防治医院获得性静脉血栓栓塞症信息化系统的建立与实践

doi:10.3761/j.issn.0254-1769.2023.14.008

摘要/Abstract

摘要：

目的构建防治医院获得性静脉血栓栓塞症（hospital-acquired venous thromboembolism，HA-VTE）信息化系统并探讨其在静脉血栓栓塞症管理中的应用效果。方法成立HA-VTE管理团队，建立防治HA-VTE信息化系统，主要包括评估、预警、决策、监控4个内容模块，实现时间节点风险评估、评估预警、预防禁忌评估、辅助决策支持、评分监管等功能，达到全院联动防控。2022年10月正式临床应用该系统，比较该系统使用前（2022年4月—9月）、使用后（2022年10月—2023年3月）医院HA-VTE风险评估率、中高危患者预防率、中高危患者预防HA-VTE知识知晓率、中高危患者基础预防措施落实率及HA-VTE发生率等指标。结果防治HA-VTE信息化系统应用后，HA-VTE风险评估率从96.96%上升至100%；中高危患者预防率从37.93%上升至46.86%（其中药物预防率从26.99%上升至37.12%、联合预防率从2.16%上升至4.66%）；中高危患者预防HA-VTE知识知晓率从87.76%上升至96.84%，基础预防措施落实率从83.67%上升至94.74%，差异均具有统计学意义（P<0.05）；HA-VTE发生率从0.066%下降至0.046%，差异无统计学意义（P>0.05）。结论防治HA-VTE信息化系统能提升护理人员风险评估的依从性，为医护人员提供准确有效的决策依据，改善住院患者HA-VTE管理现状。

关键词: 静脉血栓栓塞症, 信息系统, 预防, 护理

Abstract:

Objective To explore the application effect of the information system for prevention and treatment of hospital-acquired venous thromboembolism（HA-VTE） in HA-VTE management. Methods A team of HA-VTE management was set up and the information system for prevention and treatment of HA-VTE was established，which mainly included 4 content modules，namely assessment，early warning，decision-making，and monitoring，in order to achieve functions such as time points risk assessment，early warning assessment，prevention taboo assessment，auxiliary decision support，scoring supervision，and achieve coordinated prevention and control throughout the hospital. The system was officially clinically applied in October 2022. The hospital HA-VTE risk assessment rate，prevention rate among medium to high-risk patients，awareness rate of HA-VTE prevention knowledge among medium to high-risk patients，implementation rate of basic prevention measures among medium to high-risk patients，and incidence rate of HA-VTE were compared before（from April to September 2022） and after （from October 2022 to March 2023） the use of the system. Results After the application of the information system for prevention and treatment of HA-VTE，the risk assessment rate of HA-VTE has increased from 96.96% to 100%. The prevention rate of medium to high-risk patients increased from 37.93% to 46.86%（including the increase of drug prevention rate from 26.99% to 37.12%，and the increase of combined prevention rate from 2.16% to 4.66%）. The awareness rate of HA-VTE prevention knowledge for medium to high-risk patients has increased from 87.76% to 96.84%，and the implementation rate of basic preventive measures has increased from 83.67% to 94.74%，with statistically significant differences（P<0.05）. The incidence of HA-VTE has decreased from 0.066% to 0.046%. The difference was not statistically significant（P>0.05）. Conclusion The information system for prevention and treatment of HA-VTE can enhance the compliance of nursing staff in risk assessment，provide accurate and effective decision-making basis for medical staff，and improve the current situation of HA-VTE management in hospitalized patients.

Key words: Venous Thromboembolism, Information System, Prevention, Nursing Care

彭德清, 司菲, 吕梅叶, 林艳, 刘金金, 卫璠, 刘风华. 防治医院获得性静脉血栓栓塞症信息化系统的建立与实践[J]. 中华护理杂志, 2023, 58(14): 1719-1725.

