機構評鑑新指標與專業實踐——疼痛不該再是一場猜謎遊戲

New Survey Indicators for Long-Term Care Facilities and Professional Practice Necessary to Help Take the Guesswork out of Pain Assessment

衛生署於2012年第二次全國護理之家評鑑將疼痛處置納入長期照護機構整合式評鑑的指標之一，主要是雖然在養成教育或實務工作上，疼痛的重要性不斷被凸顯，但對於長期照顧機構的住民來說，仍是一個臨床上普遍被忽略的議題。儘管疼痛的高盛行率和所衍生的後果對機構老人造成極大影響，健康照顧者仍有不知如何執行有效疼痛評估及治療的狀況。為能改善長期照護機構執行適切疼痛評估和管理的可近性，本文概略的簡介了實務上執行疼痛評估與處置所面臨的障礙，並闡述機構照顧者疼痛資訊的可使用性和影響因子；另也進而深入說明疼痛評估應遵守的基本原則和現有應用於機構住民的疼痛評估工具，並依此給予臨床實務具體建議。目前適切的執行疼痛評估和治療已被視為是所有機構住民的基本人權，採用系統性、例行性、跨專業的疼痛評估方式，並在評估過程使用標準化、具信效度的測量工具，乃是為機構住民執行有效疼痛管理的重要基礎。

Taiwan's Department of Health included pain management as part of the long-term care facility accreditation process in 2012. Although this makes such facilities success in managing and reducing the pain perceptions of residents a consideration in facility evaluations and certification approval, pain remains a commonly neglected issue at Taiwan s long-term care facilities. Despite the high prevalence and consequences of pain among this group, healthcare professionals still have difficulty accurately assessing and treating pain. In order to enhance institutional pain assessment and management, this paper first presents a synopsis of the issues primarily responsible for the current under-recognition and under-treatment of pain, then describes the usefulness of current institutional caregivers pain information and factors of influence. We further review general pain assessment principles and measurement tools, assess the implications of these, and then make suggestions for improvement. Appropriate pain assessment and treatment are considered a fundamental human right for all residents of long-term care facilities. Systematic, routine and interdisciplinary pain assessment using standardized, validated measures should be the foundation of effective pain management in elderly residents of long-term care facilities.