]内，记录了702/706（99%）次计划的疼痛评估和218次额外的疼痛评分。在所有评估中，不可接受的高疼痛评分占96/920（10%），低疼痛评分占546/920（59%）。在出现不可接受的疼痛时，65%（62/96）的患者额外给予了吗啡，15%（14/96）的患者进行了重新评估。在303例符合条件的低疼痛评分病例中，273例（90%）未逐渐减少吗啡用量。对自动处方的镇痛药物和疼痛评估的依从性良好。对非计划的、流程图指导的干预措施的依从性较差。提高依从性可能会改善疼痛管理并减少副作用。
