气管插管危重患者口腔护理的循证实践

Evidence-based oral hygiene care for critically ill intubated patients

目的将现有的气管插管患者口腔护理的最佳证据应用于护理实践,促进护士依据循证进行口腔护理实践的行为,提高口腔护理效果。方法根据JBI的最佳实践手册,基于现有最佳证据,制定4条审查标准,对145名护士及199例患者进行基线审查,依据审查对护士进行培训和将证据应用于259例患者口腔护理实践;3个月后进行第2轮审查。结果第2轮审查,4条审查标准执行率从42.1%~68.3%升至100%。护士理论操作考核成绩从51、43分提高到93、89分;患者口腔卫生评分从16.85分降至13.36分、VAP发生率从21.7例/千机械通气日降至7.4例/千机械通气日（P〈0.05,P〈0.01）。结论基于循证的质量审查项目改善护士应用最佳证据的执行行为,有效提高气管插管危重患者口腔护理效果。

Objective To ensure the practice of oral hygiene care among critically ill intubated patients was performed according to best available evidence,to promote nurses′evidence-based practice of oral care,and to improve the effectiveness of oral care.Methods This project utilized a pre-and post-implementation audit design using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs.The project was conducted for 3months involving a sample size of 199 patients at pre-audit and 259 patients at post-audit admitted during the audit period.A convenience sample of 145 nurses also consented to be observed.Results Four audit standards were developed.The compliance to these standards was between 42.1%and 68.3% at pre-audit,and it was enhanced to 100% at post-implementation audit.Nursing staff′s knowledge was increased from51 to 93,and their skill was improved from 43 to 89.Patients′oral hygiene score was decreased from 16.85 to 13.36,and the incidence of ventilator-associated pneumonia was dropped from 21.7to 7.4cases per thousand days of mechanical ventilation（P0.05,P0.01）.Conclusion This audit project facilitates nurses to perform evidence-based nursing practice,thus to improve the effectiveness of oral hygiene care in critically ill intubated patients.