以糖尿病专科护士为主导的胰岛素泵全程管理系统的构建及应用

doi:10.3761/j.issn.0254-1769.2023.10.002

摘要/Abstract

摘要：

目的设计以糖尿病专科护士为主导的胰岛素泵全程管理系统，并评价其应用效果。方法组建研究小组设计胰岛素泵全程管理系统，包括专科护士工作站模块和住院护士工作站模块，比较系统应用前（2020年6月—12月）与系统应用后（2021年6月—12月）非内分泌科使用胰岛素泵治疗患者的专科护理质量指标（上报胰岛素泵不良事件例数、低血糖事件发生例数）和护理文书书写质量，调查护士对胰岛素泵全程管理系统的满意度。结果应用胰岛素泵全程管理系统后，低血糖事件发生例数减少（P=0.039）；护理文书质量优于系统应用前（P<0.001）；护士对系统满意度得分为40（36，45）分（满分45分）。结论应用以糖尿病专科护士为主导的胰岛素泵全程管理系统能提高非内分泌科使用胰岛素泵治疗患者的护理质量、改善对患者的安全管理，提高临床护士护理文书记录质量，护士对诊系统整体较为满意。

关键词: 糖尿病, 专科护士, 非内分泌科, 胰岛素泵, 信息化, 护理

Abstract:

Objective To design an insulin pump whole process management system led by advanced practice nurses（APN） for diabetes，and to explore its application effect. Methods A research group was established and a whole-process insulin pump management system was designed，including the functions of receiving nursing consultation，installation records，daily pump inspection records，pump withdrawal，quality monitoring of documents related to the responsible nurse pump，closed-loop management of insulin pumps，and quality control，and the differences of nursing document quality statistics. Specialty nursing quality indicators（number of adverse events reported to insulin pump and number of hypoglycemia events） and nursing document quality of patients treated with insulin pump in non-endocrinology department were compared before（June to December 2020） and after （June to December 2021） application of the system. In January 2022，a self-designed satisfaction questionnaire was used to investigate 154 nurses’ satisfaction with the system. Results After the application of insulin pump whole process management system，the number of hypoglycemia events decreased（P=0.039）. The quality of nursing documents was significantly better than that before the system application（P<0.001）. The nurse scored 40（36，45） quartile in their satisfaction with the system，with a total score of 45，which was generally satisfactory. Conclusion The insulin pump whole process management system led by diabetes APN can improve the quality of nursing and the safety management of clinical nurses，and improve the satisfaction of nurses，improve the quality of nursing documents.

Key words: Diabetes Mellitus, Practice Nurse, Non-Endocrinology, Insulin Pump, Informatization, Nursing Care

姚慧岚, 袁红娣, 黄晨, 程丽丽, 吴黎莉, 潘红英, 石文莉. 以糖尿病专科护士为主导的胰岛素泵全程管理系统的构建及应用[J]. 中华护理杂志, 2023, 58(10): 1166-1171.

YAO Huilan, YUAN Hongdi, HUANG Chen, CHENG Lili, WU Lili, PAN Hongying, SHI Wenli. Design and application of an insulin pump whole process management system led by advanced practice nurses for diabetes mellitus[J]. Chinese Journal of Nursing, 2023, 58(10): 1166-1171.

图/表 3

图1 胰岛素泵全程管理系统

Figure 1 Insulin pump management system

表1 系统应用前后病区护士胰岛素泵护理文书书写质量的比较

Table 1 Comparison of the writing quality of medical records between 2 groups

表2 系统应用前后专科护理质量相关指标的比较[例（百分率，%）]

Table 2 Comparison of related indexes of specialty nursing quality before and after system application[case（percent，%）]

