闭环管理模式结合关键指标对CVC 非计划性拔管的预防效果  

The preventive effect of closed-loop management mode combined with key indicators on CVC unplanned extubation

作　　者：王群英 孙彩霞 WANG Qun-ying;SUN Cai-xia(Yiwu Traditional Chinese Medicine Hospital Foreign Department,Zhejiang Yiwu 322000;Yiwu Traditional Chinese Medicine Hospital Department of Critical Care Medicine,Zhejiang Yiwu 322000)

机构地区：[1]义乌市中医医院外二科,浙江义乌322000 [2]义乌市中医医院重症医学科

出　　处：《中国预防医学杂志》2019年第8期729-732,共4页Chinese Preventive Medicine

摘　　要：目的探究闭环管理模式结合关键指标对CVC非计划性拔管的预防效果,旨在减少CVC非计划性拔管率。方法选取2016年3月至2018年12月于义乌市中医医院接受治疗的824例留置患者为研究对象,其中2016年3月至2017年3月244例接受闭环管理模式干预为对照组,2017年4月至2018年12月580例接受闭环管理模式结合关键指标干预为观察组,比较两组闭环管理医护工作落实率、患者导管相关性血流感染发生率、非计划性拔管发生率。结果观察组风险评估准确率96.72%,管路固定正确率98.28%,健康教育落实率97.59%,交接班落实率97.24%,身体约束有效落实率97.76%,与对照组比较差异有统计学意义(P<0.05);观察组患者导管相关性血流感染发生率为2.93%,对照组患者导管相关性血流感染发生率7.38%,差异有统计学意义(χ^2=4.876,P=0.032);观察组非计划性拔管21例,发生率3.62%,对照组非计划性拔管20例,发生率为8.20%,差异有统计学意义(χ^2=5.793,P=0.012)。结论闭环管理模式结合关键指标能够有效提高CVC医护人员工作落实率,降低患者导管相关性血流感染发生率和非计划性拔管发生率。Objective To explore the preventive effect of closed-loop management mode combined with key indicators on CVC unplanned extubation,aiming to reduce the unplanned extubation rate of CVC.Methods 824 cases of indwelling patients who were treated at Yiwu Traditional Chinese Medicine Hospital from March 2016 to December 2018 were selected as subjects.Among them,244 patients from March 2016 to March 2017 received closed-loop management mode intervention as the control group.From April 2017 to December 2018,580 patients received closed-loop management mode combined with key indicators for intervention.The implementation rate of closed-loop management medical care,the incidence of catheter-related bloodstream infection,and the incidence of unplanned extubation were compared between the two groups.Results The accuracy rate of risk assessment of observation group was 96.72%(561),the correct rate of pipeline fixation was 98.28%(570),the implementation rate of health education was 97.59%(566),the implementation rate of handover was 97.24%(564),and the effective rate of physical restraint was 97.76.%(567),the difference was statistically significant compared with the control group(P<0.05).The incidence of catheter-related bloodstream infection was 2.93%(17)in the observation group and 7.34%(18)in the control group.The difference was statistically significant(χ^2=4.876,P=0.032).In the observation group,21 patients had unplanned extubation,the incidence rate was 3.62%,and 20 patients in the control group were unplanned extubation,the incidence rate was 8.33%.The difference was statistically significant(χ^2=5.793,P=0.012).Conclusions The closed-loop management model combined with key indicators can effectively improve the implementation rate of CVC medical staff,reduce the incidence of catheter-related bloodstream infection and the incidence of unplanned extubation.

关 键 词：闭环管理模式 关键指标 CVC 工作落实率 导管相关性血流感染 非计划性拔管 

分 类 号：R459.9[医药卫生—治疗学]