成人医疗器械相关压力性损伤预防管理的循证实践

Evidence-based Implementation on Preventing Medical Device-related Pressure Injury in Intensive Care Unit

目的探讨基于最佳证据的成人医疗器械相关压力性损伤预防方法并评价其在ICU的应用效果。方法汇总成人医疗器械相关压力性损伤预防证据并结合临床情境评估证据,进行基线审查、障碍因素分析,拟订并实施相应对策。共进行1轮基线审查和4轮证据应用,比较证据应用前后成人医疗器械相关压力性损伤发生率、ICU护士医疗器械相关压力性损伤预防知识得分情况及对审查指标的依从率。结果共应用22条最佳证据,与证据应用前相比,ICU成人医疗器械相关压力性损伤发生率降低,ICU护士医疗器械相关压力性损伤预防知识总分有所提高,差异均有统计学意义(均P<0.001)。共构建14条审查指标,经过4轮证据应用,依从率>80%的审查指标分别有1、3、8、10、14条。结论开展基于最佳证据的循证实践,能够有效降低ICU患者医疗器械相关压力性损伤发生率,提高ICU护士对相关预防知识的掌握程度,减少证据与临床实践的差距,从而提高护理质量。

Objective To explore the means of prevention of medical device-related pressure injury(MDRPI)based on the best evidence and assess its application effects.Methods The preventive evidence of MDRPI was collected by the evidence-based nursing and combined with the evidence of clinical situation assessment.the baseline review and obstacle factor analysis were conducted,and corresponding countermeasures were formulated and implemented.In this study,one round of baseline review and four rounds of evidence application were conducted to compare the incidence of MDRPI in patients before and after evidence application,as well as the score of Intensive Care Units(ICU)nurses’knowledge of MDRPI prevention and their compliance rate to the review indicators.Results A total of 22 best evidences were used in this study.Compared with before-evidence application,the incidence of MDRPI in ICU patients was reduced,and the total score of knowledge of MDRPI prevention in ICU nurses was improved,with statistically significant differences(all P<0.001).A total of 14 audit indicators were constructed in this study,and there were 1,3,8,10 and 14 audit indicators with compliance rate>80%after 4 rounds of application.Conclusions Clinical practice based on the best evidence reduce the MDRPI incidence,enhance the cognition ability of nurses of MDRPI,narrow the gap between evidence and reality,and promote management.