Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
Adicionar filtros








Intervalo de ano
1.
Artigo em Inglês | IMSEAR | ID: sea-133445

RESUMO

Background : Postoperative pain remains a common complaint among PACU patients so we developed guidelines for better pain control. Patients rated their pain using a numeric rating scale (NRS, from 0 to 10). According to the guidelines, PACU nurses knew that patients with a NRS score  were in severe pain and required medication.Objective : To determine the proportion of patients not receiving treatment according to the guidelines.Design : Descriptive studySetting : PACU at Srinagarind HospitalSubjects : April 2001 PACU recordsMeasurement : The PACU records were reviewed retrospectively for age, NRS score, sedation score, number of treatments given and types of medication used.Results : the PACU admitted 474 patients in the month of April and 338 them were included in our study. Pain assessment was performed on 246 of the sample (72.8%,95%Cl : 68-77%) although 92 were not documented. Most of the patients (95.5%) were able to rate their pain using the NRS. NRS scores  5 were reported by 156 patients (66.4%,95%Cl: 60-72%) but 40 of them (25.6%,95%Cl: 19-33%) did not receive any treatment because 10 refused it and 30 gave no outward sign of needing it. Prior to discharge, 54 patients (29.8%, 95% Cl: 23-37%) still had NRS score5.Conclusion : Pain assessment according to the guidelines was performed on 72.8% of the sample. About 60% of patients had a NRS score  5 but 25.6% did not receive any treatment. We concluded that the guidelines were useful for PACU pain management. For greater improvement in the quality of PACU care, a prospective study should determind provider compliance.Keywords:\ 1. Postoperative Pain\ \ 2. PACU\ \ 3. Pain algorithm

2.
Artigo em Inglês | IMSEAR | ID: sea-133434

RESUMO

Background : Inappropriate medications, or doses, routs and duration of appropriate medications for control of acute postoperative pain have both physical and psychological sequelae.Objective : To survey the orders given over the first 24 hours for postoperative pain control at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.Methods: cross-sectional descriptive study.Setting: Post Anesthesia Care Unit (PACU), Srinagarind HosptialMaterials and Methods: We inventoried the orders given for the first 24 hours of postopetrative pain control for patients admintted to PACU between June 21 and 22, 2001.  Excluded were patients transferred to ICU postoperatively, outpatients and those given anesthesia by local infiltration. Results: 225 patients were admitted to PACU during the sampling period.  The types of pain control medication given included : Tramadol 37.4%, Pethidine 29.6% Paracetamol 22.3%, Morphine 10.2%,and Fentanyl 0.5% No jpain treatment was ordered in 8.4% of the cases.  The predominant pain control orders from the Department of Surgery was Pethidine 46.4% from Orthopedics, Tramadol Tramadol 76.6%, from ENT, Paracetamol 46.4%,  form OB-GYN, Pethidine Pethidine 67.6%, from Ophthalmology, Paracetamol 100%, and from Dentistry, Pethidine (100%). The most common administration routes ordered were: intravenous by the Department of Surgery (82%), intramuscular by Orthopedics (63.6%), intravenous by ENT (48%), intramuscular by OB-GYN (91%), oral by Ophthalmology (100%), and intramuscular by Dentistyr (100%). Differences in dose and duration of administration occurred when both appropriate and inappropriate orders were given.Conclusion: The postoperative pain orders at Srinagarind Hospital have many differences in medications, doses, and duration.  It was up to level of pain and many factors in individual patients.  This research was designed for survey of the basic information and for development of next research. Keyword: 1. Postoperative pain 2. Doctor’s order 3. Analgesic drugs

3.
Artigo em Inglês | IMSEAR | ID: sea-133219

RESUMO

Background: Pain assessment and documentation can be used as vital sign for the improvement of postoperative pain management; however, these systems have never been adopted for use at Srinagarind Hospital.Objectives:1.     To develop a systematic postoperative pain assessment and documentation as the fifth vital sign; and,2.     To implement a revised graphic sheet for pain documentation at Srinagarind Hospital.Design:  Descriptive studySetting:  Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods:  Researchers explored the ward nurses’ attitudes and practices vis-à-vis the pain assessment and documentation in a pilot ward.  Subsequently, systematic pain assessment and documentation using the old graphic sheet, originally developed for recording four other vital signs, were re-designed to include the new sign, tested and revised for its practicality.  The revised graphic sheet was re-tested in two other wards and finally the system was implemented throughout the hospital.Measurement:  Pain assessment tools, frequency of pain documentation and the number of patients assessed before and after the study were recorded.  The ward nurses were asked to give their comments on the practicality of the new system for pain assessment and documentation.Results:  In the pilot ward, misunderstanding regarding the pain assessment tools was found among some ward nurses. The frequency of pain assessment and documentation significantly increased after using the revised graphic sheet (43.2% vs. 57.3%, p=0.039).  The prevalence of no pain assessment also decreased significantly (12.1 vs. 2.2%, p=0.008).  Most of the nurses (87.5%) could complete the pain record form within one minute.  The new system, as reported by 62.5% of the ward nurses, nominally increased their workload.  Re-testing this system in the other two wards increased the number of pain assessments and documentations on the first post-operative day from 67% to 98 %.  The revised graphic sheet was then accepted by the policy makers for use throughout the hospital.Conclusion:  The system of post-operative pain assessment as the fifth vital sign was developed.  A revised graphic sheet was used for pain documentation and accepted for routine use.  The new system increased the number of pain assessments and documentations of post-operative patients. 

