Pain Management Nursing最新文献

{"title":"Online Learning to Improve Nurses’ Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults","authors":"Phichpraorn Youngcharoen PhD, RN ,&nbsp;Chayada Piyakhachornrot MNS, RN","doi":"10.1016/j.pmn.2024.02.007","DOIUrl":"10.1016/j.pmn.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>Older adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses’ knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management.</p></div><div><h3>Aim</h3><p>To determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty.</p></div><div><h3>Design</h3><p>A quasi-experimental pre-test–post-test design with intervention and control groups.</p></div><div><h3>Method</h3><p>Six inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses’ knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired <em>t</em>-tests, and independent <em>t</em>-tests.</p></div><div><h3>Results</h3><p>The knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group.</p></div><div><h3>Conclusions</h3><p>An online learning program improves nurses’ understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1524904224000134/pdfft?md5=b042c33f9660f45c398e1d2a645b2100&pid=1-s2.0-S1524904224000134-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Development and Implementation of the Fast-Pace Assessment Framework and Tiered Analgesic Orders for Opioid Optimization","authors":"Marilyn Bazinski R.N., D.N.P. ,&nbsp;Catherine Lau M.D., SFHM ,&nbsp;Brooke Clemons R.N., M.S.N. ,&nbsp;Lisa Purser R.N., B.S.N. ,&nbsp;Amy Kangwankij B.S.N., R.N. ,&nbsp;Lena Ngo R.N., M.S.N. ,&nbsp;Michael Lang M.D., M.P.H. ,&nbsp;Brianna Besen R.N., M.S.N. ,&nbsp;Kendall Gross Pharm.D., BCPS ,&nbsp;Amber Borucki M.D. ,&nbsp;Matthias Behrends M.D. ,&nbsp;Christine Miaskowski R.N., Ph.D. ,&nbsp;Hildy Schell-Chaple R.N., Ph.D.","doi":"10.1016/j.pmn.2024.01.003","DOIUrl":"10.1016/j.pmn.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Within the context of the opioid epidemic, changes needed to be made in the prescription and administration of analgesics. The purpose of this paper is to describe the development and implementation of a project that utilized a holistic pain assessment framework and introduced new order sets to guide the integration of nonopioid, opioid, and co-analgesics in a quaternary care medical center.</p></div><div><h3>Methods</h3><p>An interdisciplinary team updated policies and procedures for pain assessment and opioid administration and created new analgesic order sets for both adult and pediatric patients. Following requisite approvals, these order sets were integrated into the electronic health record. Education of clinicians, patients, and caregivers was provided to facilitate implementation of these new clinical practices.</p></div><div><h3>Results</h3><p>Prescribers’ levels of adherence with the use of the pain order sets ranged from 80% to 90% and no adverse effects were reported. Education of nursing staff was incorporated into hospital orientation. Ongoing evaluations are providing insights into how the new policies and procedures can be optimized to ensure reliable, safe, and effective pain management.</p></div><div><h3>Conclusions</h3><p>Since the implementation of the opioid optimization project, adherence with the tiered, multimodal approach to analgesic prescribing is high. Next steps include both qualitative and quantitative evaluations of the benefits and challenges associated with this practice change. For example, systems will be developed to monitor nurses’ adherence with the implementation of the pain order sets and the use of both pharmacologic and nonpharmacologic pain management interventions.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic","authors":"Tianxue Hou M.S.N., R.N.","doi":"10.1016/j.pmn.2024.02.001","DOIUrl":"10.1016/j.pmn.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes.</p></div><div><h3>Methods</h3><p>In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty.</p></div><div><h3>Results</h3><p>Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (<em>p</em>&lt; .05).</p></div><div><h3>Conclusions</h3><p>Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Psychometric Testing of a Pain Quality Pictogram Tool Among Hmong Limited English Proficient and Bilingual Community Members and Healthcare Practitioners","authors":"Maichou Lor Ph.D., R.N. ,&nbsp;Nora Cate Schaeffer Ph.D. ,&nbsp;Roger Brown Ph.D.","doi":"10.1016/j.pmn.2024.01.005","DOIUrl":"10.1016/j.pmn.2024.01.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the matching and content validity of a pain quality pictogram tool with a Hmong community.</p></div><div><h3>Design</h3><p>A Qualtrics survey was administered to two groups of participants.