Rischer J B, Childress S B
HealthInsight, Salt Lake City, UT 84106, USA.
Jt Comm J Qual Improv. 1996 Oct;22(10):683-700. doi: 10.1016/s1070-3241(16)30275-9.
Using the Agency for Health Care Policy and Research's (AHCPR's) 1994 Clinical Practice Guideline for Management of Cancer Pain, HealthInsight, the peer review organization for Utah and Nevada, organized a cooperative project with physicians and nurses from seven acute care hospitals in Utah. The project's purpose was to adapt the guideline into action plans for participating hospitals and provide the tools necessary to address six "core" guidelines-to assess and relieve pain, educate the patient/family and health care workers, measure patient satisfaction, and provide a continuum of care postdischarge. GUIDELINE DEVELOPMENT: The guidelines were further adapted to meet the needs of the individual hospitals and were implemented in January 1995. Baseline data was collected on 10 patient records per hospital.
Survey results confirmed that although attitudes about cancer pain management were changing, more needed to be done to prevent patient suffering. Follow-up data after one year showed significantly more compliance on all six core guidelines.
The oncology nurse manager and the hematology/oncology physician chief at one hospital joined the project team to support their own ongoing efforts to implement the guidelines. At that hospital, patient satisfaction with pain management has since increased from the 60%-80% level to at least 90%. STATEWIDE PROJECT EXPANSION: Statewide expansion was planned in fall 1995 to extend implementation to the remaining acute care hospitals and to other health care settings in Utah and to ease a patient's transition from one setting to another.
The project team continues to monitor progress in guideline implementation. Surveys demonstrate that, at the time of diagnosis, up to 45% of cancer patients experience moderate to severe pain; 65%-90% experience severe pain when cancer reaches the advanced stages. Unrelieved cancer pain can cause intense suffering, diminished activity, loss of appetite, and loss of sleep.
利用医疗保健政策与研究机构（AHCPR）1994年发布的《癌症疼痛管理临床实践指南》，犹他州和内华达州的同行评审组织“健康洞察”与犹他州七家急症护理医院的医生和护士开展了一个合作项目。该项目的目的是将指南转化为参与医院的行动计划，并提供落实六项“核心”指南所需的工具，即评估和缓解疼痛、教育患者/家属及医护人员、衡量患者满意度以及提供出院后连续护理。
进一步调整指南以满足各医院的需求，并于1995年1月实施。每家医院收集了10份患者记录的基线数据。
调查结果证实，尽管对癌症疼痛管理的态度在改变，但仍需做出更多努力来防止患者遭受痛苦。一年后的随访数据显示，在所有六项核心指南方面的依从性显著提高。
一家医院的肿瘤护理经理和血液学/肿瘤学主任医师加入了项目团队，以支持他们自身正在进行的指南实施工作。自那时起，该医院患者对疼痛管理的满意度从60% - 80%提高到了至少90%。
计划于1995年秋季在全州范围内扩大项目，将实施范围扩大到犹他州其余的急症护理医院以及其他医疗保健机构，并缓解患者从一种环境到另一种环境的过渡问题。
项目团队继续监测指南实施的进展情况。调查表明，在诊断时，高达45%的癌症患者经历中度至重度疼痛；癌症发展到晚期时，65% - 90%的患者经历重度疼痛。未缓解的癌症疼痛会导致剧烈痛苦、活动减少、食欲不振和睡眠障碍。
