{"title":"取消全膝关节置换术患者术后疼痛治疗方案中的缓释类阿片。","authors":"Anoush Kalachian DNP, APN, AGACNP-BC, PCCN, CCRN , Judith Barberio PhD, APN, ANP-BC, GNP-BC, PMGT-BC , Jill Cox PhD, APN-c, CWOCN","doi":"10.1016/j.pmn.2023.12.016","DOIUrl":null,"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>x<sup>2</sup></em> = 60, <em>p</em><span><span> < .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":1.6000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients\",\"authors\":\"Anoush Kalachian DNP, APN, AGACNP-BC, PCCN, CCRN , Judith Barberio PhD, APN, ANP-BC, GNP-BC, PMGT-BC , Jill Cox PhD, APN-c, CWOCN\",\"doi\":\"10.1016/j.pmn.2023.12.016\",\"DOIUrl\":null,\"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>x<sup>2</sup></em> = 60, <em>p</em><span><span> < .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\":1.6000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pain Management Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1524904223002539\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pain Management Nursing","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1524904223002539","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NURSING","Score":null,"Total":0}
Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients
Purpose
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.
Design
Retrospective cohort quality improvement.
Methods
This project utilizes a retrospective chart review to evaluate an institution's current postoperative pain 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.
Results, Conclusions, and Clinical Implications
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, t(59) = 2.2, p = .03 and length of stay, t(58) = 1.0, p = .33, and more discharges to home than rehab, x2 = 60, p < .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 patient safety and healthcare quality by supporting the current guidelines that recommend against using ER opioids for the study population.
期刊介绍:
This peer-reviewed journal offers a unique focus on the realm of pain management as it applies to nursing. Original and review articles from experts in the field offer key insights in the areas of clinical practice, advocacy, education, administration, and research. Additional features include practice guidelines and pharmacology updates.