</p></div><div><h3>Methods</h3><p>Sixty Hmong participants (<em>n</em> = 49 limited English proficiency and bilingual Hmong community members in group 1; <em>n</em> = 11 bilingual Hmong healthcare practitioners in group 2) participated in this study. Hmong community members in group 1 were asked to identify the pain pictogram that best matched a pre-recorded Hmong pain quality phrase. The practitioners in group 2 were asked to evaluate how well each pain pictogram represented the pre-recorded Hmong pain quality phrase it intended to measure. To assess the matching, we assessed agreement between the pain concept in the phrase and the pictogram intended to represent it, using group 1. A content validity index (CVI) was calculated to assess the content validity of the tool using group 2.</p></div><div><h3>Results</h3><p>Among the community participants, 8 of the 15 pictograms were matched with the intended phrase almost perfectly, and 3 were matched by a substantial majority. There were no differences in matching by patient gender and language proficiency. Among practitioners, 11 of 15 pain pictograms met the CVI threshold of 0.70 for all three dimensions (i.e., representativeness, relevance, and comprehension).</p></div><div><h3>Conclusion</h3><p>Findings support including most of the pain pictograms in the tool but suggest specific areas for improvement.</p></div><div><h3>Clinical Implications</h3><p>Findings provide insights for redesigning the selected pain pictogram tool to be used in clinical settings with LEP Hmong patients.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Nursing Approaches to Low Back Pain: Investigating the Causal Association with Lifestyle-Related Risk Factors","authors":"Jiaojiao Geng ,&nbsp;Le Li ,&nbsp;Tingting Liu ,&nbsp;Bin Yan ,&nbsp;Lili Peng","doi":"10.1016/j.pmn.2024.01.001","DOIUrl":"10.1016/j.pmn.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Notwithstanding a plethora of observational studies, the causal implications of obesity, encompassing both body mass index (BMI) and waist circumference (WC), as well as type 2 diabetes (T2D), and lifestyle factors, in relation to the vulnerability to low back pain (LBP), remain enigmatic.</p></div><div><h3>Aims</h3><p>This study was designed to investigate the related causal associations</p></div><div><h3>Design</h3><p>A two-sample Mendelian randomization (MR) analysis.</p></div><div><h3>Settings</h3><p>By utilizing genetic variants associated with pertinent factors gleaned from genome-wide association studies (GWASs), We extracted independent genetic variants about exposures such as BMI, WC, T2D, smoking, alcohol consumption, and coffee intake from published GWASs, ensuring their genome-wide significance.</p></div><div><h3>Participants/Subjects</h3><p>The GWASs were selected from the most up-to-date and largest publicly accessible databases.</p></div><div><h3>Methods</h3><p>The summary data concerning LBP emanated from a GWAS of European cases and controls, which was based on the esteemed MRC-IEU (Medical Research Council Integrative Epidemiology Unit) consortium.</p></div><div><h3>Results</h3><p>Heightened body mass index and waist circumference exhibited odds ratios of 1.003 (95% confidence interval [CI] = 1.002–1.004, p &lt; 0.001) and 1.003 (95% CI = 1.002–1.004, p &lt; 0.001) for LBP, respectively, per each standard deviation (SD) increase. As for smoking initiation and every SD increase in the frequency of alcohol intake, the odds ratios were 1.002 (95% CI = 1.001–1.003, p = 0.003) and 1.002 (95% CI = 1.000–1.003, p = 0.011), respectively, for LBP. Conversely, an increased log odds ratio for T2D, and prevalence of coffee intake, divulged no discernible causal effects on the risk of LBP.</p></div><div><h3>Conclusion</h3><p>This study provides suggestive evidence to support the causal involvement of obesity, smoking, and the frequency of alcohol intake in the development of LBP, which suggests that implementing measures to mitigate these risk factors may aid in preventing LBP.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1524904224000018/pdfft?md5=ce46d57a2b4334d0b5af3be5752ea287&pid=1-s2.0-S1524904224000018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the Extent of Pain Catastrophizing in Patients Who Have Undergone Total Knee Replacement","authors":"Ai Lin MS ,&nbsp;Zhi Qun Liu MS ,&nbsp;Jia Pei Yao MS ,&nbsp;Yan Hui Liu MS ,&nbsp;Huan Wan MS","doi":"10.1016/j.pmn.2023.12.014","DOIUrl":"10.1016/j.pmn.2023.12.014","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to analyze the current status and influencing factors of pain catastrophizing in patients undergoing total knee replacement (TKR) and to provide a basis and reference for the clinical improvement of pain catastrophizing in these patients.</p></div><div><h3>Design</h3><p>This study was designed in accordance with PRISMA guidelines.</p></div><div><h3>Data sources</h3><p>PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu and Chinese Biomedical Literature Databases.