儿童外周静脉血标本采集的循证护理实践

Practice of evidence-based nursing in children's peripheral venous blood specimen collection

目的:将儿童外周静脉血标本采集的最佳证据应用于临床实践。方法:于2020年12月至2021年3月基于复旦大学循证护理中心证据的持续质量改进模式图的标准程序,将外周静脉血标本采集的最佳证据应用于临床。证据应用前、后分别以北京市某三级甲等儿童专科医院风湿免疫科的26名护士和208例次(证据应用前)、289例次(证据应用后)患儿为研究对象开展质量审查和效果评价,使用调查问卷调查护士对最佳证据的知晓情况,采用现场观察法评估护士对最佳证据实施的依从性,由检验中心反馈血标本合格率。结果:证据应用后护士对患儿握拳时机、双人固定及站位、压脉带的使用、血标本采集顺序这4个方面共计5个指标的知晓率提升,护士执行患儿身份确认、手卫生、压脉带使用、血标本采集顺序、佩戴一次性手套这5个方面共计7个指标的依从性提升,血标本合格率提高,差异均有统计学意义(P<0.01);证据应用前、后静脉采血穿刺成功率比较,差异无统计学意义(P>0.05)。结论:儿童外周静脉血标本采集最佳证据的应用可以提升护士对证据相关知识的知晓率和依从性,提高临床护理质量,提高血标本合格率,为患儿诊断治疗提供可靠依据,不影响穿刺成功率,不增加患儿痛苦。

Objective:To apply the best evidence of children's peripheral venous blood specimen collection to clinical practice.Methods:From December 2020 to March 2021,based on the standard procedure of the continuous quality improvement model of evidence from the Fudan University Evidence-Based Nursing Center,we applied the best evidence of peripheral venous blood specimen collection to the clinical practice.A total of 26 nurses,208 and 289 children from the Department of Rheumatology and Immunology of a third-level children's hospital in Beijing were recruited.The quality was evaluated by the qualification rate blood samples.The effects were examined by investigating the knowledge of nurses about best evidence and their compliance with the best evidence before and after the application of the evidence.Results:After the evidence application,nurses'awareness of 5 indicators including the timing of children's fisting,fixation by two persons and positioning,usage of cuffs,and the order of blood specimen collection,was increased.The compliance with five aspects including identity confirmation,hand hygiene,usage of cuffs,order of blood specimen collection,and wearing the disposable gloves,was also improved.The qualification rate of blood samples was increased.All these differences were statistically significant(P<0.01).There were no significant differences regarding the success rate of blood sampling collection(P>0.05).Conclusion:The application of the best evidence for peripheral venous blood specimens collection in children can increase nurses'awareness and compliance with evidence-related knowledge,improve the quality of clinical care,and increase the qualification rate of blood specimens.The study provides a reliable basis for diagnosis and treatment of children.The evidence application does not affect the success rate of puncture and can decrease the suffering of patients.