Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France.
Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France.
BMC Geriatr. 2024 Sep 5;24(1):735. doi: 10.1186/s12877-024-05282-w.
Postoperative pain delays ambulation, extends hospital stay, reduces the probability of recovery, and increases risk of long-term functional impairment. Pain management in hip fractured patients poses a challenge to the healthcare teams. Older adults are more vulnerable to opioid-associated side effect and it is primordial to minimize their exposure to opioids. Acetaminophen is associated with reduced opioid use so we need to focus on acetaminophen use in first-line analgesia.
We conducted a controlled before/after study to assess the ability of an audit and feedback (A&F) intervention built with nurses to improve the quality of perioperative pain management in older patients hospitalized for hip fracture in an orthogeriatric unit (experimental group) versus a conventional orthopedic unit (no A&F intervention). The primary endpoint was the percentage of patients who received 3 g/day of acetaminophen during the three postoperative days, before and after the A&F intervention. Secondary endpoints included nurses' adherence to medical prescriptions, clinical data associated with patients and finally factors associated with intervention. The significative level was set at 0.05 for statistical analysis.
We studied data from 397 patients (mean age 89 years, 75% female). During the postoperative period, 16% of patients from the experimental group received 3 g/day of acetaminophen before the A&F intervention; the percentage reached 60% after the intervention. The likelihood of receiving 3 g/day of acetaminophen during the postoperative period and adhering to the medical prescription of acetaminophen were significantly increased in the experimental group as compared with the control group. The patient's functional status at discharge (assessed by Activities of Daily Living scores) was significantly better and the length of hospital stay significantly reduced after the A&F intervention.
Our controlled before/after study showed that an A&F intervention significantly improved perioperative pain management in older adults hospitalized for hip fracture. Involving teams in continuous education programs appears crucial to improve the quality of pain management and ensure nurses' adherence to medical prescriptions.
术后疼痛会延迟患者活动，延长住院时间，降低康复概率，并增加长期功能障碍的风险。髋部骨折患者的疼痛管理对医疗团队来说是一个挑战。老年人更容易出现阿片类药物相关的副作用，因此尽量减少他们接触阿片类药物至关重要。对乙酰氨基酚与减少阿片类药物的使用有关，因此我们需要关注在一线镇痛中使用对乙酰氨基酚。
我们进行了一项对照前后研究，以评估由护士构建的审核和反馈（A&F）干预措施，以改善骨科老年病房（实验组）与传统骨科病房（无 A&F 干预）中髋部骨折住院老年患者围手术期疼痛管理的质量。主要终点是在 A&F 干预前后的三个术后天内，接受 3g/天对乙酰氨基酚的患者比例。次要终点包括护士对医嘱的依从性、与患者相关的临床数据，最后是与干预相关的因素。统计学分析的显著性水平设定为 0.05。
我们研究了 397 名患者的数据（平均年龄 89 岁，75%为女性）。在术后期间，实验组中有 16%的患者在 A&F 干预前接受了 3g/天的对乙酰氨基酚；干预后这一比例达到 60%。与对照组相比，实验组在术后期间接受 3g/天对乙酰氨基酚的可能性以及对乙酰氨基酚医嘱的依从性显著增加。A&F 干预后，患者出院时的功能状态（通过日常生活活动评分评估）显著改善，住院时间明显缩短。
我们的对照前后研究表明，A&F 干预显著改善了髋部骨折住院老年患者的围手术期疼痛管理。让团队参与持续的教育项目对于改善疼痛管理质量和确保护士遵守医嘱至关重要。
