全膝髋关节置换术患者围手术期静脉血栓机械预防审查指标构建及障碍因素分析

Evaluation of perioperative mechanical prophylaxis of venous thrombosis in patients undergoing total knee and hip replacement and analysis of its obstacle factors

目的了解全膝髋关节置换术患者围手术期静脉血栓机械预防现状,分析证据临床转化中的障碍因素和改进措施。方法以证据的持续质量改进模式图为理论指导,构建团队,系统检索、评价并汇总证据,根据FAME原则(可行性、适宜性、临床意义、有效性)确立审查指标及审查方法,选取2020年4月30日至8月31日山西省人民医院行全膝髋关节置换术的患者、护士及医生为审查对象,按照审查指标逐条进行基线审查,并根据审查结果分析障碍因素及改进措施。结果本研究共纳入29条最佳证据,依据最佳证据制订17条审查指标,其中5条审查指标临床依从率>80%,12条审查指标临床依从率<80%,分析其障碍因素主要为系统层面静脉血栓栓塞症(VTE)风险评估与管理流程不完善、个人层面医护人员VTE预防与管理知识水平不高等。结论本研究基于最佳证据,科学系统地制订临床审查指标、严谨全面地进行障碍因素分析,并针对性地构建改进措施,不仅为今后开展全膝髋关节置换术患者围手术期静脉血栓机械预防证据转化提供基础,而且能够进一步推动临床实践变革和持续质量改进。

Objective To understand the current status of perioperative physical prevention of venous thrombosis in patients undergoing total knee and hip replacement and to analyze the barriers to clinical transformation of evidence and improve measures.Methods Based on the evidence-based continued quality improvement model,then building a team,systematically searching,evaluating and summarizing evidences,establishing review indicators and review methods according to FAME principles(feasibility,appropriately,meanfulness,effectiveness),selecting patients undergoing total knee and hip replacement,nurses,and doctors who underwent total knee and hip replacement surgery from April 30 to August 31,2020 in Shanxi Provincial People's Hospital as the review objects,and conducting a baseline review according to the review indicators one by one,and analyzing the obstacle factors and improvement measures based on the review results.Results This study included 29 best evidences,and 17 review indicators were formulated based on the best evidences.Among them,the clinical compliance rate of 5 review indicators were greater than 80%,and the clinical compliance rate of 12 review indicators were less than 80%.The main obstacles were due to the imperfect venous thromboembolism(VTE)risk assessment and management process at the system level,and the low level of knowledge of VTE prevention and management among medical staff at the individual level.Conclusions This study was based on the best evidences,scientifically and systematically developed clinical review indicators,rigorously and comprehensively analyzed obstacles,and constructed targeted improvement measures,not only for the future physical prevention of perioperative venous thrombosis in patients with total knee and hip replacement surgery transformation provides the basis but also can further promote clinical practice changes and continuous quality improvement.