基于指南的皮肤撕裂伤预防方案实施效果初步研究

Pilot study on effect of preventing skin tears with prevention protocol based on guideline

目的：探讨实施基于指南制定的皮肤撕裂伤预防方案的效果。方法根据国际皮肤撕裂伤预防指南建议，制定预防皮肤撕裂伤方案，包括评估预测风险人群、使用辅助工具预防跌倒和坠床、穿长袖衣裤、皮肤涂抹润肤油每日2次、补充营养和水分、使用移动技巧预防摩擦和剪切力6项综合性措施，采取学组组织培训伤口护理学组骨干护士、骨干护士培训科室护士后在护理中实施。干预前、干预后5个月和17个月，采用横断面检查方法对全院住院≥24 h和≥18岁的患者从头到脚检查皮肤，观察比较皮肤撕裂伤的发生率和预防措施的落实率。结果干预前皮肤撕裂伤发生率0.77％（12/1558），干预后5个月和17个月发生率分别降为0.16％（3/1777）和0.22％（4/1825），差异有统计学意义（P〈0.05）。干预后5和17个月皮肤撕裂伤危险人群和患者的6项预防措施落实率较干预前有不同程度提升，但落实率均不理想，差异无统计学意义（ P〉0.05）。结论基于指南的皮肤撕裂伤预防方案能降低皮肤撕裂伤的发生率，但预防措施的落实率有待于改善。今后需加强护士培训、床边督导和管理，提高护士落实预防措施的执行率。

Objective To explore the effect of preventing skin tears with prevention protocol based on guideline. Methods According to International Guideline of Prevention Skin Tears to discuss and make prevention protocol, including prediction risk people, prevention fall and fall from bed with auxiliary means, wearing long sleeves clothes, using emollient on skin twice a day, providing nutrients and water, prevention friction and shear force with movement skills, totally six comprehensive measures. Wound care team trained backbone nurses the measures and backbone nurses trained clinical nurses. Before and after intervention 5 month and 17 month, every patient with age more than 18 years and hospitalized more than 24 hours was checked skin from head to toes in order to observe and compare skin tears incidence and practicable rate of prevention measures by cross-sectional survey.Results Before intervention, skin tears incidence was 0.77%（12/1 558）, and skin tears incidence after intervention 5 month and 17 month was 0.16%（3/1 777） and 0.22%（4/1 825） （ P〈0.05） . Practicable rate of 6 measures in patients with risk and with skin tears after intervention 5 month and 17 month was increased than that before intervention which was unsatisfactory （P〉0.05）.Conclusions Preven-tion skin tears protocol can reduce skin tears incidence, but practicable rate need be improved. In future nurses training, guidance and management bedside should be strengthened in order to enhance practicable rate of prevention measures.