住院患者结肠镜检查前肠道准备的循证实践

Best evidence-based practice for promoting bowel preparation before colonoscopy in hospitalized patients

目的基于结肠镜检查前肠道准备的证据,开展循证实践,验证其在改善住院患者肠道准备中的作用。方法2019年12月—2020年11月通过证据获取、现况审查、证据引入和效果评价4个阶段将最佳证据应用于需接受结肠镜检查或治疗的住院患者,并采用中断时间序列设计,比较循证实践前(2019年12月—2020年5月)和实践后(2020年9月—11月)医护人员对结肠镜检查前肠道准备证据掌握情况、结肠镜检查前肠道准备各审查指标执行率、实践前(n=202)和实践后(n=209)两组结肠镜检查一次成功率。结果最终纳入7条证据,共8条审查指标。循证实践后,医护人员对结肠镜检查前肠道准备证据考核分数由(73.49±6.50)分提升至(80.88±6.27)分,差异有统计学意义(t=5.37,P<0.01);各审查指标执行率均得到了提高(P<0.05);肠镜检查一次成功率由95.54%提升至97.61%,差异无统计学意义(χ2=1.33,P=0.25)。结论基于结肠镜检查前肠道准备的证据开展循证实践,能够提高医护人员及患者对结肠镜检查前肠道准备最佳证据的执行率,规范肠道准备流程。

Objective To implement the best evidence of bowel preparation for colonoscopy in hospitalized patients and to evaluate the effectiveness of the evidence-based nursing protocol.Methods The process consisted of 4 steps including evidence acquisition,baseline evaluation,evidence introduction,and effect evaluation.An interrupted time series design was used to compare the effects of the evidence of bowel preparation before colonoscopy by medical staff before the practice(December 2019—May 2020)and after the practice(September2020—November)on knowledge,performance rate of pre-colonoscopy bowel preparation review index and colonoscopy one-time success rate.Results We finally included 7 pieces of evidence in protocol.The score of evidence on bowel preparation for colonoscopy in medical staff increased from(73.49±6.50)to(80.88±6.27)(t=5.37,P<0.01).The one-time success rate of colonoscopy increased from 95.54%to 97.61%(χ~2=1.33,P=0.25).Conclusion The evidence-based practice can improve the performance of medical staff and standardize the process of bowel preparation.