基于国际“PAIN OUT”调查工具PDCA改进术后患者镇痛管理质量  

Application of PDCA cycle in improving postoperative analgesia management based on international PAIN OUT survey tool

作　　者：刘冬华[1] 杨庆菊[2] 王泽中 刘晓辉[1] 冯翠翠[1] 宋纪明 张洁 刘燕[1] 刘莎莎 LIU Donghua;YANG Qingju;WANG Zezhong;LIU Xiaohui;FENG Cuicui;SONG Jiming;ZHANG Jie;LIU Yan;LIU Shasha(Department of Anesthesiology,Liaocheng People's Hospital,Liaocheng 252000;Department of Ophthalmology,Eavs,Nose and Throat,Liaocheng People's Hospital,Liaocheng 252000;Clinical Medical,Queen Mary College,Nanchang University,Nanchang 330031;School of Nursing,Shandong First Medical University,Taian 271000,China)

机构地区：[1]聊城市人民医院麻醉科,山东聊城252000 [2]聊城市人民医院眼耳鼻喉门诊,山东聊城252000 [3]南昌大学玛丽女王学院,江西南昌330000 [4]山东第一医科大学护理学院,山东泰安271000

出　　处：《麻醉安全与质控》2021年第6期403-408,共6页Perioperative Safety and Quality Assurance

基　　金：聊城市卫健委立项项目(2016年)。

摘　　要：目的探讨基于国际“PAIN OUT”过程、结果多维度质控调查工具,医护一体化采用PDCA循环法在提升患者术后疼痛管理质量的应用效果。方法随机选取2018年10~12月聊城市人民医院关节骨科、胸科、肝胆外科、胃肠外科和两腺外科5个科室的术后24 h患者共150例作为改进前组,每科室各30例,在前期成立急性疼痛服务组织的基础上,组建医护一体化多学科合作疼痛管理团队,采用PDCA通过计划、实施、检查和处理步骤对患者围术期疼痛管理实施改进,基于信息化对医务人员进行多模式疼痛知识培训教育,优化改进流程,根据手术类别,制定个体化镇痛管理方案,对患者实施多元化宣教管理和多模式镇痛管理。2019年10~12月实施改进后从改进前选取的5个科室再次随机选取术后24 h患者150例作为研究对象,采用国际“PAIN OUT”数据表,从过程、结果指标多维度进行改进后评价。结果改进前后患者术后24 h内中重度疼痛的发生率由40.00%降至10.00%;镇痛满意度由91.20%提升到98.00%;患者镇痛知识健康教育满意度由90.00%提升到98.00%;护士的疼痛评估次数(1.78±1.05)次提升至(4.02±1.03)次;疼痛非药物干预措施实施次数由0次(0,1)提升到3次(2,4),P<0.05均有统计学意义。患者疼痛最剧烈的疼痛评分从(6.49±1.02)分降至(4.02±2.01)分,患者的首次下床活动时间由术后(23.72±6.05)h降低到(17.42±3.92)h;患者术后24 h内阿片类药物的用量由(110.24±10.23)μg降低至(82.21±11.27)μg(P<0.05)。结论采用PDCA实施术后疼痛管理质量改进,并采用国际“PAIN OUT”过程和结果质控指标进行评价,不仅能提高术后患者的满意度、舒适度,提升就医体验,缩短患者首次下床活动时间;而且减少患者阿片类药物的用量,符合ERAS快速康复理念。Objective To investigate the effect of PDCA cycle in improving the quality of postoperative pain management based on the international PAIN OUT multi-dimensional quality control survey tool.Methods From October to December 2018,150 cases of patients from five departments,including joint and orthopedics,chest,hepatobiliary surgery,gastrointestinal surgery,breast surgery and thyroid gland surgery,were randomly selected as the research objects before the improvement,with 30 cases in each department.On the basis of the establishment of acute pain service organization in the early stage,a multi-disciplinary cooperative pain management team with medical integration was established,and PDCA cycle was adopted to improve the perioperative pain management of patients through the planning,implementation,examination and treatment steps.Based on information technology,medical staff received multimodal pain knowledge training and education for improving the operation process.According to the type of operation,individualized analgesia management scheme was formulated,and diversified education management and multimodal analgesia management for patients could be implemented.After the implementation of improvement approaches,150 patients within 24 h after the operation were randomly selected from the same departments mentioned above from October to December 2019 as the research objects.The international PAIN OUT data table was used to evaluate the improvement from multiple dimensions of process and outcome indicators.Results Before and after the implementation of improvement approaches,the incidence of moderate and severe pain within 24 h after operation decreased from 40.00% to 10.00%;the satisfaction of analgesia increased from 90.00% to 98.00%;the satisfaction of patient's analgesia knowledge health education increased from 90.00% to 98.00%;the number of pain assessment of nurses increased from(1.78±1.05)times to(4.02±1.03)times;the times of the implementation of non-drug pain intervention measures increased from 0(0,1)to 3(2

关 键 词：持续质量改进 术后患者 疼痛 多模式镇痛 PAIN OUT 

分 类 号：R614[医药卫生—麻醉学]