Evaluation Study On Acute Pain Service Model And It’s Continuous Quality Improvement

Background:Inadequate analgesia is a common phenomenon in clinical, although researches about the mechanism of pain is continually renewing and specializing, as well as new medicine of analgesia is uninterrupted springing up. To solve this problem, the key step is setting up Acute Pain Service. Evidences at home and abroad indicate that APS can guide medical staff in managing postoperative pain by using the evidence-based method.This not only show individual difference in the process of analgesia, but make the methods of analgesia more extensive and flexible. Adequate analgesia have many benefits, such as decreasing postoperative complication and morality, shortening hospital stays. APS is accepted by many international hospitals as a systemized mode of management, in our country, the history of APS also have more than ten years, but it’s still in the stage of fumbling. We are faced with many crucial tissues, for example, how to train the nurse complying with the guide of acute pain, how to establish APS suitable to our national situation, how to perfect our analgesia path, and how to use quality evaluation system of acute pain associating with the tool of quality improvement to make analgesia management better. This research intend to structure nurse based anesthesiologists supervised APS, standard management procedure, intensify training and education, manage postoperative pain by ward visit, except above aspects, using analgesia system and evaluation criterion of analgesia to evaluate the effect of analgesia, further more to make the effect better. Through our APS to norm analgesia management and achieve final purpose that is decreasing the nurse’ work load and increasing postoperative patients’comfort level.Objective:Establishing nurse based anesthesiologists supervised APS to standard the management of postoperative pain and improve the effect of postoperative analgesia.except that, investigating the effects of the tool of FOCUS-PDCA and the system of pain evaluation in APS.Method:Setting up nurse based anesthesiologists supervised APS, and establishing the responsibility of all level staff and perfecting the operation workflow of APS.1706patients accepted postoperative analgesia management of our APS, including preoperative visit, ward inspection, report and treatment of adverse events, and setting up records of our patients. Using the tool of FOCUS-PDCA and the system of pain evaluation to control postoperative pain and investigate300patients’ degree of satisfaction, meanwhile, assessing the level of nurses’ knowledge regarding pain and the capability of their management, and then survey the surgical word nurses’ satisfaction to APS, in order to continuously improve the quality.Result:We successfully established dour own characteristic APS to manage postoperative pain, during3days after operation, the NRS grade of rest pain is below3in all patients; the grade of movement pain is lower than5. The incidence rate of middle and serious pain decreases is from34.6%to6.6%(p<0.001).Under the intervention of our APS, the patients’ degree of satisfaction to analgesia management raises to96.4%; Rate of respiratory depression is0.00%, and rate of postoperative nausea and vomiting is7.02%, which are lower than report of others; The nurses’ score of questionnaire about pain knowledge increases from40.2±12.4to59.8±11.6after accepting our training. The numbers of pain assessment records are from0.78±1.05to11.02±2.45(p<0.001);94.5%nurses often educate postoperative patients to press the button of PCA before movement or effective cough; Nurses’ satisfaction to pain ward around and pain education is100%, but the satisfaction to APS on the holiday season is only69.9%.Conclusion:Establishment of Nurse based anesthesiologists supervised APS and implement standardized postoperative analgesia, can improve the satisfaction of patients with postoperative and reduce drug adverse reactions. Adopting FOCUS-PDCA program for postoperative pain management,not only can improve the quality of analgesia and satisfaction,but also can improve the pain knowledge level of nurse and quality of pain management. Besides, it also can improve the nurses’ satisfaction, and can reduce workload of nurses, significantly improve the quality of pain management in hospital.