急诊院内转运护理质量监测指标及其临床应用

目的建立急诊院内转运护理质量监测指标,通过对护理质量的量化监控和管理,提升急诊院内转运的护理质量。 方法根据文献检索和专家小组讨论结果选定"急诊院内转运不良事件发生率"和"急诊院内转运护理合格率"为急诊院内转运护理质量监测指标,并制定具体评定细则。对全科护士进行针对性培训考核,并应用于临床。回顾性分析2016年7月至2017年6月经江苏大学附属武进医院急诊科抢救后转运的5 958例患者的病历资料。其中男性2 850例,女性3 108例;年龄14～99岁,平均(51.97±10.15)岁。以2016年7至12月实施的2 650例次院内转运患者为对照组(未采用任何护理质量监测指标);2017年1至6月实施的3 308例次院内转运患者为观察组(采用了上述急诊院内转运护理质量监测指标)。对比两组在急诊院内转运过程中的护理不良事件发生率及具体不良事件发生情况、转运护理合格率差异;再分别以随机数字表法对两组患者资料进行抽样调查,对比其患者及相关科室满意度、措施执行规范性的差异,以评价急诊院内转运护理质量监测指标的临床应用效果。 结果观察组在转运过程中的护理不良事件发生率为3.2%(105/3 308),低于对照组15.5%(412/2 650),且仪器设备故障、氧气及药物维持不足、管路异常及患者生命体征急剧变化等转运不良事件的发生率均低于对照组,差异均有统计学意义(P均<0.05)。抽查结果显示,观察组的院内转运护理合格率90.13%(137/152)比75.17%(112/149)]、患者(家属)及93.42%(142/152)比84.56%(126/149)]相关转运科室90.79%(138/152)比71.17%(106/149)]对转运护理的满意度均得到提高;但转运护理措施的执行规范性中,仅在"物品准备不完备"1.32%(2/152)比9.39%(14/149)]以及"终末处理不到位"1.97%(3/152)比4.03%(6/149)]的发生率有所降低,其余4项(未通知目的科室、未做好医患沟通、管道护理不到位、护理交接不清楚)的差异无统计学意义。 结论建立急诊转运护理质量监测指标,能体现急诊专科特色,可有效评价和提升急诊院内转运的护理质量。

Monitoring indicators of nursing quality of emergency intra-hospital transport and their clinical application

To establish the nursing quality indicators of intra-hospital transport in emergency department. To improve the nursing quality of intra-hospital transport in the emergency department by means of quantitative monitoring and management. MethodsAccording to the results of literature search and expert panel discussions, the incidence of adverse events in the emergency intra-hospital transport and the nursing eligibility rate of emergency intra-hospital transport were selected as the indexes of the nursing quality monitoring in the emergency intra-hospital transport and the detailed evaluation rules were formulated. Targeted training for general nurses was conducted and applied to clinical practice. A retrospective case-control study was conducted on the data of 5 958 cases of patients who were transported after emergency rescue from the emergency department of Wujin Hospitalaffiliated to Jiangsu University from July 2016 to June 2017. 2 850 males and 3 108 females were included, aged 14-99 years, with an average age of (51.97±10.15)years. Among them, 2 650 cases of intra-hospital transport patients, without any monitoring indicators for the nursing quality, implemented from July to December 2016 were selected as the control group. While 3 308 cases using nursing quality monitoring indicators mentioned above, implemented from January to June in 2017, were set up as observation group. The incidence of adverse events, the occurrence of specific adverse events and the differences in the eligibility rates of nursing between the two groups in the process of emergency intra-hospital transport were compared and analyzed. The data of two groups were sampled by random number table method. The differences in satisfaction of the patients and related departments and differences in the standardized implementation of regulatory measures were compared to evaluate the clinical effect of the indicators of nursing quality monitoring in emergency intra-hospital transport. ResultsThe incidence of adverse events in the observation group was 3.2(105/3 308), lower than the control group 15.5%(412/2 650)], and the incidence of equipment malfunction, insufficiency of oxygen and drug maintenance, abnormal pipeline and sharp changes in patient’s vital signs were all lower than those of the control group. The differences were statistically significant (P< 0.05). The results of sample survey showed that the eligibility rate of nursing in the observation group 90.13% (137/152) vs. 75.17%(137/152)] and both of the satisfaction of patients (family members) 94.32% (142/152) vs. 84.56%(126/149)]and related departments 90.79% (138/152) vs. 71.17%(106/149)] were improved. But in the standardization of intra-hospital transport nursing measures implementation, only the incidence of insufficient preparation of materials 1.32% (2/152) vs. 9.39% (14/149) and incomplete terminal processing 1.97% (3/152) vs. 4.03% (6/149)] were reduced. The differences of the remaining 4 items (lack of notice to the accepting department, insufficient doctors-patient communication, unqualified pipeline nursing and the unclear nursing handover)were not significant. ConclusionFormulating the nursing quality monitoring indicators of emergency intra-hospital transport can reflect the characteristics of emergency department and effectively evaluate and improve the nursing quality in emergency intra-hospital transport.