医护合作策略在ICU镇痛和镇静安全管理中的应用

Application of physician-nurse cooperation style in safety management of patients treated with sedatives and analgesics in ICU

目的探讨一种科学的镇痛、镇静管理方法，以确保ICU镇痛、镇静治疗的安全实施。方法2012年1～12月采用医护合作策略，包括医护共同参与培训、共同决策实施方法、采用标准化沟通方式及共同讨论差错隐患等，对镇痛、镇静治疗进行安全管理，比较应用该策略前后的效果。结果应用医护合作管理策略后．医生、护士合作状况平均得分及程序化镇痛、镇静治疗的落实率均高于实施前，差异有统计学意义（P〈0．01）。镇痛、镇静不足导致气管插管和气切套管非计划拔管发生率低于实施前，差异有统计学意义（P〈0．05）。镇痛、镇静过度导致呼吸机相关性肺炎的感染率低于实施前，差异无统计学意义（P〉0．05），结论医护合作策略在镇痛、镇静安全管理中具有优势作用．ICU护士在实施过程中具有不可替代的地位，

Objective To explore a scientific management method for patients treated with sedalives and analgesics in the Intensive Care Units（ICU）,in order to ensure patient safety. Methods Physician-nurse cooperative style was applied in the managenmnt of patients who received sedatives and analgesics from January to December 2012. The measures included co-training of physicians and nurses, joint decision-making on medication administration, implementation of procedural sedation and analgesia（PSA）, and diseussion on the risks of medical etTors tngether. Results After implementing physieian-nurse cooperative methods, the stoics of physician-nurse collal）oration and the rate nf PSA increased signifieantly （P〈0.01） ; the ineidenee of unplanned extuhation （UE） de-creased signifieantly（P〈0.05）. Conclusion The application of physician-nurse cooperative style can effectively impruve the quality of sedation and analgesia and ensure patient safety. ICU nurses play an important role in the implementation of sedation and analgesia.