成年人肿瘤患者静脉化疗前护理评估的最佳证据应用  

Pre-chemotherapy nursing assessment among adult cancer patients:a best practice implantation project

作　　者：王丽英 陆海燕 杨瑒 陈凤珍 薛嵋 张晓菊 陆箴琦 Wang Liying;Lu Haiyan;Yang Yang;Chen Fengzhen;Xue Mei;Zhang Xiaoju;Lu Zhenqi(Department of Nursing,Fudan University Shanghai Cancer Center/Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院护理部,复旦大学上海医学院肿瘤学系,200032

出　　处：《中国实用护理杂志》2021年第4期241-247,共7页Chinese Journal of Practical Nursing

基　　金：复旦大学护理学院2018年度JBI Fellowship证据临床应用科研项目(FNF201858)。

摘　　要：目的将现有与成年人肿瘤患者静脉化疗前护理评估相关的最佳证据应用到护理实践,以提高护士的评估依从性,促进化疗用药安全。方法采用乔安娜·布里格斯研究所(JBI)临床证据实践应用系统(PACES),基于目前最佳证据,制订了12条审查指标,包括护士培训以及患者病史、过敏史、诊断、实验室数据、对方案的理解程度、以往治疗不良反应、生理、心理、化疗前用药、体质量及血管通路的评估。于2018年5—10月,在复旦大学附属肿瘤医院2个肿瘤内科病房开展质量审查与流程再造。结果审查前后均有68例患者、36名护士参与,项目实施前,第11条与12条(评估化疗前用药及血管通路装置)依从性已经达到100%。项目实施后,除第4、10条审查指标(每周测量患者体质量)外,其余8条护士执行依从性均得到了显著性提高,差异有统计学意义(χ^2值为10.29~132.06,P<0.01)。以往不良反应评估显示:68例患者中,3例曾经出现过化疗药物输注反应,药物分别为奥沙利铂、吉西他滨和紫杉醇;39例在入院前(居家期间)出现过化疗相关症状,出现频率占据前5位的症状分别为食欲下降、疲乏、恶心、神经毒性反应和呕吐,入院时大多已缓解。结论基于循证的质量审查项目显著改善了化疗前护理评估的临床护理实践,但仍有许多问题有待进一步解决,需要持续开展质量审查,以不断提高护理质量。Objective To promote evidence-based practice in the pre-chemotherapy nursing assessment among adult cancer patients.Methods The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used.The project was conducted in Shanghai Cancer Center of Fudan University from May to October 2018,12 audit criteria were developed in the program including nursing training,patient medical and allergic history,medical diagnosis,lab data and so on.Results A baseline audit of pre-chemotherapy nursing assessment among adult cancer patients was conducted,with a sample size of 68 patients and 36 nursing staff,during this stage,the compliance of audit 11 and 12 were 100%.After the implementation of systematic strategies,a follow-up audit involving similar sample as first audit was conducted using the same audit criteria.In the follow-up audit,except criterion 4 and 10,the compliance of the remaining 8 criteria had significantly improved,and χ^2 value was 10.29-132.06,P<0.01.The result of history adverse reaction in the follow-up audit showed that among 68 patients,3 had experienced chemotherapy infusion reactions in the past(The drugs were oxaliplatin,gemcitabine and paclitaxel),39 had chemotherapy-related symptoms before admission(most of them were relieved at admission),of which the top five were loss of appetite,fatigue,nausea,neurotoxicity and vomiting.Conclusions The aims of the project were fulfilled.We achieved increased compliance with evidence-based best practice recommended by JBI in most of audit criteria.Further audit will need to be carried out to improve the validity and quality of nursing assessment.

关 键 词：成年人肿瘤患者 化疗前护理评估 循证护理 最佳实践 质量审查 

分 类 号：R473.73[医药卫生—护理学]