非计划性拔管风险防范管理在插管患者中的应用效果
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摘要
目的分析非计划性拔管(UEX)风险防范管理在插管患者中的应用效果。方法选取2017年3—9月新疆医科大学第一附属医院开展UEX风险防范管理前收治的插管患者2 000例作为对照组,2018年3—9月开展UEX风险防范管理后收治的插管患者2 000例作为研究组。对照组患者给予常规干预,观察组患者在对照组基础上给予UEX风险防范管理。比较两组患者不同导管危险分级UEX发生率、再插管率及护理满意度。结果 (1)研究组患者高危导管、中危导管、低危导管UEX发生率低于对照组(P<0.05)。(2)研究组患者中危导管者再插管率高于对照组(P<0.05),而两组患者高危导管、低危导管再插管率比较,差异无统计学意义(P>0.05)。(3)研究组患者护理满意度高于对照组(P<0.05)。结论 UEX风险防范管理可有效降低插管患者UEX发生率,提高中危导管再插管率及患者护理满意度。
Objective To analyze the application effect of risk prevention management for unplanned extubation(UEX)in patients undergoing intubation.Methods A total of 2,000 patients undergoing intubation were selected as control group in the First Affiliated Hospital of Xinjiang Medical University from March to September 2017(did not carry out risk prevention management for UEX),while a total of 2,000 patients undergoing intubation were selected as study group in this hospital from March to September 2018(carried out risk prevention management for UEX).Patients in control group received conventional intervention,while patients in study group received risk prevention management for UEX.Incidence of UEX and reintubation ratio in patients with different catheter risk classification,and nursing satisfaction were compared between the two groups.Results(1)Incidence of UEX in patients with high-risk catheter,medium-risk catheter and low-risk catheter in study group was statistically significantly lower than that in control group(P<0.05).(2)Reintubation ratio in patients with medium-risk catheter in study group was statistically significantly higher than that in control group(P<0.05),while no statistically significant difference of reintubation ratio was found in patients with high-risk catheter or low-risk catheter between the two groups(P>0.05).(3)Nursing satisfaction in study group was statistically significantly higher than that in control group(P<0.05).Conclusion Risk prevention management for UEX can effectively reduce the incidence of UEX in patients undergoing intubation,improve the reintubation ratio in patients with medium-risk catheter and the nursing satisfaction.
Objective To analyze the application effect of risk prevention management for unplanned extubation(UEX)in patients undergoing intubation.Methods A total of 2,000 patients undergoing intubation were selected as control group in the First Affiliated Hospital of Xinjiang Medical University from March to September 2017(did not carry out risk prevention management for UEX),while a total of 2,000 patients undergoing intubation were selected as study group in this hospital from March to September 2018(carried out risk prevention management for UEX).Patients in control group received conventional intervention,while patients in study group received risk prevention management for UEX.Incidence of UEX and reintubation ratio in patients with different catheter risk classification,and nursing satisfaction were compared between the two groups.Results(1)Incidence of UEX in patients with high-risk catheter,medium-risk catheter and low-risk catheter in study group was statistically significantly lower than that in control group(P<0.05).(2)Reintubation ratio in patients with medium-risk catheter in study group was statistically significantly higher than that in control group(P<0.05),while no statistically significant difference of reintubation ratio was found in patients with high-risk catheter or low-risk catheter between the two groups(P>0.05).(3)Nursing satisfaction in study group was statistically significantly higher than that in control group(P<0.05).Conclusion Risk prevention management for UEX can effectively reduce the incidence of UEX in patients undergoing intubation,improve the reintubation ratio in patients with medium-risk catheter and the nursing satisfaction.
引文
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[11]李文娟.非计划性拔管的护理研究现状[J].护理实践与研究,2014,11(2):17-18.DOI:10.3969/j.issn.1672-9676.2014.02.008.
[12]周萍,陈红.项目管理在手术室护理质量管理成效的探讨[J].国际护理学杂志,2014,33(1):24-26.DOI:10.3760/cma.j.issn.1673-4351.2014.01.010.
[13]梁恩政,马盛琴,张丽丽,等.PDCA循环法在降低ICU中心静脉置管(CVC)非计划性拔管率的效果观察[J].实用临床护理学电子杂志,2018,3(21):74-75.DOI:10.3969/j.issn.2096-2479.2018.21.057.
[14]DA SILVA P S L,FARAH D,FONSECA M C M.Revisiting unplanned extubation in the pediatric intensive care unit:What's new?[J].Heart Lung,2017,46(6):444-451.DOI:10.1016/j.hrtlng.2017.08.006.
[15]陈娟,刘长英,成慧,等.失效模式-效果分析法在超高龄患者PICC维护中的应用[J].西南军医,2018,20(4):473-475.DOI:10.3969/j.issn.1672-7193.2018.04.023.
[16]尹哲,陈玲,曹艳,等.FMEA模式在肿瘤患者PICC风险管理中的应用及效果评价[J].新疆医科大学学报,2018,41(8):1019-1022.DOI:10.3969/j.issn.1009-5551.2018.08.022.
[17]黄晓艳.PDCA循环管理预防脑卒中留置胃管患者非计划性拔管的效果观察[J].护理实践与研究,2019,16(1):37-39.DOI:10.3969/j.issn.1672-9676.2019.01.014.
