29所三级医院儿科护士对儿童早期预警系统的认知及应用现状调查

Investigation on the pediatric nurses’cognition and practice of pediatric early warning system in 29 tertiary hospitals

目的了解国内三级医院儿科护士对儿童早期预警系统(pediatric early warning system,PEWS)的认知、态度与应用现状,为构建住院患儿病情恶化风险早期预警管理方案提供参考。方法通过目的抽样法,于2022年1月—2月从26个省(市)中选择三级医院的儿科护士作为调查对象,采用自行编制的调查问卷对其进行调查。结果共29所医院参与调查,其中儿童专科医院15所、综合医院9所、妇幼保健院5所。2583名儿科护士填写了问卷,有效问卷回收率为98.80%。儿科护士对PEWS的认知得分为(36.92±4.54)分,得分率为85.86%;态度得分为(54.72±8.24)分,得分率为84.18%。不同类型医院使用预警工具的护士比例比较,差异具有统计学意义(P=0.013),其中儿童专科医院使用预警工具的护士比例较高(73.30%)。使用频率排名前3位的预警工具类型是Brighton儿童早期预警评分、新生儿早期预警评分及小儿心脏病早期预警评分。在医院对PEWS的管理中,仅16所(55.17%)医院制订了患儿病情风险管理相关制度或流程,17所(58.62%)制订了标准化交班相关制度,15所(51.72%)开发了患儿病情预警信息化系统。结论儿科护士对PEWS的知晓度高、态度积极,但认识不够全面,应用水平有待提高。建议有应用经验的三级医院联合制订科学、规范的PEWS方案,发挥辐射引领作用,指导并促进下级医疗机构应用PEWS。

Objective To investigate the cognition and attitude of pediatric early warning system(PEWS)among pediatric nurses in tertiary hospitals in China and to clarify the implementation status,aiming to provide a reference for the construction of pediatric early warning management program for clinical deterioration in patients.Methods Pediatric nurses from tertiary hospitals across 26 provinces and cities throughout the country were selected by convenience sampling between January and February 2022 to respond to a self-designed questionnaire.Results A total of 29 hospitals participated in the study,including 15 children’s specialized hospitals,9 general hospitals,and 5 maternal and children’s hospitals.2583 subjects filled out the questionnaire with a response rate of 98.80%.The cognition scores of pediatric nurses on PEWS are(36.92±4.54),with the score rate of 85.86%.The attitude scores are(54.72±8.24),with the score rate of 84.18%.There are statistically significant differences in the usage of early warning scores among pediatric nurses in different hospitals(P=0.013),and pediatric nurses in the children’s specialized hospitals have a higher proportion(73.30%)of using early warning scores.The top 3 used early warning scores are Brighton Pediatric Early Warning Score,Neonatal Early Warning Score,and Cardiac Children’s Hospital Early Warning Score.In the management of pediatric early warning systems among different hospitals,merely 16(55.17%)hospitals developed a risk management procedure or related regulation for clinical deterioration;17(58.62%)hospitals formulated a standardized shift management program;15(51.72%)hospitals developed an early warn-ing information system.Conclusion Pediatric nurses have a great cognition and positive attitude towards PEWS,but they do not fully understand it yet,and their practice needs to be strengthened.Hospitals with practical experience can jointly develop a scientific,standardized PEWS procedure and play a leading role in guiding and promoting its implementation in lower-level medical institutions.