实施基于证据的指导方针,在心脏手术后减少阿片类药物
Roberto Galao-Malo1, Alison Davidson1, Rita D'Aoust2
1Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York.
Journal of the American Association of Nurse Practitioners
|January 18, 2024
概括
这项质量改进项目成功地减少了心脏手术患者的阿片类药物过度处方,通过增加乙氨基的使用和限制阿片类药物释放处方. 这项干预措施显著减少了阿片类药片和吗啡毫克相当量 (MME) 在出院时.
科学领域:
- 心血管外科心血管外科
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
背景情况:
- 美国的阿片类药物过量死亡人数正在上升,手术后过量处方是其中的一个因素.
- 对心血管手术患者的阿片类药物处方实践缺乏一致性,并且不完全执行出院建议.
研究的目的:
- 在接受选择性心脏手术的成年患者中减少阿片类药物过度处方.
- 通过增加对乙氨基的使用和减少出院时的阿片类药物量来改善疼痛管理策略.
主要方法:
- 一个单一的中心,前后质量改进项目是在通过胸骨切割选择性心脏手术后对成人患者进行的.
- 干预措施包括指导方针的改变,修改订单集,仪表板和提供者教育,以促进计划中的乙氨基和限制阿片类药物处方.
主要成果:
- 在降级装置上使用乙氨基的比例从9%增加到96% (p < .001).
- 患有≤25片阿片类药物片的患者出院的比例从18%上升到90% (p < .001).
- 25毫克吗啡等效 (MME) 的阿片类药物处方从30%增加到55% (p < .01),而乙氨基处方在离院时从10%增加到48% (p < .001).
结论:
- 质量改善倡议有效地增加了乙氨基的利用率,并减少了心脏手术患者的阿片类药物过度处方.
- 需要进一步的研究来优化疼痛管理协议,并尽量减少在出院时的阿片类药物处方.
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