脑卒中患者护理质量控制系统的构建及应用研究

doi:10.3761/j.issn.0254-1769.2020.11.002

摘要/Abstract

摘要：

目的建立系统、科学、适用于临床的脑卒中患者护理质量敏感性指标,基于指标构建和应用脑卒中患者护理质量控制系统。方法借鉴美国国家护理质量数据库敏感性指标开发过程,系统检索Pubmed、Embase、CINAHL、中国知网、万方数据库及国内外护理质量敏感性指标网站,经过严格筛选和文献评价,初步构建脑卒中患者护理质量敏感性指标,运用专家会议法确定脑卒中患者护理质量敏感性指标。根据脑卒中患者护理质量敏感性指标、预试验结果,制订脑卒中患者护理质量病例报告单,依托中国脑卒中中心联盟构建脑卒中患者护理质量控制系统。中国9所医院使用此系统,进行脑卒中患者护理质量敏感性指标的数据填报。结果通过文献检索,初步纳入83项脑卒中患者护理质量敏感性指标。通过专家会议法,最终纳入11项护理质量敏感性指标,包括美国国立卫生研究院脑卒中量表评估率、吞咽功能评估率、深静脉血栓预防率、吸入性肺炎预防率、入院48 h营养风险筛查率、良肢位摆放率、早期活动率、健康宣教实施率、压力性损伤发生率、泌尿系统感染发生率、脑卒中后抑郁发生率。构建脑卒中患者护理质量病例报告单时,全国17所医院根据脑卒中患者护理质量敏感性指标,填报完成298份病例报告单。全国9所医院在脑卒中患者护理质量控制系统中填报1 827份脑卒中患者护理质量敏感性指标数据。11项脑卒中患者护理质量敏感性指标中,实施率最高的前2项为健康宣教实施率（97.3%）和良肢位摆放率（96.5%）。结论该研究构建的脑卒中患者护理质量敏感性指标可操作性强,可以指导脑卒中护理实践;脑卒中患者护理质量控制系统实用性强,能够收集、分析、反馈中国脑卒中患者护理质量敏感性指标的实施情况,促进脑卒中患者护理质量持续改进。

关键词: 脑卒中, 护理质量, 敏感性指标, 数据平台, 护理管理研究

Abstract:

Objective To establish systematic,scientific,and clinically applicable sensitive indicators of stroke nursing quality and to build an information-based big data platform for nursing quality. Methods Based on sensitive indicator development process of the US National Nursing Quality Indicators Database,evidence-based analysis and expert meeting were adopted to establish the nursing quality sensitive indicators. We researched Pubmed,Embase,CINAHL,CNKI,Wanfang data and nursing sensitive indicators websites to construct stroke-related nursing quality sensitive indicators. According to the constructed sensitive indicators,a case report form of stroke nursing quality was developed,and the stroke nursing quality control system was built based on the China Stroke Center Alliance（CSCA） Database Platform. 9 hospitals in China used this system to input the data of the sensitivity index of stroke nursing. Results Through literature search,83 stroke nursing quality sensitive indicators were included. 11 nursing sensitive indicators were finally included by expert meetings,including NIHSS score rate,swallowing function evaluation rate,prevention rate of deep venous thrombosis,prevention rate of aspiration pneumonia,nutrition risk screening rate within 48 hours after admission,the placement rate of good limb position,early activity rate,implementation rate of health education,incidence of stress injury,incidence of urinary tract infection,incidence of post-stroke depression. When constructing the case report form of stroke nursing quality,17 hospitals participated and filled in the form,and a total of 298 cases were completed. 9 hospitals filled in 1 827 pieces of data of nursing sensitive indicators in the stroke nursing quality control system. Among the 11 indicators,the top 2 implementation indicators were health education rate（97.3%） and good limb position rate（96.5%）. Conclusion The stroke nursing quality sensitive indicators and information-based big data platform for nursing quality constructed in this study can better guide nursing intervention and quality control,so as to achieve continuous quality improvement of stroke nursing.

蔡卫新,尹志科,张冉,苗亚杰,陆朋玮,李京连. 脑卒中患者护理质量控制系统的构建及应用研究[J]. 中华护理杂志, 2020, 55(11): 1612-1619.

CAI Weixin,YIN Zhike,ZHANG Ran,MIAO Yajie,LU Pengwei,LI Jinglian. Construction and application of a multi-center stroke nursing quality control system[J]. Chinese Journal of Nursing, 2020, 55(11): 1612-1619.

图/表 4

图1 文献检索过程

Figure 1 Literature retrieval process

表1 专家的一般资料

Table 1 General information of experts

表2 脑卒中患者护理质量敏感性指标

Table 2 Stroke nursing quality sensitivity indicators

图2 脑卒中患者护理质量病例报告单注：填写脑卒中护理质量病例报告单的患者需满足以下条件：①发病年龄≥18岁;②临床拟诊断为下列疾病之一：缺血性脑卒中、原发性脑出血（不包括外伤性脑出血）;③脑卒中事件发生时间距就诊日期≤7 d。

Figure 2 Stroke nursing quality case report table

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