基于循证构建肠内营养护理质量敏感指标体系

doi:10.3761/j.issn.0254-1769.2019.03.004

摘要/Abstract

摘要：

目的构建住院成人患者肠内营养护理质量敏感指标体系,为监测临床肠内营养护理质量提供科学、客观及量化的依据。方法运用约翰霍普金斯循证护理方法进行证据综合,为构建肠内营养护理质量敏感指标体系奠定基础;采取小组讨论法获取符合具体实践的指标内容,初步拟订肠内营养护理质量敏感指标及其计算公式和资料收集方法;再通过2轮专家函询,改进并确立肠内营养护理质量敏感指标体系。结果最终构建了包含3项一级指标、6项二级指标、17项三级指标在内的肠内营养护理质量敏感指标体系;2轮函询专家积极系数为92%与100%,权威系数为0.915与0.925,协调系数为0.124~0.242。结论构建的肠内营养护理质量敏感指标体系科学、实用,有利于肠内营养护理质量的改进。

关键词: 肠道营养, 护理质量, 敏感指标, 循证护理

Abstract:

Objective To construct nursing-sensitive indicators system of enteral nutrition for hospitalized adult patients,so as to provide scientific,objective and quantitative monitoring standards for nursing quality of enteral nutrition.Methods Evidence synthesis was conducted based on Johns Hopkins evidence-based nursing method for laying the foundation for nursing-sensitive quality indicators system of enteral nutrition. Through group discussion,appropriate indicators feasible to application were determined,and nursing-sensitive quality indicators,calculation formulas and data collection methods were preliminarily decided. Through two rounds of expert consultation,the nursing-sensitive quality indicators system of enteral nutrition was improved and established.Results The constructed nursing-sensitive quality indicators system of enteral nutrition included 3 first-class indicators,6 second-class indicators,and 17 third-class indicators. Positive coefficients of two rounds of expert consultation were 92% and 100%,authority coefficients were 0.915 and 0.925,respectively,and the coordination coefficients were 0.124~0.242.Conclusion The nursing-sensitive quality indicators system was scientific and practical and it was beneficial to improve the nursing quality of enteral nutrition.

Key words: Enteral Nutrition, Quality of Care, Sensitivity Index, Evidence-Based Nursing

赵诗雨,喻姣花,汪欢,李瑶,刘兴红,张学辉,米元元,李梦圆,刘云访,晏蓉. 基于循证构建肠内营养护理质量敏感指标体系[J]. 中华护理杂志, 2019, 54(3): 344-349.

ZHAO Shiyu,YU Jiaohua,WANG Huan,LI Yao,LIU Xinghong,ZHANG Xuehui,MI Yuanyuan,LI Mengyuan,LIU Yunfang,YAN Rong. Construction of nursing-sensitive quality indicators system of enteral nutrition on the basis of evidence-based approach[J]. Chinese Journal of Nursing, 2019, 54(3): 344-349.

