外周静脉短导管循证标准在老年病人中的应用

Application of evidence-based criteria of peripheral venous short catheters in elderly patients

[目的]探索老年病人外周静脉短导管精细化管理的循证实践方案并应用于临床,以提高护士的循证依从性和静脉治疗专科护理质量。[方法]遵循JBI临床证据实践应用系统(PACES)的标准程序,基于外周静脉短导管相关最佳证据,制定了8条审查标准并将最新的证据引入临床护理实践,在老年病房开展为期6个月的质量审查与流程再造,最后进行效果评价。[结果]证据应用前后的两轮审查显示:8条标准的执行率显著提高(P<0.05),其中第6条、第8条标准在实践中实现了零的突破;15名护士的循证知识和应用技能考核得分显著提高(P<0.05);静脉短导管并发症的发生率显著降低(P<0.05),且证据应用后有33.75%置管未发生任何临床指证,静脉短导管留置时间显著提升(P<0.01),其中12例次留置时间>96 h。[结论]外周静脉短导管的循证标准在老年病人中的应用能够提高护士外周静脉短导管的循证依从性,降低老年病人静脉短导管并发症的发生率,提高护理质量。

Objective:To explore the evidence-based practice of meticulous management of peripheral venous short catheters in elderly patients and apply it to clinical practice,so as to improve nurses'compliance in evidence-based practice and specialist care quality of intravenous therapy.Methods:Following the standard procedure of the JBI Clinical Evidence Practice Application System(PACES),eight criteria were developed based on the best evidence for peripheral venous short catheters.Then new evidence was introduced into clinical nursing practice.A six⁃month quality review and process reengineering was conducted in the geriatric department.Finally,the effect was evaluated.Results:Two rounds of review before and after the application of the evidence showed that the implementation rate of the 8 criteria was significantly improved(P<0.05).It was mentioning that the 6th and 8th standards achieved zero breakthrough in practice;The scores of evidence-based knowledge and application skills assessment of 15 nurses were significantly improved(P<0.05);the incidence of short venous catheter⁃related complications was significantly lower(P<0.05),and 33.75%of the catheters did not have any clinical indications after evidence application.The indwelling time of the short venous catheter was significantly increased(P<0.01).And the indwelling time of 12 cases was above 96 h.Conclusion:The application of evidence-based criteria of peripheral venous short catheters in elderly patients can improve nurses'evidence-based compliance,reduce the incidence of venous short catheter⁃related complications in elderly patients,and improve the quality of care.