Weller Lori M
Pacific Lutheran University, School of Nursing, Tacoma, Washington.
J Am Assoc Nurse Pract. 2020 Aug 13;33(11):1100-1107. doi: 10.1097/JXX.0000000000000487.
Nearly 50% of opioid overdose deaths in the United States involve the use of prescription opioids. Primary care providers can help decrease the risk of opioid overdose deaths by adhering to opioid prescribing guidelines for chronic pain management.
Ten Washington State primary care clinics had gaps in guideline adherence and mandated electronic medical record (EMR) documentation for prescribing opioids.
A quality improvement project using an educational intervention was implemented.
Primary care providers and support staff (defined as registered nurses and medical assistants) from the 10 primary care clinics viewed the project's instructional YouTube webinar that explained the project's primary care clinic workflow protocol, opioid prescribing best practice guidelines, and the organization's mandated EMR charting for chronic pain management. Preintervention and postintervention measures, which included five different documented patient completion rates of the organization's best practices for opioid prescribing, were used to assess for improvement to guideline adherence. Additionally, participants completed a questionnaire regarding their perceptions of the webinar as an educational tool.
Postintervention data showed significantly (p ≤ .05) increased completion rates for three of five outcome measures, indicating improvement in guideline adherence. The majority of participants reported that the webinar information would help them better adhere to best practice guidelines.
A workflow protocol for opioid prescribing taught via a YouTube webinar was an effective method for disseminating and implementing best practices in the primary care setting. Similar workflow protocols, taught via webinar, could be equally beneficial in other primary care clinics.
在美国，近50%的阿片类药物过量死亡案例涉及处方阿片类药物的使用。初级保健提供者可以通过遵守慢性疼痛管理的阿片类药物处方指南，帮助降低阿片类药物过量死亡的风险。
华盛顿州的10家初级保健诊所在遵守指南以及规定的阿片类药物处方电子病历记录方面存在差距。
实施了一项采用教育干预的质量改进项目。
来自10家初级保健诊所的初级保健提供者和支持人员（定义为注册护士和医疗助理）观看了该项目的指导性YouTube网络研讨会，该研讨会解释了项目的初级保健诊所工作流程协议、阿片类药物处方最佳实践指南以及该机构规定的慢性疼痛管理电子病历图表记录。干预前和干预后的措施，包括该机构阿片类药物处方最佳实践的五种不同记录患者完成率，用于评估指南遵守情况的改善。此外，参与者完成了一份关于他们对网络研讨会作为教育工具的看法的问卷。
干预后数据显示，五项结果指标中的三项完成率显著提高（p≤0.05），表明指南遵守情况有所改善。大多数参与者报告说，网络研讨会的信息将帮助他们更好地遵守最佳实践指南。
通过YouTube网络研讨会教授的阿片类药物处方工作流程协议是在初级保健环境中传播和实施最佳实践的有效方法。通过网络研讨会教授的类似工作流程协议在其他初级保健诊所可能同样有益。
