血液透析安装预冲护理操作全国现状调查

Investigation on the nursing operation of hemodialysis installation and pre-flush in China

目的调查血液透析安装预冲护理操作的现状,为日后临床护理操作的质量管理和专科培训提供抓手。方法本研究为面向全国的横断面调查。安装预冲过程以操作视频形式提交,制定该操作的评分表,由2位专家依据评分表评审操作并记录扣分原因,评分表主要包含手卫生时机及方法、评估与操作前、中、后安全核查,安装与连接,体外循环预冲原则4个维度。计算各条目及各维度得分率,是否为三甲医院、是否为教学基地的组间得分比较采用独立样本t检验;多分类变量如职称的比较采用单因素方差分析,以P<0.05为差异有统计学意义。结果(1)共收到操作视频270例,有效视频229例。其中华北地区66(28.8%)例,东北地区3(1.3%)例,华东地区23(10.0%)例,华南地区5(2.2%)例,华中地区71(31.0%)例,西南地区26(11.4%)例,西北地区35(15.3%)例。主管护师及以上89(38.8%)例,护师111(48.5%)例,护士29(12.7%)例;来自国家级血液净化护理培训基地42(18.3%)例,非基地187(81.7%)例;来自三甲医院113(49.3%)例,非三甲医院116(50.7%)例。(2)4个重点维度得分率:手卫生时机及方法76.62%,评估与操作前、中、后安全核查78.69%,安装与连接88.42%,体外循环预冲原则87.75%。(3)来自三甲医院者评分表总分高于非三甲医院者(t=3.918,P<0.001),来自教学基地者评分表总分高于非基地者(t=5.540,P<0.001),不同职称评分表总分比较差异无统计学意义(F=0.853,P=0.428)。结论本研究制定的“血液透析安装预冲评分标准”可助力各级单位规范化安装预冲护理操作。三甲医院及血液净化培训基地护士的安装预冲护理操作体现出较高的水平。总体操作显露出基本卫生行业规范/标准的应用实践不足,主要表现在手卫生时机及方法、评估与操作前、中、后安全核查的环节质量中,建议各级单位应加强对以上环节的培训和实践。

Objective To investigate the status quo of hemodialysis installation and pre-flush operation,useful for the forthcoming quality management of clinical nursing operation and specialist training.Methods This was a nationwide cross-sectional survey.The installation and pre-flush operations were surveyed in the form of video records.Two professionals reviewed the video records according to a scoring scale that was developed by literature review and expert consultation.The scoring tool included four dimensions:time and method of hand hygiene;evaluation and safety check before,during and after operation;installation and connection;and principles of pre-flushing.The scores of each item and each dimension were calculated.Independent sample t test was used to compare the scores among the groups.Professional title of the operators were analyzed by one-way ANOVA.P<0.05 was considered statistically significant.Results①A total of 270 operation video records were received in this survey,and 229 were valid.There were 66(28.8%)cases in North China,3(1.3%)cases in Northeast China,23(10.0%)cases in East China,5(2.2%)cases in South China,71(31.0%)cases in Central China,26(11.4%)cases in Southwest China,and 35(15.3%)cases in Northwest China.89(38.8%)operators were the titles of nurses in charge or above,111(48.5%)were nurses,and 29(12.7%)were primary nurses.In the 229 nurses,42(18.3%)were from national blood purification nursing training bases,113(49.3%)were from the tertiary hospitals.②The scoring rates of the four dimensions were:time and method of hand hygiene(76.62%),evaluation and safety check before,during and after operation(78.69%),installation and connection(88.42%),and pre-flush principles(87.75%).③The total score was higher in the nurses from the tertiary hospitals than in those from non-tertiary hospitals(t=3.918,P<0.001),and the score was higher in the nurses from teaching bases than in those from non-teaching bases(t=5.540,P<0.001).There was no significant difference in the total score among different professional titles(F=0.853,P=0.428).Conclusion The scoring scale for hemodialysis installation and pre-flushing in this study can help standardize the nursing operation of installation and pre-flushing.Nurses from tertiary hospitals and training bases showed a higher level of the operation.This survey revealed that the application of basic norms/standards for health service professionals was insufficient,mainly in the time and method of hand hygiene,and quality evaluation and safety check before,during and after operation.We recommend that hemodialysis centers should reinforce the operation training for nurses.