University Hospitals Dorset NHS Foundation Trust, Poole, UK
University Hospitals Dorset NHS Foundation Trust, Poole, UK.
BMJ Open Qual. 2023 Feb;12(1). doi: 10.1136/bmjoq-2022-002138.
The number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance is not followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids do not always occur, and so this project sought to develop a systematic approach to integrating them into practice.
Retrospective case note analysis and prospective interventional quality improvement study.
A 16 bedded specialist palliative care inpatient unit.
Hospice inpatients with an Eastern Council Oncology Group performance score of 0-3 who had been prescribed opioids.
Three plan-do-study-act cycles were performed. First, the issue was discussed in the daily multidisciplinary team meeting to raise awareness, second a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge.
Primary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids.
Baseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study, the proportion improved to 65.2% and 60.9%, respectively.
Use of quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health.
随着老年合并症人群的增加，需要姑息治疗的人数正在增加。疼痛是姑息治疗患者常见的症状，通常用阿片类药物治疗。阿片类药物会降低反应时间，导致嗜睡和视觉障碍。有证据表明，在达到稳定的阿片类药物剂量之前，应避免开车。向开处方阿片类药物的患者传达这些事实以及如果不遵守指导方针的法律后果，对于患者和公众安全至关重要。这些讨论有助于共同决策，优化患者的自由和生活质量。然而，令人惊讶的是，这些关于驾驶和阿片类药物的重要讨论并不总是进行，因此本项目旨在开发一种系统的方法将其纳入实践。
回顾性病历分析和前瞻性干预质量改进研究。
一家有 16 张床位的专科姑息治疗住院病房。
患有东部理事会肿瘤学组（Eastern Council Oncology Group）评分 0-3 的姑息治疗住院患者，且已开阿片类药物处方。
进行了三个计划-执行-研究-行动循环。首先，在每日多学科团队会议上讨论这个问题，以提高认识；其次，在现有的病历记录表格中添加了一个提示；最后，在病房办公室张贴了一张提醒海报，以促进出院前的讨论。
主要测量指标是有记录的驾驶状况的患者比例，以及有记录的关于驾驶和阿片类药物的讨论情况。
基线数据显示，11.5%的患者有记录的驾驶状况，11.5%的患者有记录的关于驾驶和阿片类药物的讨论。在研究过程中，这两个比例分别提高到了 65.2%和 60.9%。
使用质量改进变化方法成功地整合了新的干预措施，以增加在开具阿片类药物时关于驾驶的讨论。这是该机构以前忽略的一个问题，从而改善了临床和患者信息共享，以及患者自主管理自己健康的能力。
