多学科诊疗模式下癌性伤口出血风险的管理  

Risk management of patients with Malignant Fungating Wounds bleeding in a Multi-Disciplinary Treatment model

作　　者：张其健[1] 田含章 戴薇薇[1] 唐琼芳[1] 周捷[2] 周蓉蓉[3] 粟娟[4] 高武强 岳丽青[1] ZHANG Qijian;TIAN Hanzhang;DAI Weiwei;TANG Qiongfang;ZHOU Jie;ZHOU Rongrong;SU Juan;GAO Wuqiang;YUE Liqing(Teaching and Research Section of Clinical Nursing,Xiangya Hospital Central South University,Changsha,410008,China)

机构地区：[1]中南大学湘雅医院临床护理学教研室,长沙市410008 [2]中南大学湘雅医院烧伤重建外科,长沙市410008 [3]中南大学湘雅医院肿瘤科,长沙市410008 [4]中南大学湘雅医院皮肤科,长沙市410008 [5]中南大学湘雅医院移动医疗教育部—中国移动联合实验室

出　　处：《中国护理管理》2022年第8期1142-1146,共5页Chinese Nursing Management

基　　金：湖南省自然科学基金科卫联合项目(2021JJ70150)。

摘　　要：目的 :总结我院伤口护理中心联合多学科实施癌性伤口出血风险管理的经验,为相关标准的建立和具体实践提供参考依据。方法 :组建多学科团队,施行以造口治疗师为主导的多学科诊疗模式,通过制定伤口出血风险预案,对癌性伤口患者进行系统的出血风险评估,明确风险等级并逐级强化告知,遵循TIME原则和我国慢性难愈性创面诊疗思路及原则实施伤口处理,并落实延续护理。结果 :2019年1月至2021年12月伤口护理中心共收治癌性伤口患者167人,在换药时无意外出血不良事件发生,无投诉、纠纷,患者对伤口护理中心护理工作总体满意度达98.3%。结论 :在多学科诊疗模式下实施癌性伤口出血风险管理,汇集多学科专业意见,优化工作流程,从医疗、法律、管理等方面搭建安全体系,使患者得到安全、有效救治。Objective:To summarize the experience in risk management of patients with Malignant Fungating Wounds(MFWs)bleeding in a Multi-Disciplinary Treatment(MDT)model.Methods:A MDT team was established and led by enterostomal therapist.The risk management included developing a wound bleeding risk plan,systematically assessing the bleeding risk of patients with MFWs,identifying the risk levels,reinforcing the notifcation step by step,implementing wound management following the TIME principle and Chinese chronic refractory wound diagnosis and treatment principles,and adopting continuous nursing.Results:In recent 3 years,a total of 167 patients were treated in wound care center.No accidental bleeding adverse events were reported.No complaints and disputes were recorded during dressing change.The patients satisfaction reached 98.3%.Conclusion:The risk management of patients with MFWs bleeding under the MDT model can establish security system for patients from the medical,legal,management aspects.The patients received safe and effective treatment through MDT and optimized workfow.

关 键 词：多学科诊疗 癌性伤口 出血风险 管理 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]