实施最佳实践指南建议以管理肿瘤住院患者疼痛的有效性。

Effectiveness of implementing a Best Practice Guideline recommendations to manage pain in oncological hospitalized patients.

作者信息

Alcañiz-Mesas Ana-Isabel, Ruiz-García María-Victoria, Córcoles-Jiménez María-Pilar, Caballero-García María-José, González Álvarez María Teresa

机构信息

Unidad de Oncología y Hematología, Hospital General de la Gerencia de Atención Integrada de Albacete, Albacete, Spain; Grupo de investigación NurSearch CLM, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Castilla-La Mancha, Spain.

Grupo de investigación NurSearch CLM, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Castilla-La Mancha, Spain; Servicio de Urgencias Hospitalarias, Hospital General de la Gerencia de Atención Integrada de Albacete, Albacete, Spain.

出版信息

Enferm Clin (Engl Ed). 2024 Nov-Dec;34(6):448-457. doi: 10.1016/j.enfcle.2024.11.002. Epub 2024 Nov 9.

DOI:10.1016/j.enfcle.2024.11.002

PMID:39528047

Abstract

OBJECTIVE

To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in oncological/oncohaematological hospitalized patients.

METHODS

Ambispective cohort study.

SAMPLE AND SETTING

Adults admitted to oncological unit in Hospital of Albacete.

INTERVENTION

Implementation of GBP recommendations.

VARIABLES

Demographic data. 2)On implementation of GBP recommendations. 3) Outcome in patients: pain intensity in the first 24 h after admission and maximum intensity during admission Tools: Numeric and Visual Scales.

DATA COLLECTION

indicators exported from clinical history for evaluation of the BPSO® program. Ethical aspects: anonymous data. Data analysis (SPSS®): Descriptive during periods: baseline (T0 = December 2015); initial (T1 = 2017); consolidation (T2 = 2018-2019); sustainability (T3 = 2021-2022). Measurements of central tendency and dispersion, absolute and relative frequencies. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). Statistical significance: p < 0.05.

RESULTS

Included 572 patients, 61.5% (352) men. Daily intervention of pain detection was performed in 94.6% (538) of patients (20%-T0; 98.3%-T1; 98.4%-T2; 91.2%-T3; p < 0.001), pain assessment using an appropriate scale in 97.6% (558) (0%-T0; 98.3%-T1; 99.2%-T2; 100%-T3; p < 0.001); 93.7% (535) had a care plan for assessment and management of pain (0%-T0; 98.3%-T1; 96.3%-T2; 92.3%-T3; p < 0.001). The percentage of patients who had severe pain (6-10) during the first 24 hours was reduced from T1 to T3 (5.1%-T1; 6.6%-T2; 2.1%-T3; p = 0.145), but throughout hospitalization increased from T1 to T3 (19.2%-T1; 17%-T2; 22.5%-T3; p = 0.21).

CONCLUSIONS

Implementation of recommendations has led to a statistically significant improvement over the periods in the study; however, no effectiveness has been shown to reduce pain intensity.

摘要

目的

评估实施临床最佳实践指南（BPG）“疼痛评估与管理”建议对肿瘤/肿瘤血液科住院患者疼痛控制的有效性。

方法

双向队列研究。

样本与研究地点

阿尔巴塞特医院肿瘤科室收治的成年人。

干预措施

实施GBP建议。

变量

1）人口统计学数据。2）GBP建议的实施情况。3）患者结局：入院后24小时内的疼痛强度及住院期间的最大疼痛强度。工具：数字评分法和视觉模拟评分法。

数据收集

从临床病历中导出指标以评估BPSO®项目。伦理方面：数据匿名。数据分析（SPSS®）：按时间段进行描述性分析：基线期（T0 = 2015年12月）；初期（T1 = 2017年）；巩固期（T2 = 2018 - 2019年）；可持续性阶段（T3 = 2021 - 2022年）。测量集中趋势和离散程度、绝对频率和相对频率。比较比例（卡方检验）和均值（学生t检验、方差分析）。统计学显著性：p < 0.05。

结果

纳入572例患者，61.5%（352例）为男性。94.6%（538例）的患者进行了每日疼痛检测（T0期为20%；T1期为98.3%；T2期为98.4%；T3期为91.2%；p < 0.001），97.6%（558例）的患者使用了适当的量表进行疼痛评估（T0期为0%；T1期为98.3%；T2期为99.2%；T3期为100%；p < 0.001）；93.7%（535例）的患者有疼痛评估与管理的护理计划（T0期为0%；T1期为98.3%；T2期为96.3%；T3期为92.3%；p < 0.001）。入院后24小时内有严重疼痛（6 - 10分）的患者百分比从T1期到T3期有所降低（T1期为5.1%；T2期为6.6%；T3期为2.1%；p = 0.145），但在整个住院期间从T1期到T3期有所增加（T1期为19.2%；T2期为17%；T3期为22.5%；p = 0.21）。