改善急救部门疼痛管理的障碍:从精益驱动的质量改善倡议中吸取教训
Jakub Nożewski1,2, Radosław Bondarczuk2, Grzegorz Hołody2
1Department of Emergency Medicine, Dr Jan Biziel's University Hospital No. 2, 85-168 Bydgoszcz, Poland.
精益管理和SixSigma稍微改善了急诊室的疼痛管理,但不充分的止痛仍然存在. 需要加强临床参与和结构化的协议,以实现疼痛缓解的可持续变化.
科学领域:
- 紧急医疗 紧急医疗
- 医疗保健管理的管理
- 过程改进 过程改进
背景情况:
- 疼痛是急诊室 (ED) 访问的主要原因,但疼痛管理往往是不充分的.
- 当前的做法可能会优先考虑其他生命体征,而不是有效的疼痛评估和治疗.
- 疼痛的治疗不足或疼痛的治疗不足是紧急护理机构的一个重大问题.
研究的目的:
- 实施精益管理和SixSigma方法来增强ED的疼痛管理过程.
- 改善对患有严重疼痛的患者及时有效的止痛药的使用.
主要方法:
- 在医院的急诊室内应用精益管理和SixSigma原则.
- 专注于过程改进,以解决疼痛评估和治疗方案的缺陷.
主要成果:
- 在统计学上显著,尽管在临床上是温和的,但在止痛药的使用增加被观察到.
- 没有接受止痛药的患者的百分比略有下降 (96.6%至94.8%).
- 在分组期间,在疼痛特征文档中发现了改善,但疼痛治疗的升级和强度止痛药的使用仍然有限.
结论:
- 基于瘦身的干预措施表现出部分成功,但未能完全解决ED的橄痛解症.
- 可持续的改善需要更大的临床参与,持续的员工培训和标准化的止痛方案.
- 在医院前和医院护理中更广泛地采用结构化协议对于有效的疼痛管理至关重要.
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