Duke University School of Nursing, Durham, NC.
Duke University Medical Center, Durham, NC.
J Perianesth Nurs. 2023 Aug;38(4):543-552. doi: 10.1016/j.jopan.2022.09.008. Epub 2023 Jan 2.
The purpose of this project was to improve the consistency of verbal and written discharge instructions for women of childbearing age (13-55 years) taking hormonal contraceptives who receive aprepitant perioperatively, to address the need to use a secondary form of birth control for 28 days, as well as to increase the knowledge and confidence of Registered Nurses when providing discharge instructions.
This quality improvement project used a pre-/postdesign to evaluate two separate groups of patients and registered nurses.
The patient sample consisted of 30 total women of childbearing age who received aprepitant during the perioperative period (15 pre and 15 post). The PACU nurse sample included 15 ambulatory surgery center nurses and 58 main hospital nurses for a combined sample of 73 PACU nurses. The PACU nurses were provided with educational in-service regarding information about aprepitant and its drug interactions. PACU nurses were additionally instructed to provide patient discharge instructions using both a written and verbal format. Patients were called postoperatively before and after both the written after visit summary (AVS) changes and the PACU nurse in-services, PACU nurses were evaluated on their knowledge, confidence, and frequency of discharge teaching before and after their educational in-service. The PACU nurses were surveyed 90 days after the intervention to assess their long-term knowledge retention.
There was a significant increase in nurse knowledge about aprepitant from preimplementation to postimplementation (61.39% vs 81.95%, P < .001). Nursing knowledge showed a nonsignificant decline at 90-days postimplementation (81.95% vs 73.68%, P = .096) although remained significantly higher than preimplementation scores (73.68% vs 61.39%, P = .003). There was an overall 33.3% increase in the percentage of patients who were able to recall receiving aprepitant and the need to use a secondary form of birth control when comparing the preintervention group to the postintervention group (26.7% vs 60%, P = .123).
The findings suggest that providing a standardized presentation about aprepitant may improve the PACU nurses' ability to verbalize key information about aprepitant, including the need for patients to use a secondary form of birth control. This increase in nursing knowledge and confidence, along with improved written discharge instructions, may have led to improved patient comprehension of aprepitant discharge education. Additionally, there was an increase in the percentage of patients who were able to recall the need to use a secondary form birth control for 28 days, to reduce the likelihood of an unintentional pregnancy.
本项目旨在提高接受阿瑞匹坦围手术期用药的育龄期女性（13-55 岁）口头和书面出院医嘱的一致性，以解决需要使用 28 天的辅助避孕措施的问题，并提高注册护士在提供出院医嘱时的知识和信心。
本质量改进项目采用前后设计，以评估两组患者和注册护士。
患者样本包括 30 名接受围手术期阿瑞匹坦治疗的育龄期女性（15 名术前，15 名术后）。PACU 护士样本包括 15 名日间手术中心护士和 58 名主医院护士，PACU 护士的总样本为 73 名。PACU 护士接受了有关阿瑞匹坦及其药物相互作用的教育在职培训。PACU 护士还被指示使用书面和口头两种格式向患者提供出院医嘱。在书面术后随访摘要（AVS）更改和 PACU 护士在职培训前后，对患者进行了术后电话随访，评估 PACU 护士在接受教育在职培训前后的知识、信心和出院教学频率。在干预 90 天后，对 PACU 护士进行调查，以评估他们的长期知识保留情况。
从实施前到实施后，护士对阿瑞匹坦的知识有了显著提高（61.39%对 81.95%，P<0.001）。虽然实施后 90 天的护理知识略有下降（81.95%对 73.68%，P=0.096），但仍明显高于实施前的分数（73.68%对 61.39%，P=0.003）。与干预前相比，能够回忆起接受阿瑞匹坦和需要使用辅助避孕措施的患者比例总体增加了 33.3%（26.7%对 60%，P=0.123）。
研究结果表明，提供关于阿瑞匹坦的标准化介绍可能会提高 PACU 护士口头传达有关阿瑞匹坦的关键信息的能力，包括患者需要使用辅助避孕措施。护理知识和信心的提高，以及改进的书面出院医嘱，可能会提高患者对阿瑞匹坦出院教育的理解。此外，能够回忆起需要使用辅助避孕措施 28 天的患者比例增加，降低了意外怀孕的可能性。
