From the Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery (E.S.T., B.T.Y., J.A.C., E.T.C., N.L.W., V.C.L., V.P.H.), Case Western Reserve University School of Medicine; Department of Surgery (S.J.Z.), Cleveland Clinic, Cleveland; Department of Surgery (K.J.C.-S.), Cleveland Clinic South Pointe Hospital, Warrensville; and Department of Population and Quantitative Health Sciences (V.P.H.), Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Trauma Acute Care Surg. 2021 Jul 1;91(1):212-218. doi: 10.1097/TA.0000000000003174.
Opioids are often used to treat pain after traumatic injury, but patient education on safe use of opioids is not standard. To address this gap, we created a video-based opioid education program for patients. We hypothesized that video viewing would lead to a decrease in overall opioid use and morphine equivalent doses (MEDs) on their penultimate hospital day. Our secondary aim was to study barriers to video implementation.
We performed a prospective pragmatic cluster-randomized pilot study of video education for trauma floor patients. One of two equivalent trauma floors was selected as the intervention group; patients were equally likely to be admitted to either floor. Nursing staff were to show videos to English-speaking or Spanish-literate patients within 1 day of floor arrival, excluding patients with Glasgow Coma Scale score less than 15. Opioid use and MEDs taken on the day before discharge were compared. Intention to treat (ITT) (intervention vs. control) and per-protocol groups (video viewers vs. nonviewers) were compared (α = 0.05). Protocol compliance was also assessed.
In intention to treat analysis, there was no difference in percent of patients using opioids or MEDs on the day before discharge. In per-protocol analysis, there was no different in percent of patients using opioids on the day before discharge. However, video viewers still on opioids took significantly fewer MEDs than patients who did not see the video (26 vs. 38, p < 0.05). Protocol compliance was poor; only 46% of the intervention group saw the videos.
Video-based education did not reduce inpatient opioid consumption, although there may be benefits in specific subgroups. Implementation was hindered by staffing and workflow limitations, and staff bias may have limited the effect of randomization. We must continue to establish effective methods to educate patients about safe pain management and translate these into standard practices.
Therapeutic, Level IV.
阿片类药物常用于治疗创伤后疼痛，但对患者进行安全使用阿片类药物的教育并不规范。为了解决这一差距，我们为患者创建了一个基于视频的阿片类药物教育计划。我们假设视频观看会导致患者在倒数第二天的住院期间总阿片类药物使用量和吗啡等效剂量（MED）减少。我们的次要目的是研究视频实施的障碍。
我们对创伤楼层的患者进行了一项前瞻性实用集群随机试点研究，视频教育。选择两个等效的创伤楼层之一作为干预组；患者同样有可能被分配到任一楼层。护理人员应在患者到达楼层后的 1 天内向会讲英语或西班牙语的患者播放视频，但格拉斯哥昏迷量表评分低于 15 的患者除外。比较出院前一天的阿片类药物使用量和 MED。意向治疗（ITT）（干预与对照组）和方案（视频观看者与非观看者）进行比较（α=0.05）。还评估了方案的依从性。
在意向治疗分析中，出院前一天使用阿片类药物或 MED 的患者百分比没有差异。在方案分析中，出院前一天使用阿片类药物的患者百分比没有差异。然而，仍在使用阿片类药物的视频观看者的 MED 明显少于未观看视频的患者（26 对 38，p<0.05）。方案依从性较差；只有 46%的干预组观看了视频。
基于视频的教育并没有减少住院期间阿片类药物的消耗，尽管在特定亚组中可能有好处。实施受到人员配备和工作流程限制的阻碍，并且工作人员的偏见可能限制了随机分组的效果。我们必须继续建立有效的方法来教育患者安全的疼痛管理，并将这些方法转化为标准实践。
治疗，IV 级。
