- 期刊
以病歷審查評估醫院的病人疼痛照護品質
Evaluating the Quality of Patient Pain Care Through Medical Record Reviews
摘要
病人疼痛的照護品質逐漸受到重視，於西元2000年被JCAHO（Joint Commission on Accreditation of Healthcare Organizations）認為是第五個生命徵象，並且成為國內外的評鑑重點。彰化基督教醫院於2008年，開始對病人的疼痛以視覺類比量表（VisualAnalogue Scale; VAS）方式作出完整的評估，並且運用電腦資訊的設計，提高病歷記錄的完整性，於2010年3月經由回溯性病歷審查，並以Paired t-test統計方式作分析，共設立12個品質指標以了解疼痛照護品質。其中指標一至八為住院病人疼痛照護指標，指標九至十二為住院癌症病人疼痛照護指標，由指標的分析，可以發現彰化基督教醫院對病人疼痛照護品質相當不錯，住院時有疼痛的病人，出院時幾乎已完全無痛，疼痛分數VAS平均下降4.4±1.81分，至於癌症病人，疼痛分數VAS平均下降5.6±2.00分，可見本院疼痛照護品質相當好，唯一執行較差的為指標六：住院病人疼痛評估結果VAS≧4分者，護理人員每4小時再評估率為53.7%，仍有進步的空間，現已經由相關單位以PDCA方式改進中。經由病歷審查可以了解醫院的疼痛照護品質，我們希望藉由此篇文章的發表，能激發起大家對病人疼痛照護品質之重視，希望大家一起努力，以達到「無痛醫院」的目標。
並列摘要
The care quality of pain has garnered more attention and risen in importance in recent years, and has been recognized as the fifth vital sign by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2000. It has become one key point during accreditation in Taiwan and overseas. Changhua Christian Hospital implemented a complete patient pain assessment by using visual analogue scale (VAS) back in 2008. We also improved the completeness of the medical record by developing a computerized information system. In March 2010, we established 12 quality indicators for surveying the quality of pain care and collected the data through a retrospective method of medical record review. We analyzed the data through an adopted Paired t-test. Indicators 1 to 8 are the ones for evaluating pain care of inpatients in general, and indicators 9 to 12 are for inpatients suffering from cancer in particular. Through analyzing the indicators, we found out that the quality of pain care was quite good at Changhua Christian Hospital as those inpatients who presented with pain had almost complete pain relief at the time of discharge, with an average inpatients' VAS reduction of 4.4±1.81 for the non-cancer patients, while those of the cancer inpatients averaged around 5.6±2.00. The only inferior one was the indicator 6 as the rate at which patients with VAS≤4 were re-assessed every 4 hours, which turned out to be 53.7%, apparently with room for improvement. For that, we are implementing a PDCA quality improvement cycle for this very indicator alone. We can understand the quality of pain care at the hospital through medical record reviews, and we hope that we can encourage our medical colleagues to pay more attention to the quality of pain care by publishing this article. We invite everyone to work together to reach the goal of a pain-free hospital.