</p></div><div><h3>Review/Analysis methods</h3><p>A scoping review was performed using PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu, and Chinese Biomedical Literature Databases, and after literature screening and data extraction, the results were summarized.</p></div><div><h3>Results</h3><p>A total of 23 articles were included in the study. Pain catastrophizing is mostly assessed using the Pain Catastrophizing Scale and the Coping Strategies Questionnaire. The level of pain catastrophizing is an independent predictor of pain in patients undergoing TKR and is influenced by demographic, psychological, co-morbid, and prognostic factors. Pain catastrophizing interventions mainly consist of surgery, physiotherapy, medication, and psychological therapy.</p></div><div><h3>Conclusions</h3><p>Pain catastrophizing involves multiple factors, and it is necessary to explore the predictors affecting pain catastrophizing, improve the systematic evaluation of pain catastrophizing and adopt the appropriate intervention methods.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1524904223002515/pdfft?md5=dbc3dea250c6b149c6103e535938e125&pid=1-s2.0-S1524904223002515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Procedural Pain and Anxiety in Youth With Autism Spectrum Disorder: A Scoping Review","authors":"Laurence Leblanc RN, MSc ,&nbsp;Christine Genest RN, PhD ,&nbsp;Jade Villemaire RN, BScN ,&nbsp;Philippe Dodin ,&nbsp;Jérôme Gauvin-Lepage RN, PhD","doi":"10.1016/j.pmn.2024.02.004","DOIUrl":"10.1016/j.pmn.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>Although there is a body of literature on the implementation of interventions to manage procedural pain and anxiety in youth with autism spectrum disorders (ASD), we found no literature presenting the current state of knowledge on this topic.</p></div><div><h3>Objectives</h3><p>To review the state of knowledge on interventions for the management of procedural pain and anxiety in children and adolescents with ASD.</p></div><div><h3>Method</h3><p>A scoping review using PRISMA-ScR was conducted.</p></div><div><h3>Data Sources</h3><p>PubMed, MEDLINE, all EBM reviews, Embase, APA PsychInfo, EBSCO CINAHL, and ProQuest Dissertations and Theses Global databases were searched. Gray literature was also searched.</p></div><div><h3>Analysis Method</h3><p>Braun and Clarke's (2006) model for thematic analysis in psychology was used to synthesize the search results.</p></div><div><h3>Results</h3><p>Thirty articles were selected. Analysis of the extracted data revealed four elements of intervention for better management of procedural pain and anxiety in the study population: 1) characteristics of the procedure and the immediate environment; 2) parent-child interactions; 3) health care provider-child interactions; and 4) direct pharmacological and nonpharmacological interventions.</p></div><div><h3>Implications for Nursing Practice</h3><p>Nurses must be able to implement appropriate interventions for the management of procedural pain and anxiety in youth with an autism spectrum disorder.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Education on Symptom Management and Control in Cancer Patients Receiving Palliative Care","authors":"Mahcube Cubukcu ,&nbsp;Bekir Sahin ,&nbsp;Dilek Kiymaz ,&nbsp;Nur Simsek Yurt","doi":"10.1016/j.pmn.2024.02.009","DOIUrl":"10.1016/j.pmn.2024.02.009","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to investigate the effect of an educational intervention on cancer patients receiving palliative care and their caregivers concerning symptom management and family needs.</p></div><div><h3>Methods</h3><p>This study involved 120 participants—60 cancer patients and their respective caregivers—divided into intervention and control groups. Over a 2-week period, the intervention group received a comprehensive educational program focusing on symptom management, while the control group did not receive any educational intervention. The Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS) were used to assess patients' symptoms, their intensity, and performance, while the Family Need Scale (FNS) was utilized to evaluate caregivers' needs. These assessments were conducted at the beginning and end of the study. Primary outcomes focused on symptom assessment using ESAS and PPS, along with evaluating caregivers’ needs through FNS. Secondary outcomes involved assessing participant satisfaction with the intervention.</p></div><div><h3>Results</h3><p>At the end of the study, comparing initial and second evaluations, both ESAS and PPS scores significantly increased in the intervention and control groups (<em>p</em> = .003, <em>p</em> = .002, respectively). Additionally, a statistically significant decrease in the severity of symptoms, except for lethargy/hypokinesis, was observed in the intervention group compared to the control group. The FNS scale indicated that family needs satisfaction was higher in the intervention group compared to the control group. The data obtained demonstrated that there was a reduction the pain, fatigue, depression, anxiety, drowsiness, and shortness of breath levels in the intervention group compared to the control group, but there was no significant difference other than these symptoms.