儿童镇静监测管理审查指标的制订及障碍因素分析

Audit indicators development and obstacle factors analysis for child sedation monitoring management

目的 开展儿童镇静监测的循证实践,制订审查指标,全面评估儿童镇静监测的临床现状,分析障碍及促进因素,从而制订行动策略。方法 基于儿童镇静监测的最佳证据,制订14条审查指标,对儿童镇静程度及镇静并发症的临床实践现状进行基线调查。基于证据、潜在采纳者和实践环境进行障碍及促进因素分析。结果 护士对儿童镇静程度、谵妄、戒断综合征各监测行为的依从率分别为0~100%、0~13.0%、0~43.5%。护士特异性工具使用、评估频率正确率均为0。经分析,证据转化主要的障碍因素为医护镇静监测知信行水平不高、人工决策过程低效、缺少制度、流程及监控系统等,主要的促进因素为领导力强、多学科协作、循证科研基础扎实、信息技术先进等。结论 目前儿童镇静监测临床现状与最佳证据间存在差距。应充分利用促进因素克服障碍,实施改进,促进最佳证据的临床转化。

Objectivee To carry out evidence-based practice of child sedation monitoring,develop audit indicators,comprehensively evaluate the clinical status of child sedation monitoring,analyze obstacles and promoting factors,and formulate action strategies.Methods 14 audit indicators were developed based on the best evidence of child sedation monitoring to conduct a baseline survey on the clinical practice status of sedation level and sedation complications in children.Then we analyzed obstacles and promoting factors based on evidence,potential adopters,and practical environmen.Results The compliance rates for monitoring behaviors such as sedation level,delirium,and withdrawal syndrome were 0~100%,0~13.0%,and 0~43.5%,respectively.The accuracy rates of nurse specific tool use and evaluation frequency among nurses were O.After analysis,the main obstacles to evidence transformation were poor knowledge,belief,and practice levels of sedation monitoring,inefficient decision-making,lack of systems,processes,and monitoring systems.The main promoting factors were strong leadership,multidisciplinary collaboration,solid evidence-based research foundation,and advanced information technology.Conclusion There is currently a gap between the clinical status and best evidence of pediatric sedation monitoring.We should make full use of promoting factors to overcome obstacles,implement improvements,and promote the clinical transformation of best evidence.