眼科日间手术术前管理的循证实践  

Preoperative care of ophthalmic patients undergoing day surgery:a best evidence implementation program

作　　者：王季芳[1] 洪怡莉 周行涛[3] 席淑新 葛向煜[4] 黄国秀[3] 施逸红[3] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼门诊,上海市200031 [2]复旦大学附属眼耳鼻喉科医院护理部,上海市200031 [3]复旦大学附属眼耳鼻喉科医院视光中心,上海市200031 [4]复旦大学护理学院

出　　处：《中华护理杂志》2018年第3期267-271,共5页Chinese Journal of Nursing

基　　金：上海市教委科研创新课题(15ZZ004-10);复旦大学-复星护理科研基金(FNF201602)

摘　　要：目的促进最佳证据在眼科日间手术患者术前管理中的应用,提高临床护理质量。方法采用澳大利亚乔安娜·布里格斯研究中心(Joanna Briggs Institute,JBI)的临床证据实践应用系统(Practical Application of Clinical Evidence System,PACES),根据最佳证据,制订了8条质量审查指标,在眼科日间手术病房开展基于循证的术前管理流程的优化和质量审查,实践前后分别纳入了12名护士、267名患者和12名护士、234名患者作为研究对象。结果提供多方式健康教育、术前电话访视等6条质量审查指标,护士的执行率由基线审查时的0~28.5%提高到证据应用后的71.43%~100%。患者手术等待时间由(109.70±18.34)min缩短为(88.22±9.91)min,手术相关知识知晓率从63.50%提高到85.09%,满意度得分由(84.23±17.01)分提高到(95.02±7.32)分,差异有统计学意义(P<0.001)。结论基于循证的眼科日间手术术前管理可改善临床护理实践,缩短术前等待时间,提高患者知识知晓率和满意度。质量审查仍需要持续进行,以不断提高护理质量。Objective To integrate the best available evidence of preoperative care for ophthalmic patients undergoing day surgery into clinical practice,so as to improve the quality of nursing. Methods This project was performed in an ophthalmic day surgery ward,guided by the Joanna Briggs Institute（JBI）Practice Application of Clinical Evidence System （PACES） program which includes 3 procedures：baseline audit,evidence implementation,and re-audit Eight audit criteria were made based on evidences from JBI. Twelve nurses and 267 patients were enrolled in baseline audit,and 12 nurses and 234 patients were recruited for re-audit after evidence implementation. Results Six of the audit criteria that nurses showed poor compliance in the baseline audit（0%-28.5%）,such as providing preoperative telephone screening and reducing preoperative waiting time through better preparation and planning,were significantly improved in the re-audit（71.43%-100%）. The preoperative waiting time was shortened from 109.70±18.34 minutes to 88.22±9.91 minutes;the correct rates of operation-related knowledge in patients increased from 63.0% to 85.09%;the patients＇ satisfaction scored 84.23±17.01 in baseline audit and 95.02±7.32 in the re-audit（P〈0.001 ）. Conclusion Application of evidence-based preoperative care of ophthalmic patients undergoing day surgery can improve nurse＇s behavior and compliance with the implementation of evidence into clinical practice,and increase patient satisfaction. Continuous audits are needed to continuously improve clinical nursing quality.

关 键 词：日间手术 眼科 手术前护理 循证实践 

分 类 号：R473.77[医药卫生—护理学]