QUIPSI – Qualitätsverbesserung der postoperativen Schmerztherapie bei Kindern

 

 Buy Article Permissions and Reprints

Zusammenfassung

Bei Erwachsenen ist die Erhebung der Ergebnisqualität zur Analyse der postopüerativen Schmerzmanagmentes nach Operationen zunehmend Standard. In diesem Pilotprojekt wurde erstmals versucht dies auch bei Kindern durchzuführen (QUIPSI). Es konnte gezeigt werden, dass die Ergebnisqualität der postoperativen Schmerztherapie bei Kindern nach Operationen gemessen und in die tägliche Routine integriert werden kann. QIPSI (Quality Improvement in Postoperative Pain Management in Infants) ist ein neues Tool zur Überprüfung der Ergebnis- und Prozessqualität des postoperativen Schmerzmanagementes im Kindesalter nach Operationen. In einem nächsten Schritt wird an 10 Kliniken eine multizentrische Erhebung zur Machbarkeit durchgeführt.

Abstract

Outcome-focussed benchmarking has been shown to be a successful tool in adult quality improvement of postoperative pain management in adults. We report on feasibility and first results of a similar project in operated children (quality improvement of postoperative pain management in infants, QUIPSI).

Our results show that outcomes in postoperative pain management can be measured and compared in routine clinical practice. QUIPSI (Quality Improvement in Postoperative Pain Management in Infants) represents a new tool for outcome evaluation, consisting of standardized data acquisition of outcome and process quality indicators. In the currently starting second phase of the project, a multicenter evaluation will take place in ten medical centres.

