Mirza Daniyal H, Zha Lucy, See Claudia, Paoletti Isabella N, Dai Feng, Hocevar Mark, Li Jinlei, Wiznia Daniel
Yale College, New Haven, CT, 06520-8241, USA.
Yale School of Medicine, New Haven, CT, 06520, USA.
J Pain Res. 2024 Jul 26;17:2483-2494. doi: 10.2147/JPR.S461379. eCollection 2024.
The most common route of opioid delivery is nurse-administered pills. However, there are numerous challenges such as nursing burden, opioid diversion, medication delay, and patient dissatisfaction. In this study, we conducted two surveys, first to assess patients' and nurses' opinions on the current administration of opioids in pill form, followed by their attitudes towards an innovative concept of oral medication delivery based on a medical device currently undergoing research and development within the University, patient-controlled dispenser and deactivator (PCDD) that allows patients to self-administer liquid oral opioids on demand based on physician prescription.
Questionnaires were developed, verified and deployed to assess nurse and post-surgical patient opinions on the current administration of opioids in pill form, as well as the proposed new concept of patient -controlled administration of oral liquid medication via an illustration of PCDD, from September 2022 through July 2023 at a major academic tertiary care center. Quantitative and qualitative data were collected from postoperative patients and nurses from surgical specialties including General Surgery, Surgical Oncology, Trauma Surgery, Orthopedics, and Neurosurgery.
Forty-three patients and 53 nurses were interviewed. Seventy percent of patients frequently called nurses for pain medication post-surgery 1-4 times daily, and 32% of patients were told each day by nurses that they could not receive medication because they were not due yet. Medication delay caused 24% of patients to worry about nursing availability for medication delivery. Likewise, nurses reported that half of patients receive delayed medication (22 minutes median delay time) and half of nursing time was spent administering pain medication. Nurses expressed moderate satisfaction with their current delivery of medication (median satisfaction score 6.5 out of 10). When being introduced to the concept of PCDD via a product illustration, 15% of patients said that they prefer liquid medication and 51% said they prefer PCDD or were interested in trying it.
Nurse-administered pills are a common but suboptimal method for postoperative pain management. Based on patient and nurse feedback, patient controlled self-administered liquid oral opioid delivery is conceptually innovative, practically viable and potentially a preferred alternative for timely and less nurse-exhaustive pain management.
阿片类药物最常见的给药途径是由护士发放药片。然而，这存在诸多挑战，如护理负担、阿片类药物的转移、给药延迟以及患者不满等问题。在本研究中，我们进行了两项调查，首先评估患者和护士对当前阿片类药物片剂给药方式的看法，随后了解他们对一种基于大学正在研发的医疗设备的口服给药创新概念的态度，即患者自控配药和停用装置（PCDD），该装置允许患者根据医生处方按需自行服用液体口服阿片类药物。
2022年9月至2023年7月期间，在一家大型学术三级护理中心，设计、验证并发放问卷，以评估护士和术后患者对当前阿片类药物片剂给药方式的看法，以及通过PCDD示意图展示的患者自控口服液体药物给药的新概念。从包括普通外科、外科肿瘤学、创伤外科、骨科和神经外科在内的外科专业的术后患者和护士中收集定量和定性数据。
共采访了43名患者和53名护士。70%的患者术后每天经常呼叫护士索要止痛药1 - 4次，32%的患者每天被护士告知因未到服药时间而无法服药。给药延迟导致24%的患者担心护士无法及时给药。同样，护士报告称，一半的患者存在给药延迟（中位延迟时间为22分钟），且一半的护理时间用于发放止痛药。护士对当前的给药方式表示中等程度的满意（中位满意度评分为6.5分（满分10分））。通过产品示意图向患者介绍PCDD概念时，15%的患者表示更喜欢液体药物，51%的患者表示更喜欢PCDD或有兴趣尝试。
护士发放药片是术后疼痛管理的一种常见但并非最优的方法。根据患者和护士的反馈，患者自控自行服用液体口服阿片类药物在概念上具有创新性，在实际操作中可行，并且可能是及时且减少护士负担的疼痛管理的首选替代方法。
