麻醉后监护室护理质量敏感指标的构建

Establishment of sensitive indicators of nursing care quality in post anesthesia care unit

目的构建适用于麻醉后监护室(post anesthesia care unit,PACU)的护理质量敏感指标,为PACU治疗监测及管理提供标准、量化的依据。方法以"结构-过程-结果"理论模式为依据,借鉴美国国家护理质量指标数据库及其他国内外麻醉护理专家的研究成果形成指标初稿,运用德尔菲技术进行3轮专家咨询,结合帕累托定律确定指标的内容和科学的测量方法。结果构建了包含复苏时间中位数、收治各类麻醉患者比例、低体温干预有效率、术后疼痛干预有效率等11项指标的PACU护理质量敏感指标体系。3轮专家咨询的问卷有效回收率均为100%,专家权威系数分别为0.86、0.84、0.90,专家意见的肯德尔和谐系数分别为0.245、0.256和0.356 (P<0.01)。结论 PACU护理质量敏感指标涵盖麻醉后监护的关键内容,可操作性强,专科特色鲜明,具有科学性和实用性,可为基于数据的持续质量改进和提高PACU护理质量提供参考。

Objective To establish sensitive indicators of nursing care quality in post anesthesia care unit(PACU),and to provide standard and professional quantitative basis for treatment,monitoring and management of patients in PACU.Methods The first draft was formed based on the structure-process-result theory,National Database of Nursing Quality Indicators(NDNQI)and existing research results from domestic and international anesthesia nursing experts.Delphi Method was adopted to conduct 3 rounds of expert consultations,combining with Pareto’s principle to finalize the content of the indicators and scientific measuring methods.Results A PACU nursing care quality sensitive indicators system was built up,including 11 indicators,such as the median recovery time,the proportions of patients from different departments,the effectiveness of hypothermia intervention and the effectiveness of postoperative pain intervention,etc.After 3 rounds of expert consultations,the effective response rates were all 100%with authority coefficients of 0.86,0.84 and 0.90,coefficients of concordance of 0.245,0.256 and 0.356 respectively(P<0.01).Conclusion The sensitive indicators of nursing care quality in PACU covered the key contents of post anesthesia monitoring,which was highly operable,scientific,practical and distinctive in specialty,and can provide references for data-based continuous quality improvement and improvement of nursing quality in PACU.