预防ICU经口气管插管非计划性拔管的循证护理实践  

Evidence-based nursing practice for prevention of unplanned extubation among patients with oral tracheal intubation in intensive care unit

作　　者：谷茜[1] 邢唯杰[2] 王枫[1] Gu Qian;Xing Weijie;Wang Feng(Department of Critical Medicine,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025;School of Nursing,Fudan University,JBI Evidence-based Nursing Cooperation Center,Shanghai 200032)

机构地区：[1]上海交通大学医学院附属瑞金医院重症医学科,上海200025 [2]复旦大学护理学院复旦大学JBI循证护理合作中心,上海200032

出　　处：《护士进修杂志》2020年第16期1469-1473,共5页Journal of Nurses Training

基　　金：上海交通大学医学院科技基金项目(编号:Jyh1401)。

摘　　要：目的将经口气管插管非计划性拔管(Unplanned endotracheal extubation,UEX)的最佳证据应用于临床,提高ICU护士对非计划性拔管的认知度和实践过程中对最佳证据的依从性,以降低非计划性拔管的发生率。方法系统检索UEX的相关证据,应用澳大利亚乔安娜·布里格斯研究中心(Joanna briggs institute,JBI)的实践(Getting research into practice,GRiP)模式将证据应用于临床实践。具体分为证据应用前的基线审查、将证据引入实践和证据应用后再次审查3个阶段,制定了6条审查指标,在应用前后分别测量护士对最佳证据的认知、执行情况及患者非计划性拔管发生率。结果与基线审查结果相比,证据应用后护士关于UEX最佳证据认知度从68.8%提高至93.5%;6条审查指标的执行率均显著提高(P<0.01);患者非计划性拔管的发生率从1.88%下降至0.62%(P>0.05)。结论ICU中UEX最佳证据的应用可提高护理人员的认知度和执行率,有助于降低UEX的发生。Objective To develop and implement an evidence-based nursing practice program focused on prevention of unplanned extubation among patients with orotracheal intubation in intensive care unit,to improve ICU nurses’awareness of unplanned extubation and their compliance with the best evidence in practice,so as to reduce the incidence of unplanned extubation.Method The evidence of unplanned extubation of endotracheal intubation was systematically retrieved,and the evidence was applied to clinical practice using the GRiP model of JBI.Specifically,it was divided into three stages:baseline review before the application of evidence,introduction of evidence into practice,and review again after the application of evidence.Six review indicators were developed to measure nurses’knowledge of the best evidence,behavior,and incidence of unplanned extubation before and after the application.Results Compared with the results of baseline examination,nurses’awareness of the best evidence for UEX increased from 68.8%to 93.5%,and the execution rate increased significantly compared with the results of the baseline review(P<0.01).The incidence of unplanned extubation decreased from 1.88%to 0.62%(P>0.05).Conclusion The evidence-based unplanned extubation prevention strategy could improve the nurses’ability to prevent unplanned extubation.

关 键 词：重症监护病房 机械通气 经口气管插管 非计划性拔管 循证护理 证据应用 

分 类 号：R471[医药卫生—护理学]