化疗相关性恶心呕吐的评估和管理的循证实践

Evidence based practice for the assessment and management of chemotherapy related nausea and vomiting

目的评估目前与化疗相关性恶心、呕吐的评估和管理相关的循证证据，将与化疗相关性恶心、呕吐的评估和管理相关的最佳证据应用到护理实践中，通过质量审查促进临床护理质量的改进。方法2015年6—7月，在查询澳大利亚乔安娜·布里格斯研究中心（Joanna Briggs Institute，JBI）在线临床治疗及护理证据网络（COn—NECT＋）数据库中有关化疗相关性恶心、呕吐的最佳证据推荐后，根据证据制订5条审查标准，对我市某三级医院的化疗科病区30名化疗患者进行了证据应用前的基线审查，分析了证据应用存在的障碍、可获得的资源及解决办法，制订了相应的循证实践方案，并将现有的最佳证据整合到护理实践中，于2015年8—9月，对该病区的另30名化疗患者实施干预并执行干预后的第2轮审查，比较两组审查结果。结果在基线审查中，5条审查标准的依从性为0～43％，将最佳证据引入到护理实践后，第2轮审查中，5条审查标准的依从性达到了80％～100％；护士和患者对化疗知识的掌握得到了提升。结论本次最佳证据应用改进了化疗相关性恶心、呕吐的评估和管理的护理实践，提高了护理质量。

Objective To evaluate current practice and develop strategies in Chemotherapy-induced nausea and vomiting （CINV） and promote continuous improvement in assessment and management of CINV among cancer patients. Methods Using Joanna Briggs Institute（JBI） Online clinical therapy and nursing evidence network（COnNECT ＋）in Australia, The best evidence of chemotherapy related nausea and vomiting in the database is recommended. The project was conducted in a chemotherapy ward of a large cancer hospital in China from June 2015 to September 2015. Five audit criteria were established according to the best available evidence on the assessment and management of CINV. The baseline review of 30 chemotherapy patients in a three level hospital in our city was carried out before the application of evidence, and the obstacles, the available resources and the solutions were analyzed, Formulate the corresponding evidence-based practice, and integrate the best evidence to the nursing practice. In August to Septem- ber, 2015, 30 patients in the ward of the intervention was conducted second round of review after implementation of the intervention, the results of the review of the two groups was measured and compared. Results The compliance rates in the five criteria ranged from 0-43% at baseline. After implementation of the project, significant improvement was achieved and the compliance rates in the five criteria achieved 80 % - 100%. Moreover, nurses＇ knowl- edge, patients＇ knowledge had been strengthened. Conclusion This project is successful in improving clinical changes in assessment and management of CINV and improves the quality of nursing.