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Implementation of national pain guidelines by acute care oncology nurse practitioners using an audit and feedback strategy.

机译：急诊肿瘤科护士执业医师使用审核和反馈策略实施国家疼痛指南。

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摘要

Although many institutions in the United States have made efforts to improve pain management quality, the incidence of pain experienced by hospitalized oncology patients has remained constant over the past 10 years. Despite the availability of clinical practice guidelines (CPGs) for cancer pain, consistent integration of these principles into practice has not been achieved. The optimal method for implementing CPGs and the impact of CPGs on healthcare outcomes remain uncertain. This study evaluated the effect of an audit and feedback intervention on nurse practitioner (NP) implementation of cancer pain CPG and on hospitalized patients' self-reports of pain and perception of care.Lewin's change theory guided this intervention study, conducted on two inpatient services within a comprehensive cancer center. Eight NPs and 192 patients provided informed consent and were considered study participants.NP performance and documentation of initial comprehensive pain assessments increased from 1% to 45% (p = 0.008) during audit and feedback. Repeat pain assessment increased from 7% to 87% (p = 0.008). Opioid prescribing according to guidelines increased from 63% to 81% ( p = 0.008) during the intervention.The mean percentage of assessments in which patients reported acceptable pain relief was 70% (95% CI: 63%--77%) prior to audit and feedback and 95.4% (95% CI: 93%--98%) during the intervention (p 0.0001). While there was no statistically significant change in pain severity during audit and feedback, patients' reported overall interference of pain with function was significantly decreased (p 0.0001) when compared to patients' reports in the preintervention phase. There was no significant change in patients' perceptions of the quality of NP care with the intervention. Both patient groups rated their perception of NP care highly.Findings of this study support prior research suggesting that audit and feedback may be an effective CPG implementation strategy. The actual effect of guideline adoption on outcomes such as pain requires further study. Patients' improved functional status in the absence of change in pain severity underscores the need to consider symptom clusters when studying pain. Evaluation of patients' perception of healthcare may be subject to the same inherent biases (i.e., ceiling effect) as satisfaction surveys.
机译：尽管美国许多机构都在努力改善疼痛管理质量，但过去10年中，住院肿瘤科患者经历的疼痛发生率一直保持不变。尽管有针对癌症疼痛的临床实践指南（CPG），但仍未将这些原理始终整合到实践中。实施CPG的最佳方法以及CPG对医疗结果的影响仍然不确定。这项研究评估了审核和反馈干预对实施癌症疼痛CPG的执业护士（NP）以及住院患者对疼痛的自我报告和对护理的感知的影响.Lewin的变化理论指导了这项干预研究，该研究在两项住院服务中进行在综合癌症中心内。 8名NP和192名患者提供了知情同意并被视为研究参与者。在审核和反馈过程中，NP的性能和最初的综合疼痛评估的文件记录从1％增加到45％（p = 0.008）。重复疼痛评估从7％增加到87％（p = 0.008）。在干预期间，根据指导方针的阿片类药物处方从63％增加到81％（p = 0.008）。在患者接受治疗之前，报告可接受的缓解疼痛评估的平均百分比为70％（95％CI：63％-77％）。审核和反馈，干预期间为95.4％（95％CI：93％-98％）（p <0.0001）。尽管在审核和反馈过程中疼痛严重程度没有统计学上的显着变化，但与干预前阶段患者的报告相比，患者报告的疼痛对功能的总体干扰显着降低（p <0.0001）。通过干预，患者对NP护理质量的看法没有显着变化。两组患者均对NP护理的评价很高。本研究的发现支持先前的研究，表明审计和反馈可能是有效的CPG实施策略。指南对疼痛等结局的实际影响需要进一步研究。在疼痛严重程度无变化的情况下，患者的功能状态得到改善，这凸显了在研究疼痛时需要考虑症状群的必要性。评估患者对医疗保健的看法可能会受到与满意度调查相同的内在偏差（即上限效应）的影响。

著录项

  • 作者

    Dulko, Dorothy.;

  • 作者单位

    The University of Utah.;

  • 授予单位 The University of Utah.;
  • 学科 Health Sciences Nursing.Health Sciences Oncology.
  • 学位 Ph.D.
  • 年度 2007
  • 页码 156 p.
  • 总页数 156
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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