连续性肾脏替代治疗患者中心静脉导管维护审查指标的制定及障碍因素分析  

Construction of clinical audits and analysis of obstacles for central venous catheter maintenance in patients undergoing continuous renal replacement therapy

作　　者：姜艳华[1] 沈燕[1] 邢唯杰 周兴梅[1] 王靖[1] 凌颖骋 姚丹青 费凯红[1] Jiang Yanhua;Shen Yan;Xing Weijie;Zhou Xingmei;Wang Jing;Ling Yingcheng;Yao Danqing;Fei Kaihong(Shanghai General Hospital,Shanghai 201620;Evidence-based Nursing Center of Fudan University,Shanghai 200032)

机构地区：[1]上海市第一人民医院,上海201620 [2]复旦大学循证护理中心,上海200032

出　　处：《护士进修杂志》2022年第2期102-109,123,共9页Journal of Nurses Training

基　　金：复旦大学循证护理中心项目(编号:Fudanebn202012)。

摘　　要：目的全面评估成人连续性肾脏替代治疗(Continuous renal replacement therapy, CRRT)患者中心静脉导管(Central venous catheter, CVC)维护证据在临床的应用现状,制订循证护理审查指标,分析障碍及促进因素,为临床拟定对策提供依据。方法以复旦大学循证护理中心证据临床转化模式为理论框架,确定临床护理问题,系统检索、评价、汇总证据,并评价证据的可行性、适宜性、临床意义及有效性,确定引入临床的证据。制订审查指标及审查方法,进行质量审查,根据基线审查结果,基于渥太华研究应用模式(Ottawa model of research use, OMRU)进行障碍及促进因素分析,并拟定相应对策。结果本研究共纳入23条最佳证据,基于最佳证据制订23条审查指标进行质量审查,其中仅5条指标依从率为100%,7条指标依从率>60%,4条指标依从率<60%,7条指标依从率为0。对审查结果逐条分析后得出主要障碍因素为:部分证据可操作性不强、增加工作量;护士缺乏专业培训和相关知识、技能;培训资料内容简单且形式单一;缺乏系统的护理规范、操作流程、考核质控机制和评估工具;缺乏相关耗材;护理工作量增加,缺乏时间。主要促进因素为:证据基于循证研究;管理者支持变革;护士学习氛围良好、有积极性;部分证据原有实践基础较好;证据应用对患者有益。根据障碍及促进因素分析结果,拟定综合性变革策略,主要包括:评估证据的可行性和适宜性;优化相关制度及流程;强化规范培训及考核;持续进行质量监控;申请人力资源调配;完善宣教资料及加强患者教育。结论 CRRT患者CVC维护的证据与临床实践存在较大差距,应科学、全面、动态评估临床情景中的障碍与促进因素,并给予综合性的干预策略,从而促进证据在临床的有效应用,提高临床护理质量。Objective To comprehensively evaluate the clinical application status of central venous catheter(CVC) maintenance evidence in adult patients with continuous renal replacement therapy(CRRT), and to construct evidence-based clinical nursing audits, analyze obstacles and facilitators and provide the basis for clinical countermeasure. Methods Using the evidence implementation model of Fudan university evidence-based nursing center as the theoretical framework, the clinical nursing problems were identified, evidence was systematically retrieved, evaluated and summarized. The feasibility, suitability, clinical significance and effectiveness of the evidence were assessed, and the best evidence for clinical application was determined. Developed the review indicators and review methods, conducted the quality review, analyzed barriers and promoting factors based on the Ottawa model of research use(OMRU) according to baseline review results, and formulated corresponding countermeasures. Result Totally 23 pieces of best evidence were included, and 23 clinical review indicators were developed, among which only 5 indicators had a compliance rate of 100%, 7 indicators had a compliance rate of > 60%, 4 indicators had a compliance rate of < 60%, and 7 indicators had a compliance rate of 0. After detailed analysis of the results, it is concluded that the main obstacles are as follows: the operability of some evidence is not strong and the workload is increased;nurses lack professional training and related knowledge and skills. Training materials are simple in content and single in form;lack of systematic nursing norms, operational processes, quality control mechanisms and evaluation tools;lack of relevant consumables;increased nursing workload and lack of time. The main contributing factors are: evidence based on evidence-based research;managers support change;nurses have a good learning atmosphere and enthusiasm;some evidence has an excellent practical basis. The application of evidence is beneficial to patients. According to the

关 键 词：连续性肾脏替代治疗 中心静脉导管 审查指标 障碍因素 渥太华研究应用模式 循证护理 

分 类 号：R472.9[医药卫生—护理学]