PENG Deqing, SI Fei, LÜ Meiye, LIN Yan, LIU Jinjin, WEI Fan, LIU Fenghua. Establishment and practice of information system for prevention and treatment of hospital-acquired venous thromboembolism[J]. Chinese Journal of Nursing, 2023, 58(14): 1719-1725.

图/表 3

表1 防治医院获得性静脉血栓栓塞症信息化系统使用前后风险评估率、中高危患者预防率比较

Table 1 Comparison of risk assessment rate and medium to high-risk patient prevention rate before and after the use of information system for prevention and treatment of hospital-acquired venous thromboembolism

表2 防治医院获得性静脉血栓栓塞症信息化系统使用前后中高危患者预防HA-VTE知识知晓率、基础预防措施落实率比较[例（百分率，%）]

Table 2 Comparison of awareness rate of HA-VTE prevention knowledge and implementation rate of basic prevention measures among medium to high-risk patients before and after the use of information system for prevention and treatment of VTE[cases（percentage，%）]

表3 防治HA-VTE信息化系统使用前后患者医院获得性HA-VTE发生率比较[例（百分率，%）]

Table 3 Comparison of the incidence of HA-VTE in patients before and after the use of information system for prevention and treatment of VTE[cases（percentage，%）]

参考文献 27

[1]	王骁, 王永慧, 张韬. 医院获得性静脉血栓栓塞症的危险因素及预防[J]. 中华普通外科杂志, 2023, 38(3):237-240.
	Wang X, Wang YH, Zhang T. Risk factors and prevention of hospital acquired venous thromboembolism[J]. Chin J Gen Surg, 2023, 38(3):237-240.
[2]	Siegal DM, Eikelboom JW, Lee SF, et al. Variations in incidence of venous thromboembolism in low-,middle-,and high-income countries[J]. Cardiovasc Res, 2021, 117(2):576-584. DOI URL
[3]	Brahmandam A, Abougergi MS, Ochoa Chaar CI. National trends in hospitalizations for venous thromboembolism[J]. J Vasc Surg Venous Lymphat Disord, 2017, 5(5):621-629. DOI PMID
[4]	Zhang Z, Lei J, Shao X, et al. Trends in hospitalization and in-hospital mortality from VTE,2007 to 2016,in China[J]. Chest, 2019, 155(2):342-353. DOI PMID
[5]	Stadnicki A, Stadnicka I. Venous and arterial thromboembolism in patients with inflammatory bowel diseases[J]. World J Gastroenterol, 2021, 27(40):6757-6774. DOI URL
[6]	Fritz MK, Kincaid SE, Sargent CG, et al. Venous thromboembolism(VTE) risk stratification in general medical patients at an academic medical center[J]. J Thromb Thrombolysis, 2021, 51(1):67-73. DOI
[7]	王钰, 马玉芬, 邓海波, 等. 国内静脉血栓栓塞症护理研究热点的共词聚类分析[J]. 中华护理杂志, 2020, 55(7):1001-1005. DOI URL
	Wang Y, Ma YF, Deng HB, et al. Co-word clustering analysis on hot-spots of Chinese nursing research on venous thromboembolism[J]. Chin J Nurs, 2020, 55(7):1001-1005. DOI URL
[8]	朱丽筠, 王磊, 徐园, 等. 国外静脉血栓栓塞症预防研究的文献计量学分析[J]. 中华护理杂志, 2021, 56(12):1906-1910. DOI URL
	Zhu LJ, Wang L, Xu Y, et al. Bibliometric analysis on abroad studies of venous thromboembolism prevention[J]. Chin J Nurs, 2021, 56(12):1906-1910. DOI URL
[9]	余红梅, 潘红英, 占玉芬, 等. 全院联动静脉血栓形成防治信息化体系的建立与实践[J]. 中华护理杂志, 2020, 55(3):373-378. DOI URL
