Stearns Jenna, Cortese Christine, Remington Jennifer, Patil Nirav
University Hospitals Richmond Medical Center.
Innov Pharm. 2021 Jun 10;12(3). doi: 10.24926/iip.v12i3.4228. eCollection 2021.
Pain is a common symptom reported by patients admitted to hospitals in both medical and surgical units. Due to the subjective and multidimensional nature of pain, it should be assessed regularly to ensure patient pain control. Suboptimal prescribing of opioids and other pain medications contribute to the inadequate treatment of pain. To combat the wide variability and response to pain medications, many providers prescribe as-needed range orders of pain medications to cover each pain severity. These range orders enable necessary and safe adjustments in dose based on individual responses to treatment. Currently, there are no studies analyzing the prescribing of pain medications based on pain severity, leaving a gap in literature in inpatient pain management. The purpose of this retrospective cohort study was to evaluate the appropriateness of prescribing as-needed pain medications based on the patient's pain severity scores throughout their hospital stay at a 125-bed community hospital in Northeast Ohio on the general medicine floor. Secondarily, this study also evaluated the administration of pain medications by nursing staff based on patient-reported pain severity scores. Statistical analyses including Chi-square tests, t-tests, Fisher's Exact tests and descriptive statistics were utilized to determine the significance of the data collected. This study found that there was a statistically significant difference between appropriately (47.4%) and inappropriately (52.6%) prescribed pain medications (P<0.001). There was also a statistically significant difference between appropriately (40.5%) and inappropriately (59.5%) administered pain medications (P<0.001). Pharmacists hope to improve pain management practices by providing education to both providers and nurses to prevent poor patient outcomes and uncontrolled pain.
疼痛是在内科和外科病房住院的患者报告的常见症状。由于疼痛具有主观性和多维度性，应定期进行评估以确保患者的疼痛得到控制。阿片类药物和其他止痛药物的处方不当导致疼痛治疗不充分。为应对止痛药物的广泛变异性和反应，许多医疗服务提供者开出按需使用的止痛药物剂量范围医嘱，以涵盖每种疼痛严重程度。这些剂量范围医嘱能够根据个体对治疗的反应进行必要且安全的剂量调整。目前，尚无研究分析基于疼痛严重程度的止痛药物处方情况，这在住院患者疼痛管理的文献中留下了空白。这项回顾性队列研究的目的是评估在俄亥俄州东北部一家拥有125张床位的社区医院普通内科病房，根据患者在住院期间的疼痛严重程度评分按需开具止痛药物的合理性。其次，本研究还根据患者报告的疼痛严重程度评分评估了护理人员对止痛药物的给药情况。利用包括卡方检验、t检验、费舍尔精确检验和描述性统计在内的统计分析来确定所收集数据的显著性。本研究发现，止痛药物处方合理（47.4%）与不合理（52.6%）之间存在统计学显著差异（P<0.001）。止痛药物给药合理（40.5%）与不合理（59.5%）之间也存在统计学显著差异（P<0.001）。药剂师希望通过对医疗服务提供者和护士进行教育来改善疼痛管理实践，以防止患者出现不良后果和疼痛控制不佳的情况。