Literatur

• 1 Bennett-Branson S, Craig K. Postoperative pain in children: developmental and family influences on spontaneous coping strategies.  Can J Behav Sci. 1993;  25 355-383
  PubMedGoogle Scholar
• 2 Blount R, Davis N, Powers S, Roberts M. The influence of environmental factors and coping style on children's coping and distress.  Clin Psychol Rev. 1991;  11 93-116
  CrossrefPubMedGoogle Scholar
• 3 Chambers C, Craig K, Bennett S. The impact of maternal behaviour on children's pain experiences: an experimental analysis.  J Pediatr Psychol. 2002;  27 293-301
  CrossrefPubMedGoogle Scholar
• 4 Schanberg L, Keefe F, Lefebvre J. Social context of pain in children with juvenile primary fibromyalgia syndrome: parental pain history and family environment.  Clin J Pain. 1998;  14 107-115
  CrossrefPubMedGoogle Scholar
• 5 Stamer UM, Mpasios N, Maier C, Stuber F. Postoperative analgesia in children – current practice in Germany.  Eur J Pain. 2005;  9 550-560
  PubMedGoogle Scholar
• 6 Schoeffel D, Crasser HR, Bach M et al.. Risk assessment in pain therapy.  Schmerz. 2008;  22 594-603
  CrossrefPubMedGoogle Scholar
• 7 Walker SM. Pain in children: recent advances and ongoing challenges.  Br J Anaest. 2008;  101 101-110
  PubMedGoogle Scholar
• 8 Lönnqvist PA, Morton NS. Postoperative analgesia in infants and children.  Br J Anaesth. 2005;  95 59-68
  CrossrefPubMedGoogle Scholar
• 9 Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right.  Anesth analg. 2007;  105 205-221
  CrossrefPubMedGoogle Scholar
• 10 Kehlet H, Dahl JB. The value of”multimodal” or “balanced analgesia” in postoperative pain treatment.  Anesth Analg. 1993;  77 1048-1056
  PubMedGoogle Scholar
• 11 Grass JA. Patient controlled analgesia.  Anesth Analg. 2005;  101 44-61
  CrossrefPubMedGoogle Scholar
• 12 Duarte LT, Fernandes C Mdo et al.. The incidence of postoperative respiratory depression in patients undergoing intraveous or epidural analgesia with opioids.  Rev Bras Anesthesiol. 2009;  59 409-420
  PubMedGoogle Scholar
• 13 Hudcova J, McNicol E, Quah C et al.. Patient controlles intravenous opioid analgesia versus conventional opioid analgesis for postoperative pain control:a quantitative systematic review.  Acute Pain. 2005;  7 115-132
  CrossrefPubMedGoogle Scholar
• 14 Birmingham PK, Suresh S, Rae BR et al.. Patient-Controlled Epidural Analgesia in Children: Can They Do It?.  Anesth Analg. 2003;  96 686-691
  PubMedGoogle Scholar
• 15 Moiniche S, Mikkelsen S, Wetterslev J et al.. A qualitative systemic review of incisional local anesthesia for postoperative pain relif after abdominal operations.  Br J Anaesth. 1998;  81 377-383
  PubMedGoogle Scholar
• 16 Cnar SO, Kum U, Cevizci N et al.. Effects of levobupivacaine infiltration on postoperative analgesia and stress response in children following inguinal repair.  Eur J Anaesthesiol. 2009;  26 430-434
  CrossrefPubMedGoogle Scholar
• 17 Lönnqvist PA, Morton NS. Postoperative analgesia in infants and children.  Br J Anaesth. 2005;  95 59-68
  CrossrefPubMedGoogle Scholar
• 18 Brodner G et al.. Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients.  Eur J Anaesthesiol. 2000;  17 566-575
  PubMedGoogle Scholar
• 19 Richman MJ et al.. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.  Anesth Analg. 2006;  102 248-257
  CrossrefPubMedGoogle Scholar
• 20 Gille J, Gille M, Gahr R et al.. Acute pain management in proximal femoral fractures. Femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model.  Anaesthesist. 2006;  55 414-422
  CrossrefPubMedGoogle Scholar
• 21 Schöps P, Seeger D. Physiomedical therapy of acute and chronic pain.  Schmerz. 2009;  23 191-212
  CrossrefPubMedGoogle Scholar
• 22 Howard R, Carter B, Curry J. Quick reference summery of recommendations and good practice points.  Pediatr Anesthesia. 2008;  18 (S 01) 4-13
  PubMedGoogle Scholar
• 23 Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children.  Pediatr Clin North Am. 2000;  47 487-512
  CrossrefPubMedGoogle Scholar
• 24 Treadwell MJ, Franck LS, Vichinsky E. Using quality improvement strategies to enhance pediatric pain assessment.  Int J Qual Health Care. 2002;  14 39-47
  CrossrefPubMedGoogle Scholar
• 25 Suraseranivongse S, Kaosaard R, Intakong P et al.. A comparison of postoperative pain scales in neonates.  Br J Anaesth. 2006;  97 540-544
  CrossrefPubMedGoogle Scholar
• 26 von Baeyer C, Spagrud L. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years.  Pain. 2007;  127 143-157
  PubMedGoogle Scholar
• 27 Mathew PJ, Mathew JL. Assessment and management of pain in infants.  Postgrad Med J. 2003;  79 438-443
  CrossrefPubMedGoogle Scholar
• 28 von Baeyer CL. Children's self-report of pain intensity: scale selection, limitation and interpretation.  Pain Res Manag. 2006;  11 157-162
  CrossrefPubMedGoogle Scholar
• 29 Harmer M, Davies KA. The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services.  Anaesthesia. 1998;  53 424-430
  CrossrefPubMedGoogle Scholar
• 30 Reichl S, Pogatzki-Zahn E. Concepts for perioperative pain therapy. A critical stocktaking.  Anaesthesist. 2009;  58 914-930
  CrossrefPubMedGoogle Scholar
• 31 Saur P, Junker U, Gaus P et al.. Implementation of a standardized perioperative pain management concept in three hospitals of a consortium.  Schmerz. 2008;  33 34-42
  PubMedGoogle Scholar
• 32 Brodner G, Mertes N, Buerkle H, Marcus MA, Van Aken H. Acute pain management in Europe: a 17-nation surveyof 105 hospitals. The Euro Pain Acute Pain Working Party.  Eur J Anaesthesiol. 1998;  15 354-363
  PubMedGoogle Scholar
• 33 Wiebalck A, Vandermeulen E, Van Aken H, Vandermeersch E. Ein Konzept zur Verbesserung der postoperativen Schmerzbehandlung.  Anaesthesist. 1995;  44 831-842
  CrossrefPubMedGoogle Scholar
• 34 Rawal N, Berggren L. Organization of acute pain service: A low cost model.  Pain. 1994;  57 117-123
  CrossrefPubMedGoogle Scholar
• 35 Meissner W, Ullrich K, Zwacka S. Benchmarking as a tool of continuous quality improvement in postoperative pain management.  Eur J Anaesthesiol. 2006;  23 142-148
  PubMedGoogle Scholar
• 36 Meissner W, Mescha S, Rothaug J, Zwacka S, Göttermann A, Ulrich K, Schleppers A. Qualitätsverbesserung der postoperativen Schmerztherapie – Ergebnisse des QUIPS Projektes.  Dt Arztbl. 2008;  105 865-870
  PubMedGoogle Scholar
• 37 Benchmarking im Gesundheitswesen – Verbesserung der postoperativen Schmerztherapie durch Einführung eines kontinuierlichen Benchmarkingprozesses. http://www.benchmarking-qm.de/FachThema/Projekte/Schmerztherapie/
  Google Scholar
• 38 Hicks CL et al.. The faces pain scale-revised: toward a common metric in pediatric pain measurement.  Pain. 2001;  93 173-183
  CrossrefPubMedGoogle Scholar
• 39 Stanford EA, Chambers CT, Craig KD. A normative analysis of the development of pain-related vocabulary in children.  Pain. 2005;  114 278-284
  CrossrefPubMedGoogle Scholar
• 40 Champion GD, Goodenough B, Wu E et al.. Children's self report of pain intensity using six different scale types. Paper presented at the Seventh Internationel Symposium on Pediatric pain 2000, June, London. 
  PubMedGoogle Scholar
• 41 Chambers CT, Giesberg K, Craig KD et al.. A comparison of faces scales for the measurement of pediatric pain: children's and parents' ratings.  Pain. 1999;  83 25-35
  CrossrefPubMedGoogle Scholar

Dr. med. Brigitte Messerer
Prof. Dr. med. Annelie Martina Weinberg
Prof. Dr. med. Andreas Sandner-Kiesling
Dr. med. Anton Gutmann
Dr. med. Swantje Mescha
PD Dr. med. Winfried Meissner

Email: brigitte.messerer@meduni-graz.at

Email: anneliemartina.weinberg@medunigraz.at

Email: andreas.sandner@medunigraz.at

Email: anton.gutmann@medunigraz.at

Email: Swantje.Mescha@med.uni-jena.de

Email: winfried.meissner@med.uni-jena.de

• Supplementary Material