基于临床护理路径的经皮冠状动脉介入治疗护理服务项目优化  

Optimization of nursing services for percutaneous coronary interventional therapy based on clinical nursing pathway

作　　者：王诗瑜 李朝晖 张宇扬 韦健 王舒瑶 袁杨 孟宇 李庆印[5] Wang Shiyu;Li Zhaohui;Zhang Yuyang;Wei Jian;Wang Shuyao;Yuan Yang;Meng Yu;Li Qingyin(Nursing Department,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Health Insurance Price Office,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Medical Department,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Finance,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院护理部,北京100037 [2]中国医学科学院阜外医院医保物价办公室,北京100037 [3]中国医学科学院阜外医院医务处,北京100037 [4]中国医学科学院阜外医院财务处,北京100037 [5]中国医学科学院阜外心血管病医院护理研究室,北京100037

出　　处：《中华医院管理杂志》2023年第5期392-398,共7页Chinese Journal of Hospital Administration

基　　金：中国卫生人才培养项目(2021-HLYJ-016)。

摘　　要：目的优化经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)临床护理路径、护理服务项目及其评价参数,为完善公立医院护理项目成本测算和补偿机制提供参考。方法经文献分析和小组讨论,构建PCI临床护理路径和护理服务项目及其评价参数的初始模板。采用两轮德尔菲法咨询15位专家,优化PCI护理路径和护理服务项目及其评价参数(基本人力消耗、基本耗时、技术难度和风险程度)。结果两轮德尔菲法最终确定了PCI临床护理路径和27项护理服务项目,并对10项护理服务项目的评价参数进行调整。PCI临床护理服务新增项目为双联抗血小板治疗方案调整复核、术后康复护理和关键项目核对;技术难度及风险程度最高的3个护理服务项目为静脉输血、胃管置管术和胃肠减压;重要性赋值最高的2个项目为泵辅助动/静脉输液(血)和有创连续动脉血压监测。结论本研究构建了PCI临床护理路径和护理服务项目,突出了一体化护理服务模式,体现了护士劳动价值。Objective To optimize the clinical nursing pathway,service program and evaluation parameters of percutaneous coronary intervention(PCI),for references for the cost accounting and compensation mechanism of nursing program in public hospitals.Methods After literature analysis and group discussion,the initial templates were constructed for the PCI clinical nursing pathway,nursing service projects,and their evaluation parameters.15 experts were consulted by two rounds of Delphi method to optimize PCI nursing path,nursing service items and their evaluation parameters(basic labor consumption,basic time consumption,technical difficulty and risk degree).Results Two rounds of Delphi method finally determined the PCI clinical nursing path and 27 nursing service items,and adjusted the evaluation parameters of 10 nursing service items.The new projects for PCI clinical nursing services included adjustment and review of dual antiplatelet therapy plans,postoperative rehabilitation nursing,and key project verification.The three nursing service projects with the highest level of technical difficulty and risk were intravenous blood transfusion,gastric catheterization,and gastrointestinal decompression.The two items with the highest importance assigned were high pump assisted arterial/venous infusion(blood)and invasive continuous arterial blood pressure monitoring.Conclusions The PCI clinical nursing pathway and nursing service project constructed in this study could closely integrate with clinical practice,highlight the integrated nursing service model,and reflect the labor value of nurses.

关 键 词：护理服务 临床路径 经皮冠状动脉介入治疗 德尔菲法 以资源为基础的相对价值比 疾病诊断相关分组 

分 类 号：R473.5[医药卫生—护理学]