Donahue Rebecca E, Bradbury George R, Zychowicz Michael E, Muckler Virginia C
J Perianesth Nurs. 2018 Apr;33(2):138-152. doi: 10.1016/j.jopan.2016.07.007. Epub 2017 Mar 22.
The primary aim of this quality improvement project was to improve mobilization for patients after total knee arthroscopy by developing and implementing a standardized, evidence-based, multimodal analgesia regimen and patient-educational video. Secondary outcomes included opioid consumption, pain, and length of stay.
A pre-post implementation design was used to compare two independent samples.
Patients were screened based on inclusion and exclusion criteria 1-2 weeks before surgery. The anesthesia provider made the final determination for inclusion. Data were collected by retrospective chart review.
Following implementation, patients displayed significantly improved mobilization, reduced opioid consumption, and reduced length of stay. Patient-reported pain scores were similar or significantly lower in the postimplementation group.
Variability of patient outcomes was reduced, and quality of care was improved by standardizing care and incorporating the best available evidence, consistent with organization's resources in the nonacademic-affiliated, community hospital setting.
本质量改进项目的主要目标是通过制定和实施标准化的、循证的多模式镇痛方案及患者教育视频，改善全膝关节镜检查术后患者的活动能力。次要结果包括阿片类药物的使用量、疼痛程度和住院时间。
采用实施前-后的设计来比较两个独立样本。
在手术前1-2周根据纳入和排除标准对患者进行筛选。麻醉医生做出最终的纳入决定。通过回顾性病历审查收集数据。
实施后，患者的活动能力显著改善，阿片类药物使用量减少，住院时间缩短。在实施后组中，患者报告的疼痛评分相似或显著更低。
在非学术附属的社区医院环境中，通过规范护理并纳入最佳现有证据，与机构资源相一致，减少了患者结局的变异性，提高了护理质量。
