摘要
目的基于前期构建的骨科患者静脉血栓栓塞症的预防方案,开展骨科患者静脉血栓栓塞症规范化分级预防的循证实践。方法制订相应的护理质量审查指标及审查方法,根据基线审查结果分析障碍因素及促进因素,制订行动策略,并通过随机对照研究选取343例患者进行效果验证,试验组进行循证实践,对照组为常规预防。结果根据循证方案,选择5条指标(血栓风险评估、出血风险评估、分级预防、弹力袜穿戴、护理记录)作为审查依据。循证实践后,试验组患者症状性静脉血栓栓塞症发生较对照组有所下降(住院期间2.45%vs.2.78%;出院后1个月1.23%vs.2.22%;出院后3个月1.23%vs.2.22%),差异无统计学意义;出院前患者血栓预防知识得分试验组(78.79±8.60)分明显高于对照组(66.05±7.68)分,差异有统计学意义(P<0.001);护士对静脉血栓栓塞症相关知识的认知水平(危险因素与好发部位、临床表现、风险评估、机械预防、药物预防维度)得分明显提高,差异有统计学意义;护士对审查条目的执行率由循证实践前的36.92%、20%、67.69%、58.46%、66.15%上升至100%、82.2%、100%、100%、98.16%,差异有统计学意义(P<0.001)。结论基于证据的循证实践方案的转化可帮助减少患者症状性血栓发生,提高护士和患者认知水平,促进临床依从性,规范护理行为。
Background There is a high incidence of venous thrombosis in orthopedic patients.The previous guidelines pointed out that standardized three-step prevention is crucial for patients at high risk of thrombosis.We established a nurse-centered standardized grading of patients with venous thromboembolism based on evidence in previous studies.Promoting the transformation of evidence-based practice is critical to improve clinical quality.Objective Based on the previously constructed prevention plan for venous thromboembolism in orthopedic patients,to carry out the evidence-based practice of standardized graded prevention.Methods The corresponding indicators and practices of the review of nursing quality were established.According to the results of the baseline review,the obstacle factors and facilitating factors were analyzed,and the action strategies were formulated.A randomized controlled study selected three hundred forty-three patients to verify the effect.The experimental group was given evidence-based practice,while the control group was assigned routine prevention.Results According to the evidence-based protocol,five indicators were selected as the review basis(thrombosis risk assessment,bleeding risk assessment,graded prevention,graduated compression stocking wearing,and nursing records).After evidence-based practice,the incidence of symptomatic VTE in the experimental group was lower than that in the control group(2.45 vs.2.78 during hospitalization;1 month after discharge 1.23 vs.2.22;3 months after discharge 1.23 vs.2.22),the difference was not statistically significant;Before discharge,the scores of thrombosis prevention knowledge in the experimental group were significantly higher than those in the control group(78.79±8.60 vs.66.05±7.68),and the difference was statistically significant(P<0.001).The scores of nurses'cognitive level of VTE-related knowledge(risk factors and common sites,clinical manifestations,risk assessment,mechanical prophylaxis,drug prophylaxis)were significantly increased,and the difference was statistically significant.The implementation rate of the review items 1,2,3,4 and 6 increased from 36.92%,20%,67.69%,58.46%,66.15%to 100%,82.2%,100%,100%,98.16%,with statistical significance(P<0.001).Conclusion The transformation of evidence-based practice can help reduce symptomatic thrombosis in patients,improve the cognitive level of nurses and patients,promote clinical compliance,and standardize nursing behavior.
作者
陈慧娟
张艳
李立
王红莉
赵思萌
李冰冰
赵佳音
孔祥燕
Chen Huijuan;Zhang Yan;Li Li;Wang Hongli;Zhao Simeng;Li Bingbing;Zhao Jiayin;Kong Xiangyan(Trauma Center,Peking University People's Hospital,Beijing 100044,China;Department of 0rthopedics and Naumntotogy,Peking University People's Hospital,Beijing 100044,China;Nursing Department,Peking University People's Hospital,Beijing 100044,China)
出处
《中华肩肘外科电子杂志》
2022年第2期162-168,共7页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
国家重点研发计划资助(2018YFF0301103)。
关键词
静脉血栓栓塞症
预防
循证实践
护理
Venous thromboembolism
Prophylaxis
Evidence-based practice
Nursing