	Yu HM, Pan HY, Zhan YF, et al. Establishment and practice of hospital information system of prevention and treatment for venous thromboembolism[J]. Chin J Nurs, 2020, 55(3):373-378.
[10]	施若霖, 张丽青, 孙捷豪, 等. 间歇充气加压装置不同使用模式对预防直肠癌腹腔镜术中患者静脉血栓的效果[J]. 中华护理杂志, 2022, 57(6):695-702. DOI URL
	Shi RL, Zhang LQ, Sun JH, et al. Study on the effects of different modes of intermittent pneumatic compression during operation in prevention of venous thrombosis of the lower extremities after rectal cancer surgery[J]. Chin J Nurs, 2022, 57(6):695-702.
[11]	龚文艳, 周璇, 侯黎莉. 足月妊娠产妇产后静脉血栓栓塞症快速评估简表的构建及预测效果检验[J]. 中华护理杂志, 2020, 55(7):988-993. DOI URL
	Gong WY, Zhou X, Hou LL. Construction and validation of a rapid assessment form for venous thromboembolism in women after fullterm deliver[J]. Chin J Nurs, 2020, 55(7):988-993.
[12]	中国健康促进基金会血栓与血管专项基金专家委员会. 静脉血栓栓塞症机械预防中国专家共识[J]. 中华医学杂志, 2020, 100(7):484-492.
	Expert Committee of Thrombosis and Vascular Special Fund of China Health Promotion Foundation. Chinese expert consensus on mechanical prevention of venous thromboembolism[J]. Natl Med J China, 2020, 100(7):484-492.
[13]	上海市母婴安全专家委员会, 上海市医学会围产医学专科分会, 上海市医学会妇产科专科分会产科学组, 等. 上海市产科静脉血栓栓塞症防治的专家共识[J]. 上海医学, 2020, 43(11):645-650.
	Shanghai Maternal and Infant Safety Expert Committee,Peri-natal Medicine Branch of Shanghai Medical Association,Ob-stetrics Group of Obstetrics and Gynecology Branch of Shanghai Medical Association, et al. Expert consensus on prevention and treatment of obstetric venous thromboembolism in Shanghai[J]. Shanghai Med J, 2020, 43(11):645-650.
[14]	全国肺栓塞和深静脉血栓形成防治能力建设项目专家委员会《医院内静脉血栓栓塞症防治质量评价与管理指南2022版》编写专家组. 医院内静脉血栓栓塞症防治质量评价与管理指南(2022版)[J]. 中华医学杂志, 2022, 102(42):3338-3348.
	Expert Group for the Compilation of Guidelines for Quality Evaluation and Management of Prevention and Treatment of Intra hospital Venous Thromboembolism(2022 Edition) by the Expert Committee of the National Capacity Building Project for Prevention and Treatment of Pulmonary Embolism and Deep Venous Thromboembolism. Guidelines for quality evaluation and management of prevention and treatment of intra- hospital venous thromboembolism(2022 edition)[J]. Natl Med J Chin, 2022, 102(42):3338-3348.
[15]	Bui MH, Le QC, Duong DH, et al. Economic burden of venous thromboembolism in surgical patients:a propensity score analysis from the national claims database in Vietnam[J]. PLoS One, 2020, 15(4):e0231411. DOI URL
[16]	薛爱喜, 唐守信, 张梦菲, 等. 下肢深静脉血栓的超声表现与临床特征分析[J]. 中国中西医结合影像学杂志, 2019, 17(3):314-316.
	Xue AX, Tang SX, Zhang MF, et al. Analysis of ultrasonic mani-festations and clinical features of lower limb deep vein thrombosis[J]. Chinese Journal of Integrated Traditional and Western Medicine Imaging, 2019, 17(3):314-316.
[17]	李海燕, 李蓉, 植艳茹, 等. 中老年患者院内发生静脉血栓栓塞症风险预测模型的研究[J]. 中华护理杂志, 2020, 55(1):68-73. DOI URL
