应用护嘱指引提高 ICU 护理质量的效果评价

Effect of complete nursing order guidelines on improving the nursing quality in ICU

目的：探讨应用护嘱指引对落实ICU护理措施的效果。方法2012年度收治的177例危重患者按照ICU传统护嘱制度执行护嘱，2013年度收治的183例危重患者试行护嘱指引，保证护理措施的落实。比较2012年度及2013年度在使用护嘱指引前后护理措施的落实情况、患者满意度及护士专科培训考核成绩。结果2012年度纳入177例患者，护理措施观察次数共3566例次，2013年度纳入183例患者，护理措施观察次数共3634例次。2013年度口腔护理不合格率为0．28％，低于2012年度的1．18％，差异有统计学意义（χ2＝20．45，P＝0．00）；2013年度床头抬高不合格率为0．33％，低于2012年度的1．54％，差异有统计学意义（χ2＝28．69，P＝0．00）；2013年度人工气道气囊测压落实率为99．56％，高于2012年的98．65％，差异有统计学意义（χ2＝16．76， P ＝0．00）。2013年度患者满意度得分为（98．08±0．67）分，高于2012年度的（94．58±2．47）分，差异有统计学意义（t ＝4．91，P ＝0．00）；2013年度护士专科培训考核成绩平均分为（89．33±9．64）分，高于2012年度的（82．17±4．04）分，差异有统计学意义（ t＝2．62，P＝0．02）。结论在ICU使用护嘱及护嘱指引，可以有效提高ICU整体护理水平，同时又为各层级护士的专业培训与提高提供了多元化平台。

Objective To discuss the effect of the complete nursing order and guidelines on improving the nursing quality in ICU .Methods The nursing quality , patients ’ satisfaction and the hierarchical training examination scores before and after using the improved nursing order guidelines were compared , from 2012 to 2013 .Totals of 177 patients in 2012 were treated with conventional nursing order system , and 183 patients in 2013 were treated with the improved nursing order guidelines .Results In 2012, totals of 177 patients with 3 566 times nursing observation were included , and 183 patients, with 3 634 times nursing observation were included in 2013.In 2013, oral care failure rate was 0.28%, which was significantly lower than 1.18% in 2012, with a＆amp;nbsp;significant difference（χ2 =20.45, P=0.00）.In 2013, the bed elevation unqualified rate was 0.33%, which was significantly lower than 1.54% in 2012, with a significant difference （χ2 =28.69,P=0.00）.In 2013, the artificial airway ballonet pressure implementation rate was 99.56%,which was significantly higher than 98. 65%in 2012, with a significant difference （χ2 =16.76,P=0.00）.In 2013, the patients’ satisfaction scores was （98.08 ±0.67）, which was significantly higher than （94.58 ±2.47） in 2012, with a significant difference （t=4.91,P =0.00）.The nurse training assessment scores was （89.33 ±9.64） in 2013, which was significantly higher than （ 82.17 ±4.04 ）, with a significant difference （ t =2.62, P =0.02 ）. Conclusions Nursing order guidelines applied in ICU bedside can promote the improvement of the nursing quality, ensure the safety of nursing care , and let patients receive continuous and homogeneous care .Improved nursing order guidelines not only effectively improve the whole nursing level of ICU , but also provide diversified platform for nurse training at all levels .