Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
Emory University Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, Georgia.
Pain Manag Nurs. 2022 Oct;23(5):608-615. doi: 10.1016/j.pmn.2022.03.010. Epub 2022 Apr 25.
AIM: This pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care.
This was a prospective feasibility single group pilot study at a level 1 trauma center.
The LCS is a paraprofessional behavior-based "pain coach" and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care. Numeric Rating Scale pain scores were assessed on admission, at discharge, and at 2-week follow-up. Daily morphine milligram equivalents (MME) during hospitalization, opioid medication use at 2-weeks, and patient satisfaction were recorded. T test compared mean morphine milligram equivalents (MME) to historical orthopaedic trauma patient population's mean dosage at discharge from the study site. Generalized linear models assessed pain scores over time.
Twenty-two percent of 121 total participants met criteria for moderate to severe risk of opioid misuse at initial hospitalization. On average, 2.8 LCS pain management interventions were utilized, most frequently progressive muscle relaxation (80%) and sound therapy (48%). Mean inpatient MME/day was 40.5, which was significantly lower than mean historical MME/day of 49.7 (p < .001). Pain scores improved over time from admission to 2-weeks postoperatively (p < .001). Nearly all participants agreed that the LCS was helpful in managing pain (99%).
The findings indicate feasibility to integrate LCS into orthopaedic trauma care, evident by participant engagement and satisfaction, and that LCS serve as valuable resources to assist with pain management and opioid education.
目的：本初步研究评估了将生活护理专家（LCS）整合到骨科创伤护理中的可行性和影响。
这是在 1 级创伤中心进行的前瞻性可行性单组初步研究。
LCS 是一种准专业人员行为导向的“疼痛教练”，提供以患者为中心的阿片类药物安全教育，培训参与者非药物性疼痛管理方法，进行阿片类药物风险评估，并协调护理。入院时、出院时和 2 周随访时评估数字评分量表疼痛评分。记录住院期间每日吗啡毫克当量（MME）、2 周时阿片类药物使用情况和患者满意度。t 检验比较了出院时 MME 的平均值与研究地点骨科创伤患者人群的平均剂量。广义线性模型评估了随时间的疼痛评分。
121 名参与者中有 22%在初次住院时符合中度至重度阿片类药物滥用风险标准。平均使用了 2.8 次 LCS 疼痛管理干预措施，最常见的是渐进性肌肉松弛（80%）和声音疗法（48%）。平均住院期间 MME/天为 40.5，明显低于平均历史 MME/天的 49.7（p<.001）。从入院到术后 2 周，疼痛评分逐渐改善（p<.001）。几乎所有参与者都认为 LCS 有助于管理疼痛（99%）。
研究结果表明，将 LCS 整合到骨科创伤护理中具有可行性，这体现在参与者的参与度和满意度上，并且 LCS 是协助疼痛管理和阿片类药物教育的有价值资源。
