Abstract:

Objective To apply the best evidence for prevention of inadvertent perioperative hypothermia（IPH）and to evaluate its clinical effects.Methods Following steps of practical application of clinical evidence system developed by Joanna Briggs Institute,based on best evidence obtained from previous studies,we constructed audit indicators and then performed clinical audits. We analyzed obstacles and facilitators and formulated strategies. Awareness of nurses towards prevention and management of IPH,incidence of IPH among patients,implementation of audit indicators among nurses were compared before and after application.Results Before and after application of the best evidence,operating room nurses’ score for knowledge on prevention and management of IPH was 10~100（40.03±13.55） and 65~100（85.23±8.25）,and the difference was statistically significant（P<0.01）. The incidence of IPH among patients were 47.83% and 16.67%,and the difference was statistically significant（P<0.01）. Before application,implementation rate of audit indicator No. 17 was 98.55%,No. 16 was 76.81%,and the rest were under 50%. After application,implementation rates of audit indicators No.1 to No.9,No.11 to No.15,and No.18 were significantly improved（P<0.01）.Conclusion Evidence-based practice of IPH prevention can regulate behaviors of nurses,improve nurses’ compliance,and reduce the incidence of IPH.

Key words: Perioperative Period, Body Temperature Changes, Evidence-based Nursing, Operating Rooms, Nursing Administration Research

摘要：

目的 将预防围手术期非计划性低体温的最佳证据应用于临床实践并评价其效果。方法 遵循Joanna Briggs Institute（JBI）临床证据实践应用模式,根据前期研究获得的最佳证据制订相应的临床审查指标及审查方法,逐条审查并进行障碍因素分析,制订行动策略。比较最佳证据应用前后手术室护士对围手术期非计划性低体温预防及管理的认知水平、患者围手术期非计划性低体温的发生率以及手术室护士对质量审查指标的执行率。结果 最佳证据应用前后,手术室护士对围手术期非计划性低体温预防和管理的相关知识得分分别为10~100（40.03±13.55）分和65~100（85.12±9.14）分,差异具有统计学意义（P<0.01）;患者围手术期非计划性低体温的发生率分别为47.83%和16.67%,差异具有统计学意义（P<0.01）。最佳证据应用前,手术室护士对审查指标17的执行率为98.55%、审查指标16的执行率为76.81%,其余审查指标的执行率均在50%以下;最佳证据应用后,审查指标1~9、11~15、18的执行率均有明显提高,差异具有统计学意义（P<0.01）。结论 基于最佳证据的集束化预防低体温策略在成人择期手术患者中应用后,可规范护士行为,提高护士执行依从性,并降低患者围手术期非计划性低体温的发生率。

关键词: 围手术期, 体温变化, 循证护理学, 手术室, 护理管理研究