骨科围手术期患者静脉血栓栓塞症预防最佳证据应用

Evidence-based for venous thromboembolism prevention to Perioperative patients in Orthopedic

目的将骨科围手术期患者静脉血栓栓塞症(VTE)预防的最佳证据应用于临床实践,提高护士对骨科围手术期患者VTE预防实践活动中相关证据应用的依从性,从而降低骨科围手术期患者VTE的发生率。方法遵循JBI循证中心的证据应用模式,获取相关证据并制定审查标准。采用现场观察法、访谈法及查阅护理文书进行资料收集。证据应用前后共纳入167例患者及36名护士,分析每条证据应用存在障碍、可获得的资源及解决办法。以护士对VTE预防证据的依从性及VTE的发生率来评价证据应用前后的有效性。结果基线审查中"每日检查VTE风险评估的正确情况""为VTE高危患者正确穿戴梯度压力长袜""使用间歇性充气加压装置者,2次/d,30 min/次"3条依从性差的标准在证据应用后显著提高,由证据应用前的47.22%(17/36)、36.11%(13/36)、36.11%(13/36)提高到86.11%(31/36)、86.11%(31/36)、91.67(33/36),差异有统计学意义(χ^2=12.25、18.94、24.08,均P<0.01);VTE发生率由证据应用前的2.70%降至0,差异无统计学意义(P=0.195);护士VTE风险评估正确率、患者健康教育知晓率、患者物理预防措施落实率、护士VTE相关知识技能合格率分别由证据应用前的82.43%(61/74)、74.32%(55/74)、83.78%(62/74)、77.03%(57/74),提高到97.85%(91/93)、91.40%(85/93)、97.85%(91/93)、96.77%(90/93),差异有统计学意义(χ^2=8.86~15.24,均P<0.01)。结论骨科围手术期患者VTE预防的最佳证据的临床应用,可规范VTE预防的护理行为,降低VTE的发生率,提高临床护理的服务质量,提升护理满意度。

Objective To integrate the best evidence of venous thromboembolism (VTE) prevention into practice, improve nurses′ compliance, and reduce the incidence of VTE in orthopaedic department. Methods Guided by the standard procedure in the JBI-Paces program, collected the best evidence from online databases and set the standards. Collected data through field observation, interviews and review of nursing records. A total of 167 patients and 36 nurses we recruited in the study and audited twice. We judged the result by the knowledge level of nurses and patients, nurses′ compliance with the evidence and the incidence rate of VTE. Results In baseline review, three criteria of poor compliance,"the correct situation of daily inspection of VTE risk assessment","Wear gradient pressure stockings correctly for VTE high-risk patients","Intermittent pneumatic compression device (IPCD) used twice a day for 30 minutes each time", were significantly improved after the application of evidence, increased from 47.22%(17/36),36.11%(13/36),36.11%(13/36) to 86.11%(31/36), 86.11%(31/36), 91.67 (33/36) respectively (χ^2=12.25, 18.94, 24.08, all P < 0.05);The incidence of VTE decreased from 2.7% to 0 (P=0.195);the correct rate of VTE risk assessment, awareness rate of health education among patients, implementation rate of physical preventive measures and qualified rate of VTE-related knowledge and skills among nurses increased from 82.43%(61/74),74.32%(55/74),83.78%(62/74),77.03%(57/74) to 97.85%(91/93),91.40%(85/93),97.85%(91/93),96.77%(90/93) respectively (χ^2= 8.86-15.24, all P < 0.01). Conclusion The integration of best evidence standardize nurses′ behaviors, reduce the incidence rate of VTE, improve the quality of clinical care and promote the satisfaction of patients continuously.