老年患者医用粘胶剂相关性皮肤损伤预防及管理的循证实践  

Evidence-based practice on prevention and management of medical adhesive-related skin injury among hospitalized aged patients

作　　者：郭卫婷 王文君 曹英娟[3] 白雪 杨静 吕晓燕[1] Guo Weiting;Wang Wenjun;Cao Yingjuan;Bai Xue;Yang Jing;Lv Xiaoyan(School of Nursing,Shandong University,Jinan 250014,China)

机构地区：[1]山东大学护理学院,山东济南250014 [2]山东大学齐鲁医院急诊内科 [3]山东大学齐鲁医院护理部

出　　处：《护理学杂志》2020年第4期69-73,共5页Journal of Nursing Science

基　　金：山东省科技厅2017年重点研发计划(2017GSF218001)。

摘　　要：目的将老年患者医用粘胶剂相关性皮肤损伤预防及管理的最佳证据应用于临床实践,通过质量审查促进护理质量改进。方法采取前瞻性对照设计,总结老年患者医用粘胶剂皮肤损伤的最佳证据,基于证据制定10条审查指标。于2018年7~11月在试点病房实施循证护理实践,通过基线审查(基线审查组119例),分析临床情景障碍因素,构建循证变革方案,并将方案应用于132例老年患者(证据应用组)。结果最佳证据应用后进行第2轮审查,老年患者医用粘胶剂相关性皮肤损伤发生率由10.08%降至0.76%,患者皮肤瘙痒发生率、揭除敷贴后疼痛发生率由19.33%、39.50%降至2.27%、3.79%,差异有统计学意义(均P<0.01)。护士对最佳证据的执行率及相关知识知晓率均大幅提高。结论老年患者医用粘胶剂相关性皮肤损伤预防及管理的最佳证据应用于临床,可规范护士应用医用粘胶剂的操作手法,降低患者皮肤损伤发生率,促进患者舒适。Objective To apply the best evidence of prevention and management of medical adhesive-related skin injury(MARSI)to elderly patients clinically,and to boost nursing quality improvement through quality reviews.Methods In the prospective controlled study,the best evidence of MARSI prevention and management for elderly patients was summarized.Then 10 review indicators were established.Evidence-based nursing practice was pushed through in pilot wards from July to November 2018.Through baseline review of 119 elderly patients(the baseline group),clinical obstacles were identified,and an evidence-based practice change protocol was constructed.Then the protocol was implemented to another 132 elderly patients(the implementation group).Results After the application of the best evidence,the implementation group was subjected to 2nd round quality review.The incidence rate of MARSI in the elderly patients decreased from 10.08%(baseline)to 0.76%,the incidence rates of skin itching,and pain after removal of the medical adhesive decreased from 19.33%,39.50%to 2.27%,3.79%respectively,with before-after differences being significant(P<0.01 for all).Nurses′implementation rates and knowledge of the best evidence have been greatly improved.Conclusion The best evidence of MARSI prevention and management for elderly patients can standardize the usage of medical adhesive by nurses,reduce the incidence rate of skin injury in patients,and promote patient comfort.

关 键 词：老年患者 医用粘胶剂相关性皮肤损伤 最佳证据 皮肤瘙痒 循证护理 循证实践 

分 类 号：R47[医药卫生—护理学] C931.2[医药卫生—临床医学]