精准护理路径在脊髓损伤患者围手术期中的应用

THE APPLICATION OF PRECISION NURSING PATH IN PERIOPERATIVE PERIOD OF SPINAL CORD INJURY PATIENTS

目的创建脊髓损伤患者围手术期精准护理路径,保障患者安全,防范术后并发症,为新入职护士及同专业护理同仁在护理实践中提供参考方案。方法成立专家团队,以2017年患者十大安全目标及脊髓损伤患者术后并发症为依据,建立重点患者、重点环节、重点时段的精准护理路径。纳入三个脊柱科脊髓损伤患者300例,分为观察组(150例)和对照组(150例)。观察组在对照组基础上给予脊髓损伤患者围手术期专科精准护理路径,在患者入院时及术后第五天测评患者:身份识别、手术核查、用药错误、危急值处理、有效沟通、医院相关性感染、医疗器械信息相关事件、跌倒坠床、非计划拔管、安全事件上报、便秘、压疮、术前皮肤准备、下肢深静脉血栓、坠积性肺炎、泌尿系感染、术后突发低血压、疼痛(SAS)状况、创伤后成长状况。结果二组患者入院时一般情况及骨折部位比较差异无统计学意义(P>0.05)。二组患者在有效沟通、跌倒坠床、安全事件上报、便秘、压疮、术前皮肤准备、下肢深静脉血栓发生、坠积性肺炎、泌尿系感染、术后突发低血压、疼痛及创伤后成长状况比较差异有统计学意义(P﹤0.05),观察组患者优于对照组。结论基于患者安全的临床精准护理路径在脊髓损伤患者围手术期中的应用能够更好地促进患者身心康复。

Objective To establish the precise nursing pathway for patients with spinal cord injury during perioperative period for ensuring patient safety and preventing postoperative complications,and to provide reference for new nurses and professional nursing colleagues in practical nursing.Methods We set up expert team and established key patients,key links,key period precision nursing path on the basis of Ten safety goals for patients in 2017 and postoperative complications.Three hundred cases of spinal cord injury in three patients with spinal cord injury were enrolled,the patients were divided into experimental group（n = 150）and control group（n = 150）.On the basis of the control group,the experimental group was given precise nursing path for the perioperative period of patients with spinal cord injury.The patients were assessed at admission and fifth days after the operation：identity recognition,operation check,medication errors,critical value processing,effective communication,hospital related infection,medical device information related events,falling and falling bed,unplanned extubation,security incident reporting,constipation,pressure sore,preoperative skin preparation,deep venous thrombosis of lower extremity,hypostatic pneumonia,urinary tract infection,postoperative hypotension,pain（SAS）status,posttraumatic growth status.Results There was no significant difference in general condition and fracture site between the two groups（P〈0.05）.Two groups of patients were statistically significant on effective communication,falling bed,safety incident reporting,constipation,pressure sores,preoperative skin preparation,lower extremity deep vein thrombosis,hypostatic pneumonia,urinary tract infection,postoperative hypotension,the difference of pain and posttraumatic growth status（P〈0.05）;the patients in the experimental group were better than those in the control group.Conclusion The application of clinical precise nursing pathway based on patient safety in perioperative period of patients with spinal cord injury can better promote the physical and mental rehabilitation of patients.