医院-社区-家庭联动多维延伸护理模式在PICC带管出院患者中的应用

Application of hospital-community-home linkage pattern in extended nursing for patients with peripherally inserted central catheter after discharge from hospital

目的探讨建立医院指导、社区参与、居家合作多维联动的经外周静脉穿刺置入中心静脉导管(PICC)维护模式,以满足不同患者及家属的服务需求的可行性和安全性。方法选取2018年7月-12月在医院行PICC置管的患者,有社区、居家维护需求的患者60例为观察组,以同时期返院实施PICC导管维护的60例患者为对照组。观察组通过以医院为主导,对社区医院护士进行培训,建立区域化维护网络,对有需求的家属进行培训,患者根据需求选择社区维护或护士指导的居家维护;对照组选择返院到PICC专科护理门诊维护。对比2组患者导管并发症发生情况,记录患者单次PICC维护路途花费时间、费用支出,评价患者PICC依从性和满意度。结果 2组患者接触性过敏性皮炎、静脉炎、局部皮肤感染、导管堵塞、非计划拔管的发生率比较,差异无统计学意义(P>0.05)。观察组患者单次PICC维护路途花费时间和经费支出低于对照组(P<0.05),PICC维依从性和满意度高于对照组(P<0.05)。结论医院-社区-家庭联动多维延伸护理模式可满足PICC带管出院患者间歇期个性化的维护需求,确保留置导管安全,提高患者维护依从性和满意度。

Objective To investigate the feasibility and safety of hospital-community-home linkage pattern in extended nursing for patients with peripherally inserted central catheter(PICC) after discharge from hospital. Methods Totally 60 patients who need community and home-based PICC maintenance were assigned to the observation group, another 60 patients who underwent PICC maintenance at hospital were included in the control group. In the observation group, A hospital-led PICC maintenance network was established, providing healthcare education programs for community nurses, and patients selected community or home-based PICC maintenance according to their own demand. The incidence of PICC-related complications, time spent and maintenance cost were compared between two groups. The self-made questionnaire was used to investigate the patient compliance with PICC maintenance and satisfaction with nursing service. Results There was no significant difference in incidence of allergic contact dermatitis, phlebitis, local skin infection, catheter blockage and unplanned extubation between two groups(P>0.05). Patients in the observation group spent less time and lower cost in PICC maintenance compared with those in the control group(P<0.05), and the compliance and satisfaction rates in the observation group were higher than those in the control group(P<0.05). Conclusion The hospital-community-home linkage pattern in extended nursing could meet the demand for individualized PICC maintenance for patients after discharge from hospital.