负压封闭辅助闭合技术用于伤口治疗的流程设计

Procedure Flow Design of Vacuum Assisted Closure Technique for Wound Care

目的探讨负压封闭辅助伤口闭合技术(vacuum-assisted closure,VAC)在门诊伤口治疗中的操作流程及其合理性。方法参照负压伤口治疗的相关指南报告和流程优化及再造的文献,设计了"十步法"操作流程。2007年1月至2008年12月对门诊伤口护理中心工作和进修的护士共22人进行了流程应用培训,并筛选12例慢性伤口进行应用评价,针对问题每6个月修改1次,持续性改良。评价方法:计算平均操作时间;每月考核每名护士VAC流程操作;每月调查每名护士对流程操作的满意度;每周调查每例患者对护士流程操作的满意度。使用SPSS11.0软件进行统计学处理。结果2007年和2008年护士流程操作考核成绩差异无统计学意义,分别为89.65±3.37、89.80±4.39(P>0.05),护士平均操作时间2008年较2007年明显缩短(P<0.05)。护士和患者对流程合理、便捷、有效的满意率分别为98.90%、96.13%和97.24%。结论用理论指导实践制定VAC操作流程和培训护士有助于流程准确规范使用,在VAC治疗实践中评价和修改流程有助于提高流程管理的效果。12例慢性伤口患者接受"十步法"操作流程进行VAC结果表明,流程合理实用,值得推广。

Objective To explore the reasonable procedure flow of vacuum assisted closure （VAC） in wounds treatment for outpatients. Methods According to the reports relevant to practice guidelines of VAC and references about improving and reproducing flows,the＂ten steps＂ procedure flow for VAC was designed. From Jan. 2007 to Nov. 2008, twenty-two nurses working and learning in the wound care center were trained. Twelve patients with chronic wounds were inclusive in the research. The problems in the application were continuously improved every six months. The evaluating methods included recording each procedure time of each nurse and calculating mean time,examining the procedure of nurses and investigating satisfactory degree of nurses every month and satisfactory degree testing of patients every week. The data was statistically analyzed with SPSS 11.0. Results The difference of nurses＇ procedure scores in 2007 and 2008 had not significance （89.65±3.37 vs 89.80±4.39,P〉0.05）. The mean procedure time in 2008 were significantly less than that in 2007 （P〈0.05）. The satisfactory rate of nurses and patients to procedure flow was 98.90% ,96.13% and 97.24% ,respectively. Conclusion The theories of procedure flow of VAC were introduced to design procedure flow and to train nurses. It would enhance the effectiveness of flow administration by evaluating and improving procedure flow in practice. The therapeutic effects in 12 patients with chronic wounds treated with＂ten steps＂ indicated that it was reasonable and useful to manage nurses＇ procedure.