参考文献 28

[1]	Aleksandrova K, Romero-Mosquera B, Hernandez V . Diet,gut microbiome and epigenetics:emerging links with inflammatory bowel diseases and prospects for management and prevention[J]. Nutrients, 2017,9(9):962-975. DOI URL PMID
[2]	危娟, 林凤英, 莫红平 , 等. ICU患者肠内营养期间腹泻的相关因素分析[J]. 中华护理杂志, 2015,50(8):954-959. DOI URL
[3]	Qiu C, Chen C, Zhang W , et al. Fat-modified enteral formula improves feeding tolerance in critically ill patients:a multicenter,single-blind,randomized controlled trial[J]. J Parenter Enteral Nutr, 2017,41(5):785-795. DOI URL PMID
[4]	张华芳, 黄丽华 . 护理质量敏感性指标的研究进展[J]. 中华护理杂志, 2014,49(8):991-993. DOI URL
[5]	Philbrick V . Johns Hopkins nursing evidence-based practice:model and guidelines,2nd edition[J]. AORN J, 2013,97(1):157-158. DOI URL
[6]	Mcclave SA, Dibaise JK, Mullin GE , et al. ACG clinical guideline:nutrition therapy in the adult hospitalized patient[J]. Am J Gastroenterol, 2016,111(3):315-334. DOI URL PMID
[7]	McClave SA, Taylor BE, Martindale RG , et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient[J]. J Parenter Enteral Nutr, 2016,40(2):159-211. DOI URL
[8]	Arribas L, Frías L, Creus G , et al. Document of standardization of enteral nutrition access in adults[J]. Nutr Hosp, 2014,30(1):1-14. DOI URL PMID
[9]	Mccall ME, Adamo A, Latko K , et al. Maximizing nutrition support practice and measuring adherence to nutrition support guidelines in a Canadian tertiary care ICU[J]. J Intensive Care Med, 2018,33(3):209-217. DOI URL PMID
[10]	Heyland DK, Lemieux M, Shu L , et al. What is “best achievable” practice in implementing the enhanced protein-energy provision via the enteral route feeding protocol in intensive care units in the United States? Results of a multicenter,quality improvement collaborative[J]. J Parenter Enteral Nutr, 2018,42(2):308-317.
[11]	Bermejo DL HS , De la Calle De La Rosa L,Arias DJ,et al. Tube feeding monitoring as a clinical quality indicator at intensive care units[J]. Nutr Hosp, 2018,35(1):6-10. URL PMID
[12]	Lee A, Oliveira Filho RS, Cardenas TC , et al. Quality control of enteral nutrition therapy in cancer patients at nutritional risk[J]. Nutr Hosp, 2017,34(2):264-270. DOI URL PMID
[13]	Oliveira FRS, Ribeiro LM, Caruso L , et al. Quality indicators for enteral and parenteral nutrition therapy:application in critically ill patients “at nutritional risk”[J]. Nutr Hosp, 2016,33(5):1027-1035. DOI URL PMID
[14]	Kozeniecki M , McAndrew N,Patel JJ. Process-related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit[J]. Nutr Clin Pract, 2016,31(1):80-85. DOI URL PMID
[15]	Heyland DK, Dhaliwal R, Lemieux M , et al. Implementing the pep up protocol in critical care units in Canada:results of a multicenter,quality improvement study[J]. J Parenter Enteral Nutr, 2015,39(6):698-706. DOI URL PMID
[16]	Rahman A, Martin C, Heyland DK . Nutrition therapy for the critically ill surgical patient with aortic aneurismal rupture:defining and improving current practice[J]. J Parenter Enteral Nutr, 2015,39(1):104-113. DOI URL
[17]	Verbanck L, De Waele J, Duysburgh I , et al. Identification of quality indicators for the nutritional management of adult hospitalized patients by a modified Delphi process[J]. Acta Anaesthesiol Belg, 2015,66(4):1-8. URL PMID
[18]	Duprat CG, Coelho AW, Akutsu R . Development of a tool for quality control audits in hospital enteral nutrition[J]. Nutr Hosp, 2014,29(1):102-120. DOI URL PMID
[19]	Taylor B, Brody R, Denmark R , et al. Improving enteral delivery through the adoption of the “feed early enteral diet adequately for maximum effect(feed me)” protocol in a surgical trauma ICU:a quality improvement review[J]. Nutr Clin Pract, 2014,29(5):639-648. DOI URL
[20]	Verotti CC, Torrinhas RS, Cecconello I , et al. Selection of top 10 quality indicators for nutrition therapy[J]. Nutr Clin Pract, 2012,27(2):261-267. DOI URL PMID
[21]	Martin FT, Alvarez HJ, Burgos PR , et al. Analysis of the relevance and feasibility of quality indicators in nutrition support[J]. Nutr Hosp, 2012,27(1):198-204. DOI URL PMID
[22]	Cahill NE, Dhaliwal R, Day AG , et al. Nutrition therapy in the critical care setting:what is “best achievable” practice? An in-ternational multicenter observational study[J]. Crit Care Med, 2010,38(2):395-401. DOI URL PMID
[23]	van den Bemt PM, Cusell MB, Overbeeke PW , et al. Quality improvement of oral medication administration in patients with enteral feeding tubes[J]. Qual Saf Health Care, 2006,15(1):44-47. DOI URL PMID
[24]	Heyland DK, Dhaliwal R, Day A , et al. Validation of the Canadian clinical practice guidelines for nutrition support in mechanically ventilated,critically ill adult patients:results of a prospective observational study[J]. Crit Care Med,2004,32(11):2260-2266. DOI URL PMID
[25]	Donabedian A.Quality assurance . Structure,process and outco-me[J]. Nurs Stand, 1992,7(11):4-5.
[26]	曹晶, 李佳倩, 贺茜 , 等. 我国三级甲等医院专科护士队伍培养与使用现状的调查研究[J]. 中华护理杂志, 2015,50(11):1349-1353. DOI URL
[27]	王燕燕, 史妍萍, 张毅 . 神经外科重症鼻饲患者误吸预防的研究进展[J]. 护理管理杂志, 2016,16(1):27-29.
[28]	程红萍, 刘佳 . 阻碍护理不良事件上报的原因分析及对策[J]. 护理研究, 2018,32(14):2294-2296.