	Li HY, Li R, Zhi YR, et al. Study on the risk prediction model of in-hospital venous thromboembolism in middle-aged and elderly patients[J]. Chin J Nurs, 2020, 55(1):68-73.
[18]	王宏飞, 唐亮, 喻姣花, 等. 院内静脉血栓栓塞症综合性防治管理体系的建立和效果分析[J]. 中华医院管理杂志, 2019, 35(9):757-760.
	Wang HF, Tang L, Yu JH, et al. Establishment and the effectiveness analysis of a comprehensive management system for preventing and curing venous thromboembolism within hospital[J]. Chin J Hosp Admin, 2019, 35(9):757-760.
[19]	区洁芬, 冯雁玲, 罗少芳, 等. 护士主导的静脉血栓栓塞症防控管理[J]. 中华护理教育, 2021, 18(4):377-381.
	Ou JF, Feng YL, Luo SF, et al. A nurse-led management strategy of prevention and control of venous thromboembolism[J]. Chin J Nurs Educ, 2021, 18(4):377-381.
[20]	Ortel TL, Neumann I, Ageno W, et al. American Society of Hema-tology 2020 guidelines for management of venous thromboembolism:treatment of deep vein thrombosis and pulmonary embolism[J]. Blood Adv, 2020, 4(19):4693-4738. DOI URL
[21]	王琦, 刘涛, 白燕, 等. 医院静脉血栓栓塞症信息管理系统的研发与应用[J]. 中国医学装备, 2020, 17(8):135-139.
	Wang Q, Liu T, Bai Y, et al. Development and application of hospital venous thromboembolism information management system[J]. Chin Med Equip, 2020, 17(8):135-139.
[22]	刘成刚, 赵志勇, 孙仁峰. 基于三级医院评审标准的静脉血栓栓塞症防控策略研究[J]. 中国卫生质量管理, 2022, 29(4):39-41.
	Liu CG, Zhao ZY, Sun RF. Prevention and control strategy of venous thromboembolism based on tertiary hospitals accreditation standards[J]. Chin Health Qual Manag, 2022, 29(4):39-41.
[23]	中华护理学会外科护理专业委员会, 中华医学会外科学分会护理学组. 普通外科患者静脉血栓栓塞症风险评估与预防护理专家共识[J]. 中华护理杂志, 2022, 57(4):444-448. DOI URL
	The Surgical Nursing Committee of Chinese Nursing Association,the Nursing Group of Chinese Society of Surgery of Chinese Medical Associaton. Expert consensus on risk assess-ment and prevention of venous thromboembolism in general surgical patients[J]. Chin J Nurs, 2022, 57(4):444-448. DOI URL
[24]	马玉芬, 邓海波, 王晓杰, 等. 成人新型冠状病毒肺炎患者静脉血栓栓塞症防控护理专家共识[J]. 中华护理杂志, 2020, 55(5):666-669. DOI URL
	Ma YF, Deng HB, Wang XJ, et al. Expert consensus on nursing prevention and control of venous thromboembolism in adult patients with coronavirus disease 2019[J]. Chin J Nurs, 2020, 55(5):666-669. DOI URL
[25]	Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism:the Padua Prediction Score[J]. J Thromb Haemost, 2010, 8(11):2450-2457. DOI PMID
[26]	柳清霞, 王薇, 孙育红. 手术室护士围手术期预防静脉血栓栓塞症知信行现状的调查与分析[J]. 中华现代护理杂志, 2021, 27(28):3809-3815.
	Liu QX, Wang W, Sun YH. Status of knowledge,attitude and practice of perioperative prevention of venous thromboembolism among operating room nurses:a survey analysis study[J]. Chin J Mod Nurs, 2021, 27(28):3809-3815.
[27]	杨琴, 温贤秀, 蒋文春, 等. 基于网格化管理的持续质量改进模式在静脉血栓栓塞症防控中的应用效果[J]. 解放军护理杂志, 2022, 39(2):84-87,91.
	Yang Q, Wen XX, Jiang WC, et al. Effect of continuous quality improvement in venous thromboembolism prevention and control based on grid management plan-do-check-active model[J]. Nurs J Chin PLA, 2022, 39(2):84-87,91.