多重安全管理模式提高脑卒中患者安全依从性的效果

Improvement of safety compliance in stoke patients through multiple-care safety management

目的：探讨多重安全管理模式提高脑卒中患者对安全健康宣教的依从性。方法本研究采用前瞻性对照研究的方法,连续收集2013年5月—2014年2月首都医科大学附属北京天坛医院血管神经病学二病区收治的脑卒中患者853例,根据入院时间先后分为对照组和观察组,其中对照组438例,观察组415例。对照组采用常规安全管理,观察组采用多重安全管理模式,包括病情、用药评估、安全知识宣教、功能训练等措施,比较两组患者安全的依从性、患者满意度及护理不良事件发生率。结果对照组患者完全依从率为49.75%,观察组患者完全依从率为63.68%,差异有统计学意义（χ2=21.19,P=0.01）；对照组跌倒率为1.99%,坠床率为1.24%,压疮率为3.23%,非计划性拔管率为5.22%,观察组跌倒率为0.25%,坠床率为0.00%,压疮率为0.25%,非计划性拔管率为0.75%,差异均有统计学意义（P〈0.01）；对照组患者满意度为77.63%,观察组患者满意度为92.47%,差异有统计学意义（χ2=30.06,P〈0.01）。结论多重安全管理模式有助于提高脑卒中患者对安全的依从性,减少护理不良事件的发生,提高患者的满意度,实施方便可行,值得临床推广。

Objective To investigate the effects of multiple safety management model on improving the safety compliance of stroke patients. Methods This study used prospective control study. A total of 853 stroke patients collected since May 2013 to February 2014 were divided into control group with 438 cases and observation group with 415 cases according to admission time. The control group used the conventional model, the observation group accepted the multiple safety management model, factors were recorded including pathogenic condition, medicine assessment, safety education and functional training. Comparison of safety compliance, satisfaction and rate of adverse nursing events were made in two groups using prospective case-control study. Results The safety compliance was 49. 75% and 63. 68% in control and observation group respectively（χ2 =21. 19,P=0. 01）. Rates of fall, bed-falling, pressure sore and unplanned extubation were 1. 99%, 1. 24%, 3. 23% and 5. 22% in control group and they were 0. 25%, 0. 00%, 0. 25% and 0. 75% in observation group （P〈0. 01）. In terms of satisfaction, the rates were 77. 63% and 92. 47% in control and observation group （χ2 =30. 06,P〈0. 01）. Conclusions Multiple safety management model contributes to the improvement of safety compliance, decreases adverse nursing events and increases satisfaction in stroke patients. Considering the advantages and operability, multiple safety managements are worth popularization in clinical nursing.