Caswell D R, Williams J P, Vallejo M, Zaroda T, McNair N, Keckeisen M, Yale C, Cryer H G
Department of Surgery, University of California at Los Angeles Center for Health Sciences, USA.
Jt Comm J Qual Improv. 1996 Oct;22(10):702-12. doi: 10.1016/s1070-3241(16)30276-0.
In April 1994 at the University of California at Los Angeles Medical Center the Surgical Intensive Care Unit's (SICU's) Quality Improvement Council unanimously agreed on pain management as one of the major factors that negatively affect outcomes for their patient population. Using the FOCUS-PDCA (plan-do-check-act) model for quality improvement (QI), the council chartered a subcommittee to improve the pain management in their ICUs.
The subcommittee first measured the pain assessment scores of patients at transfer from the ICU. After ascertaining that these scores were greater than the goal of 2, the process of providing pain relief was examined with the assistance of process control statistics, which showed a process barely capable of meeting the goal of pain score of 2 or less on a 0-5 scale. The process factors that affected this outcome were examined and changes were made where appropriate. One of these changes was development of a guideline for acute pain management based on the Agency for Health Care Policy Research's Acute Pain Management Clinical Practice Guideline. Reassessment of the pain scores and the process was then conducted.
The pain assessment scores at transfer from the ICU decreased significantly. Thirty-five percent of patients in the preguideline survey rated their scores as greater than 2, compared with only 21% at the postguideline survey. Pain assessment and documentation also improved significantly.
The Quality Improvement Council felt that improvements in pain management were due largely to their having provided staff with the right tools to use in assessing, documenting, and controlling pain. Gains in pain management continue to be made.
1994年4月，在加利福尼亚大学洛杉矶分校医学中心，外科重症监护病房（SICU）的质量改进委员会一致认为，疼痛管理是对其患者群体预后产生负面影响的主要因素之一。该委员会采用质量改进（QI）的FOCUS-PDCA（计划-执行-检查-行动）模型，特许成立了一个小组委员会来改善其重症监护病房的疼痛管理。
小组委员会首先测量了患者从重症监护病房转出时的疼痛评估分数。在确定这些分数高于目标值2后，借助过程控制统计数据对缓解疼痛的过程进行了检查，结果显示该过程勉强能够达到0至5分制下疼痛分数为2或更低的目标。对影响这一结果的过程因素进行了检查，并在适当的地方进行了更改。其中一项更改是根据医疗保健政策研究机构的《急性疼痛管理临床实践指南》制定了急性疼痛管理指南。然后对疼痛分数和过程进行了重新评估。
从重症监护病房转出时的疼痛评估分数显著下降。在指南前调查中，35%的患者将其分数评为高于2分，而在指南后调查中这一比例仅为21%。疼痛评估和记录也有显著改善。
质量改进委员会认为，疼痛管理的改善很大程度上归功于他们为工作人员提供了用于评估、记录和控制疼痛的正确工具。疼痛管理方面的成果仍在不断取得。
