基于证据的持续质量改进模式的住院患者低分子肝素皮下注射的循证护理实践  

Evidence-based nursing practice for low-molecular-weight heparin subcutaneous injection in inpatients based on evidence-based continuous quality improvement model

作　　者：卢晓虹[1] 李少玲[1] 崔岩[1] 魏丽丽[2] 赵倩[1] 王韶韶 陈瑜[3] Lu Xiaohong;Li Shaoling;Cui Yan;Wei Lili;Zhao Qian;Wang Shaoshao;Chen Yu(Department of Cardiovascular Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Nursing Department,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]青岛大学附属医院心血管内科,青岛266000 [2]青岛大学附属医院护理部,青岛266000 [3]复旦大学护理学院,上海200032

出　　处：《中华现代护理杂志》2020年第28期3940-3945,共6页Chinese Journal of Modern Nursing

基　　金：复旦大学循证护理中心立项(Fandanebn201823)。

摘　　要：目的形成住院患者皮下注射低分子肝素循证护理实践规范,提高护士证据知晓率和临床操作规范率,降低患者不良反应发生状况。方法于2018年6月—2019年6月基于证据的持续质量改进模式的标准程序,结合行动促进框架(i-PARIHS)分析证据应用的障碍因素并制订可获得的解决方案。证据应用前、应用后第1轮、第2轮每个阶段分别以青岛市某综合性三级甲等医院心血管内科的44名护士和80例患者为研究对象开展质量审查和效果评价。结果证据应用后第2轮审查指标的知晓率和执行率均提高,淤斑、硬结、出血的发生率和VAS得分均降低,差异均有统计学意义(P<0.05)。科室相关工作流程得到完善,形成住院患者皮下注射低分子肝素循证护理实践规范。结论该循证项目的临床开展可规范护士注射低分子肝素的操作行为,降低患者不良反应的发生状况。Objective To establish an evidence-based nursing practice standard for subcutaneous injection of low-molecular-weight heparin in inpatients so as to improve the evidence awareness of nurses and the standard rate of clinical practice and reduce the incidence of adverse reactions in patients.Methods From June 2018 to June 2019,we analyzed the obstacle to evidence application and formulated available solutions according to the standard procedure of evidence-based continuous quality improvement and by combining promotion framework(i-PARIHS).We selected 44 nurses and 80 patients of Department of Cardiovascular Medicine at a general ClassⅢGrade A hospital in Qingdao as the research object to carry out quality review and effect evaluation before evidence application,in the first round and the second round after evidence application.Results In the second round of review after evidence application,the awareness and implementation rate were significantly improved,and the incidence of ecchymosis,induration,bleeding and the VAS score were significantly reduced with statistical differences(P<0.05).The department related work process was improved,and the evidence-based nursing practice standard for subcutaneous injection of low-molecular-weight heparin in inpatients was formed.Conclusions The clinical development of the evidence-based project can standardize nurses'operation behavior of subcutaneous injection of low molecular weight heparin and reduce the incidence of adverse reactions in patients.

关 键 词：注射 皮下 低分子肝素 循证护理实践 质量改进 

分 类 号：R473.73[医药卫生—护理学]