Improving patient and nurse outcomes: a comparison of nurse tasks and time associated with two patient-controlled analgesia modalities using delphi panels.
Increased demand on nursing time may adversely affect nurse satisfaction and patient outcomes. Technologies to reduce nursing time and burden may improve patient care. Two Delphi panels assessed the perceived nursing time of fentanyl iontophoretic transdermal system (ITS) and intravenous patient-controlled analgesia (IV PCA) for postoperative pain management. The panels were asked to estimate the time spent on individual nursing tasks from a list. The Clinical Trial panel (n = 14) was composed of nurses who participated in two clinical trials, and data for both PCA modalities were collected from this panel. The routine practice panel (n = 13) was composed of nurses from various hospital units, and only data for IV PCA were collected from this panel. From the Clinical Trial panel, the estimated total average task time was 251 minutes for IV PCA and 210 minutes for fentanyl ITS. From the Routine Practice panel, the estimated total average task time was 163 minutes for IV PCA. Thirteen extra tasks were identified by the Clinical Trial panel to be associated only with IV PCA, and these eliminated steps primarily explained the estimated total nursing time difference between IV PCA and fentanyl ITS. According to the two Delphi panels, the perceived nursing time consumed was less and the number of tasks was lower for fentanyl ITS than for IV PCA. This benefit associated with fentanyl ITS may lead to other positive outcomes, such as improved nurse satisfaction and improved patient outcomes.
Evans
Christopher
C
Mapi Values, Boston, MA 02108, USA. chris.evans@mapivalues.com
Schein
Jeff
J
Nelson
Winnie
W
Crespi
Simone
S
Gargiulo
Kathryn
K
Horowicz-Mehler
Nathalie
N
Panchal
Sunil
S
D000279:Administration, Cutaneous; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000451:nursing*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003697:Delphi Technique; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing*; D013527:Perioperative Nursing / Q000379:methods* / Q000458:organization & administration; D013647:Task Performance and Analysis; D017748:Time Management; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D005283:Fentanyl