《血液透析安全核查表》的设计及应用研究

Design and application of the"Hemodialysis Safety Checklist"

目的设计血液透析安全核查表,应用于临床,规范血液透析操作流程,提高操作治疗的规范性和各项护理措施的执行率,提升血液透析室的整体安全水平和护理质量。方法回顾分析四川省自贡市第一人民医院血液透析室2016~2018年不良事件发生的性质,通过指南筛选及参考国外血液透析核查表,结合四川省自贡市现况,设计《血液透析护理措施落实现状调查表》进行问卷调查,根据结果形成核查表初稿,采用德尔菲法进行2轮专家函询,设计出《血液透析安全核查表》,按照核查表的流程,从进入血液透析室前、透析开始前、透析中和透析后4个方面进行核查操作。结果《血液透析安全核查表》共涵盖4阶段24个条目,选取四川省自贡市4家三级综合医院血液透析室医生、护士、维持性血液透析患者各30人作为研究对象,核查表操作执行项目执行率,使用前为70.00%,使用后为93.33%,总体措施执行率差异有统计学意义(x^2=5.455,P=0.020);医生、护士、患者满意度均有增长(x^2值分别为4.043,4.320,5.455;P值分别为0.044,0.038.0.020),差异存在统计学意义,无不良事件的发生。结论实施《血液透析安全核查表》的核查流程,可以规范护士各项操作,提高各项措施执行率,为血液透析的安全管理和优质护理提供重要保障。

Objective To design a "Hemodialysis Safety Checklist" for clinical use, in order to standardize the hemodialysis procedure, raise the rate of standardized treatment and nursing operations, and increase the overall safety and nursing quality in hemodialysis center. Methods We first retrospectively analyzed the causes of hemodialysis incidents from 2016 to 2018 in the Hemodialysis Center, Zigong First People’s Hospital, Sichuan Province. A primary checklist of"Questionnaire for the Present Performance of Hemodialysis Nursing Operations" was set up following the Hemodialysis Guidelines, using the hemodialysis safety checklists from foreign countries as the references, and taking the present status in Zigong city as the basis. A "Hemodialysis Safety Checklist" was then designed based on the practice results of the"Questionnaire for the Present Performance of Hemodialysis Nursing Operations" and two rounds of consultation from experts using the Delphi method. We inspected the operations for patients before entering the hemodialysis room, and before, during and after hemodialysis according to the checklist in "Hemodialysis Safety Checklist". Results The"Hemodialysis Safety Checklist"contained 24 items in the 4 stages. The research objects, including doctors(n=30) and nurses(n=30) working in hemodialysis centers and maintenance hemodialysis patients(n=30), were recruited from 4 higher level hospitals in Zigong city, Sichuan Province. Their implementation rate was 70.00% before use and 93.33% after use of the "Hemodialysis Safety Checklist". The difference in overall implementation rate was statistically significant(x^2=5.455, P=0.020). The satisfaction rate of doctors,nurses and patients increased significantly(x^2=4.043, 4.320 and 5.455 respectively;P=0.044, 0.038 and 0.020 respectively). No adverse events occurred. Conclusion The implementation of the "Hemodialysis Safety Checklist" can standardize the nursing operations, raise the application rate of guidelines, and provide reliable safety management and higher quality care for hemodialysis patients.