骨科四肢手术气压止血带安全使用的最佳证据应用

目的将气压止血带安全使用的最佳证据应用于骨科四肢手术患者,降低气压止血带使用并发症的发生率。方法遵循JBI的最佳证据临床应用程序,使用证据的持续质量改进模式图,获取气压止血带压力安全使用的相关证据,制定10条审查标准。采用现场观察、问卷调查、专家访谈等方法收集证据应用的障碍,分析可获得的资源,制定解决办法。结果证据应用后10条审查指标的执行情况显著高于基线审查(均P<0.01);手术后即刻皮肤损伤发生率由基线审查的65.0%降至20.0%(P<0.01)。结论手术室气压止血带安全使用最佳证据的临床应用,可规范手术室护士气压止血带临床操作,减少使用后并发症的发生,保证骨科手术患者的安全。

Safe pneumatic tourniquet use in orthopedic surgery of the limbs: a best-evidence summary

Objective To apply the best available evidence of safe pneumatic tourniquet use in orthopedic surgery of the limbs and to reduce complications. Methods Following the JBI model for evidence-based healthcare and the "evidence-based continuous quality improvement framework", we chose the best evidence for safe pneumatic tourniquet use and formulated 10 audit criteria. Then we conducted field observation, questionnaire survey and expert interview to identify barriers to the implementation of the evidence, to analyze the available resources and to formulate solutions. Results The implementation of the 10 audit criteria was significantly improved during re-audit compared with the baseline audit(P<0.01 for all). The incidence of skin injury immediately after the surgery decreased from 65.0% in baseline audit to 20.0% in re-audit(P<0.01). Conclusion The implementation of best evidence about pneumatic tourniquet use in operating room can standardize nurses′ practice, thus to reduce complications in patients undergoing orthopedic surgery and ensure patient safety.