精神科临床护理路径脱组原因分析及应对措施

Dropping off analysis and coping strategies of the psychiatric clinical nursing pathway

目的：探讨精神科临床护理路径实施过程中病例脱组的原因并制定应对措施降低脱组率。方法将2012年12月1日-2013年3月31日入组患者（对照组）的脱组现象进行回顾性调查分析，明确脱组原因并制定应对措施，以此对2013年4月1日-7月31日入组患者（干预组）进行干预。将两组之间的脱组率、脱组原因等进行比较分析。结果对照组脱组率为11．3％，干预组明显下降为5．1％，两组比较差异有统计学意义（χ2＝5．747，P＜0．05）。主要脱组原因中，“家属或患者认为病情好转而出院”单项因素在干预前后的比较差异有统计学意义（2．3％比0．0％，χ2＝5．376，P＜0．05）。结论明确脱组原因，有针对性地干预可避免因素，可降低脱组率，完善变异管理，帮助精神科临床护理路径的开展。

Objective To explore the causes of dropping off in the psychiatric clinic nursing pathway , and to develop efficient coping strategies to prevent dropping off .Methods A retrospective analysis was performed to determine the causes of dropping off amongst patients within the control group （ from December 2012 to March 2013 ） .The findings were used to devise efficient coping strategies which were then applied to the intervention group （ from April to July 2013 ） .The rate of dropping off and the reasons for dropping off were compared between the control group and intervention group .Results The rate of dropping off of the intervention group was 5.1%, which was significantly lower than 11.3%of the control group （χ2 =5.747,P〈0.05）.Main reasons for dropping off included “Discharged due to patient” or “Discharged due to patients ’ family”.There were significant differences compared with the single factor analysis （2.3%vs.0.0%;χ2 =5.376,P〈0.05）. Conclusions Major reasons for dropping off were identified and appropriate coping strategies were implemented .These interventions were shown to help lower the dropping off rate , improved the variance management techniques , and could promote the development of psychiatric clinical nursing pathway .