改善卢旺达两家急诊室对创伤患者的疼痛管理

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE African Journal of Emergency Medicine Pub Date : 2024-09-11 DOI:10.1016/j.afjem.2024.08.009
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引用次数: 0

摘要

背景对撒哈拉以南非洲地区急诊科(ED)疼痛治疗方案和指南使用的有效性知之甚少。因此,为了填补这一研究空白,本研究的目标如下:1)评估在卢旺达两家教学医院的急诊科实施基本疼痛管理(EPM)课程并指导患者使用世界卫生组织(WHO)基于疼痛阶梯的方案是否能提高创伤患者的疼痛管理质量;2)确定在相同环境下创伤患者实施基于疼痛阶梯的WHO方案的障碍。干预措施是对急诊室临床人员进行为期 1 天的基本疼痛管理培训,然后就如何使用世界卫生组织疼痛阶梯方案进行为期 1 周的指导。结果我们共招募了 261 名患者(干预前为 47.5%,干预后为 52.5%),其中大部分患者的年龄在 21 岁至 40 岁之间(干预前为 60%,干预后为 33%),男性(干预前为 76%,干预后为 73%)。干预后,未记录疼痛评分的患者人数从 58% 降至 24%(P 值为 0.001),轻度疼痛患者人数从 37% 增至 62%(P 值为 0.001),这表明急诊室的疼痛管理质量有所改善。此外,对疼痛治疗质量表示满意的患者从干预前的 42% 显著增加到 80%(p 值为 0.001)。结论在实施 EPM 课程的同时,还指导如何使用 WHO 疼痛阶梯方案,这大大提高了两家转诊医院急诊室创伤患者的疼痛管理质量。尽管如此,一些障碍仍未得到解决,如员工经验不足、记录不全以及患者不愿报告疼痛等。应采取适当的干预措施来解决已发现的障碍,确保卢旺达公立医院急诊室收治的患者得到充分的疼痛管理。
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Improving pain management for trauma patients at two Rwandan emergency departments

Background

Little is known regarding the effectiveness of pain protocols and guideline use in Emergency Departments (ED) in Sub-Saharan Africa. Therefore, to shed light on this research gap, this study had the following objectives: 1) to evaluate if the implementation of the Essential Pain Management (EPM) course combined with mentorship to use the World Health Organization (WHO) pain ladder-based protocol improves the quality of pain management among trauma patients at the ED of two teaching hospitals in Rwanda; and 2) to determine barriers to implementing the WHO pain ladder-based protocol among trauma patients in the same settings.

Methods

This was a pre- and post-intervention study. The intervention was 1-day essential pain management training for ED clinical staff followed by 1 week mentorship on the use of the WHO pain ladder-based protocol.

Results

We enrolled 261 patients (47.5% pre versus 52.5% post intervention), most of them were aged between 21 and 40 (60% pre versus 33% post intervention), and male (76% pre versus 73% post intervention). The quality of pain management at the ED improved as shown by the decrease of the number of patients with undocumented pain scores from 58% to 24% after the intervention (p-value > 0.001) and the increase of the number of patients with mild pain from 37% to 62% (p-value > 0.001). In addition, patients who were satisfied with the quality of pain management increased significantly from 42% before the intervention to 80% (p-value > 0.001). Barriers to the implementation of the WHO pain ladder-based protocol were identified related to staff (i.e. inadequate experience), to the hospital (i.e. poor documentation), and to patients (i.e. reluctance to report pain).

Conclusion

The implementation of the EPM course along with mentorship to use the WHO pain ladder-based protocol significantly improved the quality of pain management for trauma patients in EDs of both referral hospitals. Despite this, some barriers remain unfixed such as inadequate staff experience, poor documentation, and patient's reluctance to report pain. Appropriate interventions should be implemented to address the identified barriers and ensure adequate pain management for patients admitted at EDs in public hospitals in Rwanda.

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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
78
审稿时长
85 days
期刊最新文献
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