参考文献 16

[1]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志, 2021, 13(4):311-398.
	Chinese Diabetes Society. Guidelines for prevention and treatment of type 2 diabetes in China(2020 edition)[J]. Chin J Endocrinol, 2021, 13(4):311-398.
[2]	Sun X, Gui M, Huang H, et al. Investigation of daily glucose profile of inpatients in non-endocrinology departments in Chinese population[J]. Front Public Health, 2020, 8:521227. DOI URL
[3]	郭晓惠. 中国胰岛素泵治疗护理管理规范[M]. 武汉: 湖北科学技术出版社, 2018.
	Guo XH. China insulin pump nursing management practice[M]. Wuhan: Hubei Science & Technology Press, 2018.
[4]	叶志弘, 王菊香. 立体收住病人的实施与护理应对[J]. 中华护理杂志, 2003, 38(3):196-198.
	Ye ZH, Wang JX. Discussion effects upon patient care in units with subspecialties[J]. Chin J Nurs, 2003, 38(3):196-198.
[5]	陶静, 黄国敏, 高莲莲, 等. 降低非内分泌科胰岛素泵不良事件发生率的实践[J]. 中国护理管理, 2019, 19(5):725-729.
	Tao J, Huang GM, Gao LL, et al. Practice of reducing adverse events of insulin pump in non-endocrinology department[J]. Chin Nurs Manag, 2019, 19(5):725-729.
[6]	冯金娥, 胡宏鸯, 楼青青. 开展高级临床专科护士角色的探讨[J]. 中华护理杂志, 2004, 39(2):115-117.
	Feng JE, Hu HY, Lou QQ. The exploratory study for the role development of advanced practice nurse[J]. Chin J Nurs, 2004, 39(2):115-117.
[7]	黄晨, 潘红英. 信息护士岗位的设立及实践[J]. 中华护理杂志, 2017, 52(5):546-548.
	Huang C, Pan HY. The position-setting and clinical practice of informatics nurse[J]. Chin J Nurs, 2017, 52(5):546-548.
[8]	袁红娣, 冯金娥, 徐玉斓, 等. 胰岛素泵在非糖尿病病区的应用和管理[J]. 中华护理杂志, 2012, 47(8):731-732.
	Yuan HD, Feng JE, Xu YL, et al. Application and management of insulin pumps in non-diabetic areas[J]. Chin J Nurs, 2012, 47(8):731-732.
[9]	陈利群, 牟绍玉, 丁福, 等. 护理临床思维训练平台的构建[J]. 中华护理杂志, 2019, 54(5):649-653. DOI URL
	Chen LQ, Mu SY, Ding F, et al. Construction of nursing clinical thinking training platform[J]. Chin J Nurs, 2019, 54(5):649-653. DOI URL
[10]	张素兰, 刘倩倩, 王佳琪, 等. 手臂输液港信息化管理平台的构建及应用[J]. 中华护理杂志, 2020, 55(7):1075-1080. DOI URL
	Zhang SL, Liu QQ, Wang JQ, et al. Construction and application of an information management platform of arm infusion port[J]. Chin J Nurs, 2020, 55(7):1075-1080. DOI URL
[11]	赵燕, 黄丽华, 尚启云, 等. 儿童早期预警评分护理记录模板的设计及应用[J]. 中华护理杂志, 2018, 53(6):679-683.
	Zhao Y, Huang LH, Shang QY, et al. The design of nursing record template for pediatric early warning and its application in children with critical respiratory diseases[J]. Chin J Nurs, 2018, 53(6):679-683.
[12]	孙玉娇, 史婷奇, 张宁, 等. 低血糖护理决策支持系统的设计及应用[J]. 中华护理杂志, 2020, 55(7):1028-1032. DOI URL
	Sun YJ, Shi TQ, Zhang N, et al. Design and application of hypoglycemia nursing decision support system[J]. Chin J Nurs, 2020, 55(7):1028-1032. DOI URL
[13]	王攀峰, 胡佳慧, 张洪君, 等. 结构化护理风险评估与记录系统的构建与应用[J]. 中华护理杂志, 2018, 53(6):717-719.
	Wang PF, Hu JH, Zhang HJ, et al. Construction and application of the structured nursing risk assessment and recording system[J]. Chin J Nurs, 2018, 53(6):717-719.
[14]	张晓静, 张会芝, 李葆华. 非计划性拔管信息化管理系统的建立及应用研究[J]. 中华护理杂志, 2018, 53(11):1360-1362.
	Zhang XJ, Zhang HZ, Li BH. Establishment and effects of application of informationized management system for prevention of unplanned extubation[J]. Chin J Nurs, 2018, 53(11):1360-1362.
[15]	杨存美, 马燕兰, 亢君, 等. 糖尿病住院患者低血糖发生时间段的调查及分析[J]. 中华护理杂志, 2015, 50(3):303-307.
	Yang CM, Ma YL, Kang J, et al. The time distribution of hypoglycemia in hospitalized patients with diabetes[J]. Chin J Nurs, 2015, 50(3):303-307.
[16]	Destree L, Vercellino M, Armstrong N. Interventions to improve adherence to a hypoglycemia protocol[J]. Diabetes Spectr, 2017, 30(3):195-201. DOI URL