“床旁交班五项”在儿童神经科床旁交接班中的使用

Application of five principles of bedside-shift change in pediatric neurological ward

目的分析护士传统床旁交接班模式存在的问题并进行改进，对比改进前后的交接班效果。方法2013年1～12月首都医科大学宣武医院儿科采用传统交接班模式完成了432人次交接，采用根因分析法，从人员、机器／设备、材料、方法／管理、环境5个方面对传统床旁交接班模式中出现的问题进行原因分析，并提出改进后接班模式——床旁交班五项。2014年1—12月采用改进后交接班模式完成了434人次交接。以病情重点突出、病情条理清晰、检查情况交接到位、管路交接清楚、日常生活能力评定、跌倒／坠床风险评估、压疮风险评估、疼痛评估、各类给药交接为评价指标，对比改进前后交接班的效果。结果与传统交接班模式比较，采取改进后交接班模式后，护士在病情重点突出、病情条理清晰、检查情况交接到位、管路交接清楚、日常生活能力评定、跌倒／坠床风险评估、压疮风险评估、疼痛评估、各类给药交接方面均明显提高，差异均有高度统计学意义（P〈0．01）。同时在床旁交接班中，护士变被动为主动，护士从对患儿病情的充分了解、动态细化的风险评估、针对护理及安全问题给予有效的护理措施这一工作流程得到了落实。结论改进后的床旁交接班模式使交接班更加规范、合理，有利于护理工作质量的持续提高。

Objective To analyze and improve the traditional bedside-shift exchange model and compare the effect of the shift exchange model before and after improved. Methods From January to December 2013, 432 patients were giv- en the traditional bedside-shift model in the Department of Pediatrics of Xuanwu Hospital Capital Medical University, and the root cause analysis was applied to identify problems in the traditional bedside-shift model in five aspects： per- sonnel, machines/equipment, materials, methods/management and environment, and a optimized bedside-shift model was put forward, called five principles of bedside-shift. A total of 434 patients were given the optimized bedside-shift model from January to December 2014. The effect of two kinds of bedside-shift model was evaluated in patient＇s con- dition highlight, well-organized of patient＇s condition, well shift of inspection, clear pipeline management, daily life ac- tivity function assessment, risk assessment of fall/drop of bed, risk assessment of pressure ulcer, pain assessment, and drug administration. Results Compared with the traditional bedside-shift change model, patient＇s condition highlight, well-organized of patient＇s condition, well shift of inspection, clear pipeline management, daily life activity function as- sessment, risk assessment of fall/drop of bed, risk assessment of pressure ulcer, pain assessment, and drug administra- tion of nurses were significantly improved after the application of optimized bedside-shift model, with statistically sig- nificant differences （P 〈 0.01）. At the same time, nurses became more actively involved and work processes were prac- ticed, including fully understanding the illness/condition, detailing risk evaluation, and applying effective nursing inter- vention for safety. Conclusion The optimized shift model makes shifting of duty more normative and efficient, while continuously enhancing the quality of nursing care.