手術病患疼痛處置品質之探討

Quality Evaluation of Postoperative Pain Management

本研究旨在探討手術後病患疼痛處置品質之現況，其目的有：了解病患所接受的術前疼痛護理、術後疼痛處置、術後疼痛與緩解程度、對疼痛處置之滿意度及使用止痛藥後相關副作用之發生情形。本研究採描述性調查設計，以中部某家區域醫院骨科病房100位接受手術治療之病人為取樣對象。結果顯示：(1)術前有92人曾接受至少一項疼痛護理衛教，但13項的衛教內容中，每人平均得到3.57項；其中關於術後疼痛止痛藥使用的指導比率偏低。(2)98％的骨科手術病患有疼痛問題，以0～10分量尺測量，術後疼痛程度之平均為3.68分，最嚴重的疼痛程度平均為7.27分；以0～100％的量尺測量病患接受止痛處理後的疼痛緩解的程度，平均有66.9％的疼痛得到緩解。(3)需要時止痛用藥醫囑的執行率為59.8%，使用劑量佔醫囑可用劑量的31.3～55.4％，18％的病患於使用止痛藥後自覺有副作用產生。(4)14％病患因未能減輕疼痛而要求更換或加強止痛藥，其中有64.4％需等待2至4小時才得以更換處方。(5)病患對疼痛處置的滿意度(1～6分)，平均得分介於5.04至5.14分。(6)該醫院並未制定任何術後病患疼痛處置流程。本研究結果呈現術後病患疼痛處置並不理想，可做為臨床實務之參考，以提昇術後疼痛處置的品質。

The purpose of this study was to evaluate the quality of postoperative pain management, which included the following aspects: preoperative pain-related nursing instruction, postoperative pain management, level of postoperative pain and pain relief, satisfaction of postoperative pain management, and side effects of using analgesics. The descriptive survey study collected a convenient sample of 100 postoperative patients drawing from an orthopedic ward at a district hospital. The results revealed the following findings (1) Ninety-two patients had received preoperative pain care instruction. The average items of pain care instruction were 3.57; (2) Ninety eight percent of the patients experienced postoperative pain. The reported pain level was 3.68 on a 0-10 scale. The worst pain level was 7.27. The degree of pain relief after using analgesics was 66.9%. (3) The proportion of executing prn analgesics order was 59.8%. The dose of prn analgesics was 31.3% to 55.4% of the maximum prescribed doses. Eighteen percent of the receivers reported side effects. (4) Fourteen of patients had requested changing medications or higher dose due to unrelieved pain and 64.4% of them needed to wait for 2-4 hours for an alternative order. (5) Patients’ average satisfaction level toward pain management ranged between 5.04 and 5.14 on a 1-6 scale. (6) The hospital in this study didn’t establish any pain management protocol for postoperative patients. This study revealed that the postoperative pain care and pain management in this hospital was not satisfactory. The findings can serve as a guide for future clinical practice of postoperative pain management.