4.
Artigo em Inglês | IMSEAR | ID: sea-133201

RESUMO

Background: Currently, post-operative pain management is considered an integral part of recovering and reducing complications related to pain. Acute pain service (APS) has been established worldwide in order to improve the effectiveness of patient care. The Departments of Anesthesia at Khon Kaen and Chiang Mai Universities (KKU and CMU, respectively) developed an APS system each at approximately the same time. Collaboration of the two institutions to benchmark their APS data will help them move forward vis-à-vis post-operative pain management.Objectives: Comparing the results of the respective APS systems between Khon Kaen and Chiang Mai Universities.Design: Retrospective, descriptive studyMethods: The 2005 calendar year data, from the respective APS databases, were reviewed, allowing a comparison of post-operative pain management at KKU and CMU hospitals. We focused on the percentage of post-operative orthopedic patients care through the APS system compared with (1) APS service, (2) days of service, (3) method of pain management, (4) pain assessment, (5) complications, (6) the APS system and (7) patient satisfaction. The data were analyzed using descriptive statistics.Results: Patients who received APS accounted for 12.3 and 7.2 percent of KKU and CMU patients, respectively. The greatest proportion of patients at KKU receiving APS was for intra-abdominal surgery (60%) while at CMU it was for cardiovascular and thoracic surgery (76%). Both institutions provided an average 2.0+1.0 days of service. Surgery on extremities (orthopedics) ranked second at both institutions (26.8 and 20.7 percent, respectively). KKU used variety techniques for controlling pain among orthopedic patients: viz., IV PCA (59%), IV opioid infusion (30%), epidural (6.8%) and spinal morphine with PCA (5.2%), while the primary modality for pain control at CMU was IV PCA (97%). Resting pain for CMU patients was less than that reported by KKU patients (6 vs. 9.5 percent, respectively); however, dynamic pain was not assessed at CMU. Serious complication was not found and patient rated satisfy with APS approximately 94% and 97% (CMU, KKU).Conclusion: The delivery of APS for orthopedic surgery patients at two regional university hospitals in Thailand were studied and benchmarked. There was some difference in the strengths of the APS system between the two institutions; such as, techniques of pain treatment, pain scores and system for pain management. Strengths and weaknesses observed during this benchmarking exercise will be used to improve the delivery of APS at both institutions.Keywords: Acute Pain Service; Benchmark; Post-Operative Pain; University Hospital

5.
Artigo em Inglês | IMSEAR | ID: sea-133195

RESUMO

Background and Objectives: Effective pain control can minimize post operative complications especially for pulmonary complications. Previous reports showed pain management using combined spinal morphine (spinal MO) plus patient-controlled analgesia (IV PCA) was more effective than either intravenous or PCA alone. This technique had been conducted in our institute since 2004 but its effect on postoperative pain control was not reported. Aim is study the effect of spinal morphine plus IV PCA on postoperative pain control. Methods: The author conducted this descriptive study at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, by retrospectively reviewing all medical record of surgical patients who received spinal morphine plus PCA for postoperative analgesia between January 2005 and December 2006. Data extracted were age, gender, types of operation, dosage of spinal morphine, pain scores (both at rest and during movement) on the first post operative day, adverse effects, and patient’s satisfaction. Effect of the pain control were classified as; effective (pain score 0-4) and ineffective (pain score 5-10)Results: Two hundred and sixty two records were analyzed. There were 63% female with a mean age of 49.6+10.5 years. Most of patients (69%) underwent abdominal surgery (excluded cesarean section and kidney surgery). Median dosage of spinal morphine was 0.3 mg depending on types of surgery. There were 62% of cases received effective analgesia at rest whereas 35.4% received while movement. No respiratory depression was reported but 1.5% of patients experienced severe nausea and vomiting. However, 92% of patients were satisfied with the treatment received.Conclusion: Spinal morphine plus PCA is effective for pain control in the first postoperative day only for at rest, but not during movement. Keywords: postoperative pain, spinal morphine, patient-controlled analgesia

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA