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临床药师从业者对骨科手术围手术期疼痛管理的影响。

The Impact of a Clinical Pharmacist Practitioner on Perioperative Pain Management for Orthopedic Surgeries.

机构信息

West Palm Beach VA Healthcare System, West Palm Beach, Florida, USA.

出版信息

J Pain Palliat Care Pharmacother. 2024 Mar;38(1):84-93. doi: 10.1080/15360288.2023.2299437. Epub 2024 Jan 22.

Abstract

The objective of this quality improvement (QI) project was to assess the impact of an evidence based clinical pharmacist practitioner (CPP) model applied to perioperative pain management by integrating a CPP into the perioperative orthopedic surgery clinical pathway. Secondary objective was to assess the effect of CPP pain management service on surgical team satisfaction. This QI project expanded CPP pain management services for patients who were scheduled for an orthopedic surgery. Surgical provider satisfaction of CPP pain management services was assessed through a provider survey. Pain management recommendations by the Pain CPP were implemented 61% ( = 23/38) of the time by the orthopedic surgeon. The impact of the Pain CPP on perioperative pain management was demonstrated by improvement in the Clinically Aligned Pain Assessment Tool, which was similar in patients where CPP recommendations were accepted compared to surgeon only recommended regimens ( = 0.048). Five orthopedic surgical providers responded to our satisfaction survey, 80% ( = 4/5) strongly agree that a pain management CPP should become a permanent member of the care team. Through an evidence-based CPP model we observed a reduction in quantity of opioid prescribed and morphine equivalent daily dose utilized in patients who underwent an orthopedic surgery.

摘要

本质量改进(QI)项目的目的是评估将临床药师从业者(CPP)模式应用于围手术期疼痛管理的效果,该模式通过将 CPP 整合到围手术期骨科临床路径中。次要目标是评估 CPP 疼痛管理服务对手术团队满意度的影响。本 QI 项目扩展了 CPP 围手术期疼痛管理服务,适用于计划接受骨科手术的患者。通过提供者调查评估了外科医生对 CPP 疼痛管理服务的满意度。CPP 的疼痛管理建议在 61%(=23/38)的时间内由骨科医生实施。疼痛 CPP 对围手术期疼痛管理的影响通过临床一致疼痛评估工具的改善得到证明,在接受 CPP 建议的患者与仅接受外科医生建议方案的患者中,该工具的改善情况相似(=0.048)。五名骨科外科医生对我们的满意度调查做出了回应,80%(=4/5)强烈同意疼痛管理 CPP 应成为护理团队的永久成员。通过基于证据的 CPP 模式,我们观察到接受骨科手术的患者处方阿片类药物的数量和吗啡当量日剂量减少。

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