[18]ZHAO C M,QIAN J B,ZHANG C M,et al.Open-label randomised controlled trial about application of bundle care in prevention of unplanned extubation of nasobiliary drainage catheter after endoscopic retrograde cholangiopancreatography[J].J Clin Nurs,2018,27(13/14):2590-2597.DOI:10.1111/jocn.13927.
[19]张秀平,张莉,苏敏谊,等.运用项目管理防范非计划拔管的效果评价[J].护理学报,2016,23(17):30-33.DOI:10.16460/j.issn1008-9969.2016.17.030.
[20]孟燕.风险管理对减少新生儿PICC非计划性拔管率的影响[J].临床医学研究与实践,2016,1(5):66.DOI:10.19347/j.cnki.2096-1413.2016.05.056.
[2]LIN P H,CHEN C F,CHIU H W,et al.Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit:A STROBE-compliant case-control study[J].Medicine(Baltimore),2019,98(11):e14841.DOI:10.1097/MD.0000000000014841.
[3]唐丽娟,马春秀,刘映珊.HFMEA在减少ICU气管插管病人非计划性拔管中的应用[J].全科护理,2018,16(22):2763-2766.
[4]郑丽霞,谢辉,李雪芬,等.品管圈管理模式对重症监护病房非计划性拔管事件发生率的干预效果[J].解放军护理杂志,2018,35(9):64-67.DOI:10.3969/j.issn.1008-9993.2018.09.016.
[5]许云妥,陈凌群.失效模式、效应与危害性分析在预防非计划性拔管中的应用[J].护理实践与研究,2018,15(2):130-131.DOI:10.3969/j.issn.1672-9676.2018.02.054.
[6]张晓静,张会芝,李葆华.非计划性拔管信息化管理系统的建立及应用研究[J].中华护理杂志,2018,53(11):1360-1362.
[7]王桂兰,林莉.医疗失效模式与效应分析管理模式在儿童重症监护室气管插管非计划性拔管中的预防效果[J].中国全科医学,2017,20(S2):278-280.
[8]李秀云,李范强,范小红,等.追踪法联合TRM管理模式在预防非计划性拔管中的应用[J].海南医学,2018,29(13):1913-1915.DOI:10.3969/j.issn.1003-6350.2018.13.044.
[9]AYDON L,ZIMMER M,SHARP M.Reporting the incidence of unplanned extubation in the neonatal intensive care unit[J].J Paediatr Child Health,2018,54(7):784-787.DOI:10.1111/jpc.13850.
[10]MOONS P,SELS K,DE BECKER W,et al.Development of a risk assessment tool for deliberate self-extubation in intensive care patients[J].Intensive Care Med,2004,30(7):1348-1355.DOI:10.1007/s00134-004-2228-2.
[11]李文娟.非计划性拔管的护理研究现状[J].护理实践与研究,2014,11(2):17-18.DOI:10.3969/j.issn.1672-9676.2014.02.008.
[12]周萍,陈红.项目管理在手术室护理质量管理成效的探讨[J].国际护理学杂志,2014,33(1):24-26.DOI:10.3760/cma.j.issn.1673-4351.2014.01.010.
[13]梁恩政,马盛琴,张丽丽,等.PDCA循环法在降低ICU中心静脉置管(CVC)非计划性拔管率的效果观察[J].实用临床护理学电子杂志,2018,3(21):74-75.DOI:10.3969/j.issn.2096-2479.2018.21.057.
[14]DA SILVA P S L,FARAH D,FONSECA M C M.Revisiting unplanned extubation in the pediatric intensive care unit:What's new?[J].Heart Lung,2017,46(6):444-451.DOI:10.1016/j.hrtlng.2017.08.006.
[15]陈娟,刘长英,成慧,等.失效模式-效果分析法在超高龄患者PICC维护中的应用[J].西南军医,2018,20(4):473-475.DOI:10.3969/j.issn.1672-7193.2018.04.023.
[16]尹哲,陈玲,曹艳,等.FMEA模式在肿瘤患者PICC风险管理中的应用及效果评价[J].新疆医科大学学报,2018,41(8):1019-1022.DOI:10.3969/j.issn.1009-5551.2018.08.022.
[17]黄晓艳.PDCA循环管理预防脑卒中留置胃管患者非计划性拔管的效果观察[J].护理实践与研究,2019,16(1):37-39.DOI:10.3969/j.issn.1672-9676.2019.01.014.
[18]ZHAO C M,QIAN J B,ZHANG C M,et al.Open-label randomised controlled trial about application of bundle care in prevention of unplanned extubation of nasobiliary drainage catheter after endoscopic retrograde cholangiopancreatography[J].J Clin Nurs,2018,27(13/14):2590-2597.DOI:10.1111/jocn.13927.
[19]张秀平,张莉,苏敏谊,等.运用项目管理防范非计划拔管的效果评价[J].护理学报,2016,23(17):30-33.DOI:10.16460/j.issn1008-9969.2016.17.030.
[20]孟燕.风险管理对减少新生儿PICC非计划性拔管率的影响[J].临床医学研究与实践,2016,1(5):66.DOI:10.19347/j.cnki.2096-1413.2016.05.056.