降低心臟外科病房傳統開心手術病人中度疼痛以上發生率

Strategies to Reduce the Incidence of Moderate or Severe Pain in Patients Undergoing Traditional Open Heart Surgery on Cardiac Surgery Wards

鄭伊婷(I-Ting Cheng) ； 吳佩璇(Pei-Hsuan Wu) ； 劉秀華(Hsiu-Hua Liu)

《榮總護理》 37卷3期 (2020/09) Pp. 298-305

https://doi.org/10.6142/VGHN.202009_37(3).0009

摘要

疼痛是手術病人常見問題，優質的疼痛控制可促進術後復原，為臨床照護品質重要指標。本單位2016年傳統開心手術中度疼痛以上（≧4分以上）發生率達62.2%，專案目的為降低傳統開心手術病人中度以上疼痛發生率，達到無痛照護水準。經現況分析，原因有病人束胸帶移位或鬆脫、不清楚離床動作步驟及定時服藥之重要性；新進護理師對心臟專科臨床照顧經驗不足；缺少緩解胸廓回彈用物之輔具、疼痛控制政策缺乏專科止痛藥物使用指引。對策包括縫製防滑型束胸帶及拍攝穿戴口訣步驟影片、製作下床活動步驟海報及藥物資訊專欄、拍攝傳統開心手術病人術後照護衛教影片及舉辦教育訓練、製作安心抱枕、制訂術後疼痛藥物指引等方案進行改善。專案實施後，傳統開心手術病人中度疼痛以上發生率由62.2%降至28.4%，有效降低中度以上疼痛，提升傳統開心手術病人照護品質。

關鍵字

傳統開心手術 ； 疼痛

並列摘要

Postoperative pain is a common symptom and considered a key indicator of clinical care quality. According to statistics, the incidence of moderate pain (numeric rating scale [NRS] ≥ 4) after traditional open heart surgery was 62.2% in 2016, motivating us to reduce the postoperative pain of patients. Through analysis of the current situation, postoperative patients were discovered to be unfamiliar with the correct application of medical corset belts, have coughing, have an incorrect posture when getting out of bed, have inadequate care, have low participation in pain-related exercises, be unaware of analgesic guidelines, miss analgesic doses, and have insufficient analgesic doses. The proposed improvement program involved the following activities: (1) designing of an antiskid medical corset belt and preparing instructions and videos on how to use it, (2) preparing posters to demonstrate how to correctly get out of bed and set up a drug information column, (3) preparing new nursing education videos, (4) holding educational exercise training, (5) establishing a clinical pathway for postoperative analgesic medication guidelines, and (6) adjusting pain reliving regimes. The program reduced the incidence of postoperative pain (NRS ≥ 4) to 28.4%, and thus, our goal was achieved.

並列關鍵字

traditional open heart surgery ； pain

參考文獻

Hamid, M., Gangwani, A., & Akhtar, M. (2015). A quality improvement survey to assess pain management in cardiac surgery patients. Open Journal of Anesthesiology, 5(5), 105-112.

郭瑞萍、翁靜美、陳金玫（2015）．護理人員在術後疼痛照護中的挑戰．領導護理，16（4），11-20。

呂欣衿、邱存梅、王斐雯（2016）．運用跨理論模式提升護理人員對重症病人疼痛評估處置完整性．長庚護理，27（3），353-367。

吳春滿、賴甫誌、趙從賢、童恒新、苗迺芳（2016）．急診醫護人員疼痛處理知識與影響因素之探討．護理雜誌，63（1），99-109。

Caimmi, P. P., Sabbatini, M., Kapetanakis, E. I., Cantone, S., Ferraz, M. V., Cannas, M., & Tesler, U. F. (2017). A randomized trial to assess the contribution of a novel thorax support vest (corset) in preventing mechanical complications of median sternotomy. Cardiology and Therapy, 6(1), 41-51.