遵守阿片类药物处方指南在全州的手术质量改善协作合作中
Audra J Reiter1, Reiping Huang1, Cassandra B Iroz2
1Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
The Journal of surgical research
|October 7, 2023
概括
针对性阿片类药物处方和多模式疼痛管理是常见的,但根据外科专业而异. 手术后阿片类药物使用和疼痛控制的文档往往缺失,突出需要更好的跟踪.
科学领域:
- 疼痛管理 疼痛管理
- 手术瘤学手术瘤学
- 公共卫生 公共卫生
背景情况:
- 美国面临着持续的阿片类药物危机,3-7%的术后患者患有慢性阿片类药物滥用.
- 有效的疼痛管理策略对于减轻阿片类药物相关风险至关重要.
研究的目的:
- 评估针对目标的阿片类药物处方和使用多模式疼痛管理策略.
- 在实施全州协作质量改进计划2年后评估这些做法.
主要方法:
- 针对10种向性外科手术的阿片类药物处方和多模式策略的前性数据收集 (2020年7月至2021年9月).
- 按期处方定义为每天≤50毫克的吗啡等价物.
- 多种模式的策略包括在手术后48小时内≥2个非阿片类添加剂.
主要成果:
- 在993个病例中,目标处方率为79.6%,根据专业有显著差异 (一般外科92.5%,妇科84.9%,骨科59.0%).
- 多模式方法与患者教育,神经阻塞和非阿片类药物处方有关.
- 在目标和目标之外的阿片类药物处方组之间,在使用多式联络方法方面没有显著差异 (73.8%和77.3%).
- 术后阿片类药物使用 (57.3%),药片数量 (93.8%) 和疼痛控制充足度 (52.8%) 的数据缺失率很高.
结论:
- 定位处方和多模式策略普遍存在,但在专业之间表现出显著的变化.
- 术后疼痛控制和阿片类药物使用的不一致的文档妨碍了个性化处方.
- 对患者和专业水平阿片类药物使用的进一步研究对于优化疼痛管理和减轻风险至关重要.
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