急诊科危重病人院内转运过程中不良事件及风险因素分析

Analysis of adverse events and related risk factors during intra-hospital transfer of critically ill patients in emergency department

[目的]分析急诊科危重病人在院内转运过程中不良事件的发生率、种类及风险因素,以期为减少不良事件的发生提供依据。[方法]选取2018年5月—9月北京某三级甲等医院急诊抢救室和急诊监护室进行院内转运的461例成人病人,采用自行设计的急诊科危重病人院内转运不良事件记录表进行调查,按不良事件是否发生进行分组,通过单因素分析和Logistic回归分析,筛选出影响不良事件发生的风险因素。[结果]共90例(19.5%)病人发生不良事件,其中非病情变化类不良事件发生率较高。输注儿茶酚胺类药物、携带氧气袋及转运过程总用时是影响不良事件发生的风险因素。[结论]急诊科危重病人院内转运过程中发生的不良事件主要集中在转运设备、组织管理、导管/管路、液体/药物及病情变化5方面,护士在转运前应充分评估转运风险,对转运过程中易发生不良事件的关键环节进行核以避免不良事件的发生。

Objective:To analyze the incidence rate,types and risk factors of adverse events during intra hospital transfer of critically ill patients in emergency department,so as to provide a basis for reducing the occurrence of adverse events.Methods:A total of 461 adult patients,who were in the emergency room and emergency intensive care unit and received intra hospital transfer in a tertiary grade A hospital in Beijing from May to September 2018,were selected.The self designed"Adverse Events Record Form During Intra Hospital Transport of Critically Ill Patients in Emergency Department"was used to record the transfer events.Then according to whether adverse events occurred,subjects were grouped.And single factor analysis and logistic regression analysis were used to screen out the risk factors causing adverse events.Result:A total of 90 patients(19.5%)had adverse events,among which the incidence of adverse events that were unrelated to disease changes was higher.Infusion of catecholamines,carrying oxygen bag and total transfer time were major risk factors causing adverse events.Conclusions:The adverse events during intra hospital transfer of critically ill patients in the emergency department are mainly concentrated in five aspects:transfer equipment,organization coordination,catheter/pipelines,liquid medicine and disease changes.The nurse should fully evaluate the transfer risks before transshipment,and check the key links that are prone to cause adverse events in the transshipment process.Thereby,to reduce and avoid the occurence of adverse events.