先天性心脏病患儿营养风险筛查及评估循证决策支持系统的构建与应用

doi:10.3761/j.issn.0254-1769.2023.17.002

摘要/Abstract

摘要：

目的开发先天性心脏病患儿营养风险筛查及评估循证决策支持系统，并评价其临床应用效果。方法汇总先天性心脏病患儿营养风险筛查及评估的循证证据，基于证据开发循证决策支持系统。采用非同期前后对照研究设计，选取上海市某三级甲等儿童医院心脏重症监护室的医护人员及收治的先天性心脏病患儿作为应用对象，将2021年9月—12月作为试验组数据来源时间，2020年9月—12月作为对照组数据来源时间，比较两组责任护士及营养专科护士营养风险筛查结果的一致性、营养风险筛查耗时、接受营养评估患儿的比例、接受营养干预患儿的比例、营养筛查高风险警示值响应时间、医护人员对信息系统的满意度。结果试验组纳入191例患儿，对照组纳入193例。试验组营养风险筛查结果的一致性系数为0.890，对照组为0.689。试验组营养风险筛查耗时为（2.97±1.05） min，对照组为（4.05±1.01） min；试验组接受营养评估患儿的比例为95.29%，对照组为89.64%；试验组接受营养干预患儿的比例为69.11%，对照组为54.92%；试验组营养筛查高风险警示值响应时间为（4.73±2.31） min，对照组为（41.53±9.13） min；试验组医护人员对信息系统的满意度得分为（108.04±11.31）分，对照组为（92.89±9.37）分，以上数据两组间比较，差异均具有统计学意义（P<0.05）。结论使用先天性心脏病患儿营养风险筛查及评估循证决策支持系统，可以提高营养风险筛查结果的一致性，缩短营养风险筛查耗时，促进医护人员进行营养评估及营养干预，提升医护人员对信息系统的满意度。

关键词: 先天性心脏病, 营养, 证据总结, 决策支持, 护理信息学, 儿科护理学

Abstract:

Objective To develop an evidence-based decision support system for nutritional risk screening and assessment in children with congenital heart disease（CHD），and to evaluate its clinical effect. Methods The best evidence for nutritional risk screening and assessment in CHD children was summarized，and an evidence-based decision support system was developed. A before-and-after study design was adopted，and the medical staff and children with CHD admitted to the Cardiac Intensive Care Unit of a tertiary A-level hospital for children in Shanghai were selected as the research subjects. The data of the experimental group was collected from September to December 2021，while the data of the control group was collected from September to December 2020. The outcome measurement were the consistency of nutritional risk screening results of the responsible nurses and nutrition specialist nurses，the time-consuming of nutritional risk screening，the proportion of children receiving nutritional assessment and intervention，the response time of high-risk warning value of nutritional screening，and the satisfaction of medical staff with the use of information system. Results 191 children were included in the experimental group，and 193 were in the control group. The consistency coefficient of the nutritional risk screening results was 0.890 in the experimental group，and it was 0.689 in the control group. The nutritional risk screening time was（2.97±1.05） min in the experimental group，and it was（4.05±1.01） min in the control group. The proportion of infants who received nutritional assessment in the experimental group was 95.29%，compared with 89.64% in the control group；the proportion of infants receiving nutritional intervention was 69.11% in the experimental group，and 54.92% in the control group. The response time of the high-risk warning value of nutritional screening in the experimental group was（4.73±2.31） min，while the control group was（41.53±9.13） min. The satisfaction score of medical staff on the use of the clinical nursing information system was（108.04±11.31） points，and it was（92.89±9.37） points in the control group. The above data were compared between the 2 groups，and all the difference were statistically significant（P<0.05）. Conclusion Using the evidence-based decision support system for nutritional risk screening and assessment of CHD children can improve the consistency of nutritional risk screening results，shorten the time-consuming of nutritional risk screening，promote nutritional assessment and nutritional intervention by medical staff，and improve satisfaction with the use of information system.

Key words: Congenital Heart Disease, Nutrition, Evidence Summary, Decision Support, Nursing Informatics, Pediatric Nursing

傅唯佳, 顾莺, 杨玉霞, 王颖雯, 宓亚平, 王桢絮, 龚卫娟, 任玥宏. 先天性心脏病患儿营养风险筛查及评估循证决策支持系统的构建与应用[J]. 中华护理杂志, 2023, 58(17): 2059-2066.

FU Weijia, GU Ying, YANG Yuxia, WANG Yingwen, MI Yaping, WANG Zhenxu, GONG Weijuan, REN Yuehong. The construction and evaluation of an evidence-based decision support system for the nutrition risk screening of congenital heart disease children[J]. Chinese Journal of Nursing, 2023, 58(17): 2059-2066.

图/表 5

图1 先天性心脏病患儿营养风险筛查及评估护理程序

Figure 1 Nutritional risk screening and assessment nursing procedures for congenital heart disease

图2 营养风险筛查流程注：ENS为肠内营养支持；STRONGkids为儿童营养风险及发育不良筛查工具。

Figure 2 Nutritional risk screening process

表1 两组医护人员的一般资料比较

Table 1 Comparison of the general information of 2 groups of medical staff

表2 两组患儿的一般资料比较

Table 2 Comparison of the general information of the 2 groups of children

表3 两组医护人员对信息系统的满意度比较（分，$\bar{x}±s$）

Table 3 Comparison of 2 groups of medical staff’s satisfaction with the use of information systems（score，$\bar{x}±s$）

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