基于证据的成人ICU失禁相关性皮炎护理质量改进

doi:10.3761/j.issn.1672-9234.2020.03.015

摘要/Abstract

摘要：

目的探讨基于证据的成人ICU失禁相关性皮炎（incontinence-associated dermatitis,IAD）护理质量改进的效果。方法以基于循证质量持续改进模式为理论框架,通过系统地文献检索和质量评价,获取预防及管理成人ICU失禁相关性皮炎的相关证据,并对应制订出9项质量改进审查内容。2018年12月1日—2019年2月1日,采用现场观察、查阅护理记录、文献分析、问卷调查等方法对本院ICU收治的29例失禁患者和46名ICU护士开展基线审查,对证据应用障碍进行分析并提出解决方法,包括引入IAD风险评估工具、规范失禁评估及处理记录、制订IAD防治规范、进行IAD相关知识系统培训。2019年2月10日—2019年7月30日引入证据,并审查护士对在此期间收治的51例失禁患者的相关证据应用情况。调查证据应用前后护士对IAD相关知识的知晓率、相关护理行为的执行率以及IAD的发生率的变化。结果证据应用后护士对IAD相关知识的知晓率和护理行为执行率均有所提高（P＜0.05）,IAD发生率由24.1%降为5.9%。结论基于证据的成人ICU失禁相关性皮炎的持续质量改进有助于降低失禁患者IAD发生率,使护士有章可循,可有效提高护理质量。

关键词: 重症监护病房, 大便失禁, 尿失禁, 皮炎, 护理, 循证实践

Abstract:

Objective To explore the evidence based effects of continuous quality improvement of incontinence- associated dermatitis（IAD） in adult ICU. Methods Based on the theoretical framework of evidence-based quality continuous improvement model,the relevant evidence of prevention and management of IAD in adult ICU was found through systematic literature search and quality evaluation. Nine quality improvement measures were proposed. From December 1,2018 to February 1,2019,29 incontinent patients and 46 ICU nurses were examined at baseline by means of observing,checking nursing records,analyzing literature,and questionnaire survey. The obstacles in evidence application were collected and analyzed. Problem solutions were proposed including introducing IAD risk assessment tools,standardizing incontinence assessment and processing records,formulating IAD prevention and control measures,and improving IAD related knowledge system training. From February 10,2019 to July 30,2019,the evidence was introduced and nurses used these evidence measures to care for 51 incontinence patients. The use of evidence measures was investigated among the nurses. Nurses’ IAD related knowledge,the implementation rate of related nursing behaviors and the change of IAD incidence before and after the evidence application were all evaluated. Results The IAD related knowledge and the implementation rate of nursing behavior were significantly increased after the evidence measures were implemented（P＜0.05）. The incidence of IAD was reduced from 24.1% to 5.9%. Conclusion The continuous quality improvement of incontinence-associated dermatitis in adult ICU based on evidence can help to reduce the incidence of IAD in incontinence patients,make nurses have rules to follow and improve the quality of nursing.

Key words: Intensive Care Units, Fecal Incontinence, Urinary Incontinence, Dermatitis, Nursing Care, Evidence-Based Practice

张艳, 张延红, 王春华. 基于证据的成人ICU失禁相关性皮炎护理质量改进[J]. 中华护理教育, 2020, 17(3): 259-263.

ZHANG Yan, ZHANG Yan-hong, WANG Chun-hua. Evidence based continuous quality improvement of incontinence-associated dermatitis in adult ICU[J]. Chinese Journal of Nursing Education, 2020, 17(3): 259-263.

图/表 2

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