ICU患者身体约束决策支持系统的研发与应用

Construction and application of a Clinical Decision Support System for physical restraints in ICU patients

目的:研发ICU患者身体约束决策支持系统并评价其临床应用效果,为护士进行患者身体约束决策提供便利。方法:成立研发小组,构建ICU患者身体约束影响因素预测模型并进行验证,以此为基础开发ICU患者身体约束决策支持系统并投入使用。选取2022年8月至2023年3月江苏省某三级甲等医院ICU的764例患者为研究对象,将患者随机分为干预组(n=366)和对照组(n=398),对照组护士实施基于经验性评估的常规身体约束流程,干预组护士实施基于ICU患者身体约束决策支持系统的身体约束流程,比较两组患者的身体约束率、谵妄发生率、非计划性拔管发生率;同时验证ICU患者身体约束决策支持系统与约束决策轮的一致性。结果:使用ICU患者身体约束决策支持系统后,干预组患者的约束率为24.9%,谵妄发生率为2.2%,均低于对照组(P<0.05);两组非计划性拔管发生率差异无统计学意义(P>0.05)。ICU患者身体约束决策支持系统与约束决策轮Kappa一致性检验结果为0.853(P<0.001),显示结果一致性较好。结论:ICU患者身体约束决策支持系统可以应用于临床并辅助护士决策,在有效降低身体约束率及谵妄发生率的同时不会增加非计划性拔管发生率。

Objective:To construct a Clinical Decision Support System(CDSS)for physical restraints in ICU patients and explore its clinical application effect,in order to provide convenience for nurses'restraint decision making.Methods:A research team was set up to construct and validate the prediction model of physical restraint for ICU patients.A CDSS for physical restraints in ICU patients was constructed based on the prediction model.Totally 764 ICU patients from August 2022 to March 2023 in a tertiary hospital in Jiangsu province were selected as the research participants.The patients were divided into intervention group(n=366)and control group(n=398)by random method.In control group,nurses made a decision about physical restraint based on empirical assessment.And the physical restraint CDSS for ICU patients was used to help nurses to make a decision about physical restraint in intervention group.The physical restraints rate,delirium incidence rate and unplanned extubation rate of the two groups were compared,and the consistency of CDSS and restraint decision wheel was verified.Results:After using the CDSS,the physical restraints rate was 24.9%,and the incidence of delirium was 2.2%in intervention group,which were significantly lower compared with the control group(P<0.05).There was no statistically significant difference in the incidence of unplanned extubation between the two groups(P>0.05).The Kappa consistency test between CDSS and restraint decision wheel was 0.853(P<0.001),showing good consistency.Conclusion:The physical restraint CDSS in ICU patients can be applied to clinical practice and assist nurses in decision-making.It can effectively reduce the rate of physical restraint and delirium without increasing the rate of unplanned extubation.