麻醉恢复室专科护理质量敏感指标体系的构建  

The construction of the sensitive indicator system of specialist nursing quality in PACU

作　　者：伍彩红[1] 刘雁[1] 朱进[1] 谭婷 卿春华[2] 徐红艳 唐懿芳 WU Caihong;LIU Yan;ZHU Jin;TAN Ting;QING Chunhua;XU Hongyan;TANG Yifang(Department of Anesthesiology,the Second Xiangya Hospital of Central South University,Changsha,410011,China)

机构地区：[1]中南大学湘雅二医院麻醉科&临床护理学教研室,长沙市410011 [2]中南大学湘雅二医院呼吸内科&临床护理学教研室,长沙市410011

出　　处：《中国护理管理》2021年第6期926-930,共5页Chinese Nursing Management

基　　金：中南大学湘雅二医院2018年临床护理科研基金(2018-YHL-02)。

摘　　要：目的:建立重要的、敏感的、与预后相关的麻醉恢复室(PACU)护理质量敏感指标。方法:运用约翰霍普金斯循证护理方法进行证据综合,初步拟定PACU护理质量敏感指标、内涵及计算公式,运用两轮德尔菲法进行筛选、论证与校正。结果:构建了结构、过程、结果3项一级指标,人力资源、执业环境、护理过程、不良事件、护理效果5项二级指标,床护比、护士满意率、护士洗手依从性、急救药品物品完好率、患者身份识别准确率、静脉给药正确率、苏醒评估准确率、疼痛评估准确率、麻醉记录单合格率、非计划性拔管率、非计划性气管导管再次插管率、非计划性ICU转入率、苏醒延迟发生率、误吸发生率、皮肤压力性损伤PACU新发生率、坠床发生率、低体温患者复温率、疼痛治疗有效率18项三级指标。两轮专家函询的专家权威系数分别为0.90、0.91,积极系数为0.91、1.00,肯德尔协调系数为0.30~0.52,P均<0.05。结论:本研究制订的PACU护理质量敏感指标,从结构质量、过程质量、结果质量3个方面对PACU实施质量监管,包含重要的、敏感的、预后相关的护理质量指标,可为PACU护理质量评价与监测提供参考依据。Objective:To establish a prognostic-related sensitive Post-Anesthesia Care Unit(PACU)nursing quality indicator system.Methods:Johns Hopkins evidence-based nursing method was used to synthesize the evidence.The sensitive indicators,connotations and calculation formula of PACU nursing quality were initially drawn up.Two-round Delphi method was used for screening,demonstration and correction.Results:Three first-level indicators(structure,process,and results),five second-level indicators(human resources,practice environment,nursing process,adverse events,and nursing effect),and eighteen three-level indicators(bed-to-nurse ratio,nurse satisfaction rate,nurse hand washing compliance,and integrity rate of emergency medicines and equipment,patient identification accuracy rate,intravenous administration accuracy rate,recovery assessment accuracy,pain assessment accuracy,anesthesia record sheet qualification rate,unplanned extubation rate,unplanned tracheal tube reintubation rate,unplanned rate ICU transfer rate,incidence of delayed recovery,incidence of aspiration,new incidence of skin pressure injury in PACU,incidence of bed fall,rewarming rate of hypothermia patients,and pain treatment efficiency)were established.The expert authority coefficients for the two rounds of expert inquiries were 0.90 and 0.91 respectively,the positive coefficients were 0.91 and 1.00,and the Kendall coordination coefficient was 0.30-0.52(all P<0.05).Conclusion:The sensitive indicators of nursing quality in PACU developed in this study,which supervises the quality of nursing from three aspects:structural quality,process quality,and result quality.The sensitive and prognostic-related nursing quality indicators can provide a basis for the evaluation and monitoring of nursing quality in PACU.

关 键 词：护理质量 指标 麻醉恢复室 德尔菲法 

分 类 号：R47[医药卫生—护理学]