全麻术后基于体位护理风险评估表指导的安全护理效果评价

Evaluation on the nursing safety management based on the risk assessment scale of operative position nursing after general anesthesia

目的探讨应用《全麻手术体位护理风险评估表》规范全麻手术体位护理的效果。方法以2017年9月—2018年3月全麻手术35名巡回护士为研究对象,其中2017年9月—11月开展65台全麻手术; 2018年1月—3月开展71台全麻手术,自行编制《全麻手术体位护理风险评估表》,并对护士进行2个学时理论培训、6个学时实践培训。观察实施前后体位措施执行情况及体位不适症状发生率。结果实施后巡回护士体位风险防控措施执行总评分为(13. 70±2. 20)分,高于实施前的(10. 66±2. 82)分(t=6. 965,P <0. 01)。实施前,"不影响操作情况下,提醒手术人员勿施压"一项执行率最低仅为10. 77%,仅有5项执行率在90. 00%以上;实施后,"局部未与金属接触""肢体放置到位""受力点放置减压贴或衬垫""管道未受压"4项措施执行率达100. 00%,有9项执行情况较实施前显著改善(P <0. 05)。实施前全麻患者体位相关不适症状总发生率为23. 08%,实施后降为2. 82%,差异有统计学意义(χ~2=6. 303,P <0. 01)。结论体位风险评估单可有效提高巡回护士体位护理措施的执行率,减少术后体位并发症的发生。

Objective To investigate the application efficacy of nursing safety management based on the risk assessment scale of operative position nursing after general anesthesia. Methods Totally 35 circulating nurses were included as the study subjects between September 2017 and March 2018. There were 65 cases of general anesthesia performed between September 2017 and November 2017. Since January 2018, a self-made risk assessment scale of operative position nursing was used in the training of circulating nurses, and 71 cases of general anesthesia were performed between January 2018 and March 2018. The implementation rate of operative position nursing and rate of position-related complications were observed before and after implementation of risk assessment scale. Results After implementation of risk assessment scale, circulating nurses achieved a higher score of implementing measures to prevent position-related risks （13.70±2.20 points vs. 10.66±2.82 points, t =6.965, P 〈0.01）. Before the implementation of risk assessment scale, the implementation rate of item “reminding the surgeon not to press the limbs without affecting the operation” was 10.77%, and only five times reached a 90.00% of implementation rate or above. After implementation of risk assessment scale, the implementation rate of “no contact with metal instruments” “appropriate operative position”“ decompression at stress surface ”and “ keep catheter in a uncompressed shape” was 100.00%, respectively. The implementation rates was significantly improved in nine items （ P 〈0.01）. The rate of position-related complications dropped from 23.08% to 2.82%, with a significant different difference （ χ 2=6.303, P 〈0.05）. Conclusion The application of risk assessment scale is effective to improve the implementation rate of operative position nursing and reduce the risk of position-related complications in patients undergoing general anesthesia.