背景:在对剖宫产后患者的早期研究中,对乙酰氨基酚和非甾体类抗炎药的同时给药与术后阿片类药物的总使用量大幅减少有关.如果护士给药对乙酰氨基酚和非甾体抗炎药的时间通常与到期时间有实质性差异,则这种可能的药效学作用可能会有所不同。我们检查了止痛药剂量给药时间的“迟到”,如果给药较晚,如果提前,则为负值。
方法:回顾性队列研究使用了所有67,900个预定的药物给药记录(即,不是\“根据需要\”)对乙酰氨基酚,布洛芬,在2021年1月至2023年12月期间,爱荷华大学的所有3,163例剖宫产病例中和酮咯酸。在每次给药之前,在患者的床边使用条形码扫描。
结果:在4.8小时的窗口中,有95%的剂量给药,从早108分钟(97.5%单侧置信上限早105分钟)到晚181分钟(97.5%单侧下限晚179分钟)。不到一半的剂量(46%,P<0.0001)在到期时间的±30分钟内给药。组内相关系数约为0.11,表明患者之间存在较小的系统差异。基于对乙酰氨基酚和布洛芬或酮咯酸的同时给药,迟到率也有很小或没有系统性差异,一天中药物到期的时间,工作日,Year,或15分钟内所有此类患者的药物数量。
结论:其他医院应检查药物给药的延迟,以改变其进行或应用镇痛临床试验结果的能力(例如,同时与交替给药)。
BACKGROUND: In an earlier study of patients after cesarean delivery, the concurrent versus alternating administration of acetaminophen and non-steroidal anti-inflammatory drugs was associated with a substantial reduction in total postoperative opioid use. This likely pharmacodynamic effect may differ if the times when nurses administer acetaminophen and non-steroidal anti-inflammatory drugs often differ substantively from when they are due. We examined the \"lateness\" of analgesic dose administration times, the positive difference if administered late, and the negative value if early.
METHODS: The retrospective cohort study used all 67,900 medication administration records for scheduled (i.e., not \"as needed\") acetaminophen, ibuprofen, and ketorolac among all 3,163 cesarean delivery cases at the University of Iowa between January 2021 and December 2023. Barcode scanning at the patient\'s bedside was used right before each medication administration.
RESULTS: There were 95% of doses administered over a 4.8-hour window, from 108 minutes early (97.5% one-sided upper confidence limit 105 minutes early) to 181 minutes late (97.5% one-sided lower limit 179 minutes late). Fewer than half of doses (46%, P <0.0001) were administered ±30 minutes of the due time. The intraclass correlation coefficient was approximately 0.11, showing that there were small systematic differences among patients. There likewise were small to no systematic differences in lateness based on concurrent administrations of acetaminophen and ibuprofen or ketorolac, time of the day that medications were due, weekday, year, or number of medications to be administered among all such patients within 15 minutes.
CONCLUSIONS: Other hospitals should check the lateness of medication administration when that would change their ability to perform or apply the results of analgesic clinical trials (e.g., simultaneous versus alternating administration).