基于PDCA循环模式构建急诊重症监护室患者标准化风险管理体系
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摘要
目的初步构建一套科学、客观、较为完善的EICU住院患者标准化风险管理体系,为重症患者的护理干预措施提供循证依据。方法采用文献查证及德尔菲(Delphi)专家函询法,确定指标体系及权重,该方法获得专家一致性意见,从而初步构建EICU住院患者标准化风险管理体系,便于临床应用。结果最终确定了包含"患者一般情况"、"潜在风险筛查"、"导管相关性滑脱"、"导管相关性感染"、"用药相关"、"评分系统"、"支持系统"和"心理与社会"在内的8个维度、46项标准化管理体系指标。专家权威程度系数为0.796～0.829;专家协调系数为0.641～0.791 (P<0.001);Cronbach’sα系数为0.813,折半信度为0.862。专家对本研究的意见相对一致。结论初步构建了EICU住院患者标准化风险管理体系,该指标体系的覆盖内容全面,权重的分配科学、客观,对急诊重症监护室的患者风险管理具有较高的科学性、实用性和可操作性,可为护理人员临床实践提供指导性策略。
Objective To initially construct a scientific, objective and relatively complete EICU inpatient risk standardization management system,andto provide evidence-based evidence for nursing interventions for critically ill patients. Methods The document verification and Delphi expert correspondence method were used to determine the indicator system and weight. The method obtained the expert consensus opinion, thus initially constructing the EICU hospitalized patient risk standardization management system, which is convenient for clinical application. Results In the end, eight dimensions including the general condition of the patient, potential risk screening, catheter-related spondylolisthesis, catheter-related infection, medication-related, scoring system, support system, and psychology and society were identified, for a total of 46 standardized management system indicators. The experts' degree of authority was 0.796-0.829, the expert coordination coefficient was0.641-0.791, the Cronbach's alpha coefficient was 0.813, and the half-confidence degree was 0.862. Experts' opinions on this study were relatively consistent. Conclusion The EICU inpatient risk standardization management system was initially constructed. The coverage of the indicator system is comprehensive, the weight distribution is scientific and objective, and it has high scientific, practical and operability for the risk management of emergency intensive care unit patients. Nursing staff clinical practice provides a guiding strategy.
Objective To initially construct a scientific, objective and relatively complete EICU inpatient risk standardization management system,andto provide evidence-based evidence for nursing interventions for critically ill patients. Methods The document verification and Delphi expert correspondence method were used to determine the indicator system and weight. The method obtained the expert consensus opinion, thus initially constructing the EICU hospitalized patient risk standardization management system, which is convenient for clinical application. Results In the end, eight dimensions including the general condition of the patient, potential risk screening, catheter-related spondylolisthesis, catheter-related infection, medication-related, scoring system, support system, and psychology and society were identified, for a total of 46 standardized management system indicators. The experts' degree of authority was 0.796-0.829, the expert coordination coefficient was0.641-0.791, the Cronbach's alpha coefficient was 0.813, and the half-confidence degree was 0.862. Experts' opinions on this study were relatively consistent. Conclusion The EICU inpatient risk standardization management system was initially constructed. The coverage of the indicator system is comprehensive, the weight distribution is scientific and objective, and it has high scientific, practical and operability for the risk management of emergency intensive care unit patients. Nursing staff clinical practice provides a guiding strategy.
引文
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[15]符春花,周保娇,李珍美,等.综合ICU呼吸机相关性肺炎患者的危险因素及护理对策[J].现代预防医学,2017,44(8):1528-1531.
[16]侯永超,王建芬,宁亮亮.ICU危重病人营养风险筛查与营养支持效果[J].护理研究,2015,29(3):361-362.
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[3]武芳,伍祥林,刘海霞.PDCA循环在病历质量管理中的应用实例研究[J].现代预防医学,2015,42(9):1636-1639.
[4]李霞.PDCA循环管理在ICU护理工作中的应用研究进展[J].护理实践与研究,2018,15(11):19-20.
[5]殷珺妹,龙莉,杨亚敏,等.PDCA循环在持续改进多重耐药菌管理中的应用[J].现代预防医学,2015,42(12):2195-2196, 2205.
[6]徐群,黄雀兰,李伶.PDCA循环管理在重症监护中心护理风险管理中的实施效果分析[J].护理实践与研究,2016,13(8):107-108.
[7]徐国建,冯飞,刘慧铭,等.应用德尔菲法构建精神疾病监测系统评价指标体系[J].现代预防医学,2017,44(7):1236-1241.
[8] Pappalardo A, Grazia CG, Montanari E, et al. The clinical value of Coop/Wonca charts in assessment of HRQo L in a large cohort of relapsing-remitting multiple sclerosis patients:results of a multicenter study[J]. Multiple Sclerosis and Related Disorders, 2017, 17:154-171.
[9]王嘉艺,杜建姝,米玉倩,等.基于德尔菲法构建我国恶性肿瘤相关监测系统评价指标体系[J].现代预防医学,2018,45(19):3457-3460.
[10]查丽玲,周松,王建宁.ICU护士对患者早期活动认知和行为的调查研究[J].中华护理杂志,2018,53(2):221-225.
[11]齐秀杰,刘沫,张会君,等.产科护士健康教育能力评价指标体系的构建[J].现代预防医学,2018,45(3):480-484, 519.
[12]吴孟航,卢小丽,蔡丹,等.肺癌手术患者对ICU护理满意度的现状调查[J].现代预防医学,2018,45(12):2270-2273, 2283.
[13]钟晓,汪东篱.风险管理在ICU医院感染控制中的作用[J].现代预防医学,2015,42(22):4205-4207, 4213.
[14]冯洁惠,徐建宁,方强,等.医护合作策略在ICU镇痛和镇静安全管理中的应用[J].中华护理杂志,2014,49(1):44-48.
[15]符春花,周保娇,李珍美,等.综合ICU呼吸机相关性肺炎患者的危险因素及护理对策[J].现代预防医学,2017,44(8):1528-1531.
[16]侯永超,王建芬,宁亮亮.ICU危重病人营养风险筛查与营养支持效果[J].护理研究,2015,29(3):361-362.