</p></div><div><h3>Conclusions</h3><p>The educational intervention positively impacted symptom management and family needs. Optimizing symptom control would greatly benefit palliative care patients and their caregivers.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team","authors":"Madison Peters RN, BScN, MN ,&nbsp;Dr. Justin Kutzko C.C.F.P., M.B.B.S. ,&nbsp;Kalli Stilos (RN, BScN, MScN, CHPCA (C))","doi":"10.1016/j.pmn.2024.02.014","DOIUrl":"10.1016/j.pmn.2024.02.014","url":null,"abstract":"<div><h3>Background</h3><p>The use of Patient Controlled Analgesia (PCA) via a Continuous Ambulatory Delivery Device (CADD) is a common and effective means of pain and symptom management for hospitalized patients with a malignancy. Studies exploring the indications for starting such a device for hospitalized inpatients referred to inpatient palliative care teams are limited.</p></div><div><h3>Aim</h3><p>This retrospective chart review aims to explore indications, timing of initiation, and barriers to the use of a CADD.</p></div><div><h3>Methods</h3><p>Over a six month period, during daily inpatient palliative care consult team rounds, patients who required a CADD were enrolled in this study. Sixty-one adult patients were identified who required a pump for symptom control. The team’s database sheets were used to capture patient demographics.</p></div><div><h3>Results</h3><p>The main reasons for initiating a Continuous Ambulatory Delivery Device in the above setting included: lack of efficacy of oral opioids and to increase patient autonomy of their pain management. Approximately 20% of patients required transfer to another unit that could accommodate the CADD. The median length of stay for these patients was 13 days, with a median length of half a day for a pump to be started.</p></div><div><h3>Conclusions</h3><p>This initial study provides the Palliative Care Consult Team with information on the indications for the use of a CADD. The lack of universal access to a CADD in various areas of our hospital due to differences in departmental protocols may compromise good symptom management and patient safety. These results strengthen the argument that the existing hospital policy requires revamping to improve CADD access.</p><p>A CADD has been shown to provide hospitalized patients, with a malignancy, with timely access to effective symptom management, and in turn, reducing their length of stay in hospital. These findings will help inform this organization's CADD policy and support the need to broaden access to this device.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1524904224000237/pdfft?md5=01ca7c0c42442b5e5b59fcdb731319c2&pid=1-s2.0-S1524904224000237-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients","authors":"Anoush Kalachian DNP, APN, AGACNP-BC, PCCN, CCRN ,&nbsp;Judith Barberio PhD, APN, ANP-BC, GNP-BC, PMGT-BC ,&nbsp;Jill Cox PhD, APN-c, CWOCN","doi":"10.1016/j.pmn.2023.12.016","DOIUrl":"10.1016/j.pmn.2023.12.016","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether the elimination of extended release (ER) opioids in the multimodal medication regimen of total knee replacement (TKR) patients resulted in improved patient outcomes.</p></div><div><h3>Design</h3><p>Retrospective cohort quality improvement.</p></div><div><h3>Methods</h3><p>This project utilizes a retrospective chart review to evaluate an institution's current postoperative pain<span> protocol. The outcomes of interest include mean hospital length of stay, discharge disposition, mean pain score, antiemetic use, mean opioid dose used, and number of opioid discharge prescriptions.</span></p></div><div><h3>Results, Conclusions, and Clinical Implications</h3><p>Sixty patients were reviewed with a mean age at 70 years for both the pre-protocol (n = 36) and post-protocol groups (n = 34). There was a reduction in antiemetic use, <em>t</em>(59) = 2.2, <em>p</em> = .03 and length of stay, <em>t</em>(58) = 1.0, <em>p</em> = .33, and more discharges to home than rehab, <em>x²</em> = 60, <em>p</em><span><span> &lt; .001. All patients received 30 tablets of only one opioid prescription upon discharge with no refill, either oxycodone-IR (82%, n = 49), hydromorphone (5%, n = 3), or tramadol (12%, n = 7). The project, aimed to reduce opioid overprescription and overconsumption, has the potential to improve prescribing practices, promoting </span>patient safety<span> and healthcare quality by supporting the current guidelines that recommend against using ER opioids for the study population.</span></span></p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139712811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}