心力衰竭患者出院计划最佳证据的应用

Discharge planning for heart failure patients:a best practice implementation project

目的将现有的心力衰竭患者出院计划的最佳证据运用到护理实践,促进护士依据循证进行护理实践的行为,提高护理质量。方法采用JBI临床证据实践应用系统(PACES)进行临床质量审查。基于现有最佳证据,制订5条审查标准。首先进行基线审查,随后设计并实施相应的循证实践方案,最后进行第2轮审查来评价证据运用后的效果。结果实施基于循证的心力衰竭患者出院计划后,完成出院核对表、患者在出院前接受宣教、出院宣教包含6个方面内容、在患者出院前为其安排好下次门诊随访4条审查标准分别由0、93.3%、6.7%、93.3%均提高至100%,进行电话或上门随访以加强患者的自我照护指导由0提高至76.2%。患者心力衰竭自我照护知识得分从19.7升至25.5。结论基于循证的质量审查项目改善了心力衰竭患者出院计划的护理实践,今后需要进行持续质量审查,以不断提高护理质量。

Objective To integrate the best available evidence regarding discharge planning for heart failure patients into nursing practice, and to improve evidence based nursing practice and quality of care. Methods A clinical audit was undertaken using the Joanna Briggs Institute （JBI） Practical Application of Clinical Evidence System （PACES） tool. Five audit criteria were identified. After a baseline audit, countermeasures were taken and re-audit was performed to determine the effect. Results The compliance rates of 4 criteria including completion of the discharge checklist, provision of health education, discharge education concerning 6 aspects, and scheduling an outpatient clinic visit were improved from 0, 93.3%, 6.7%, and 93.3% to 100%. The compliance rate of conducting telephone follow-up to enhance patients＇ self-care ability was improved from 0 to 76.2 %. The score of patients＇ self-care knowledge was increased from 19.7 to 25.5. Conclusion The project demonstrated positive changes in discharge planning practices for heart failure patients. The audit and re-audit should be carried in the future to continuously improve quality of care.