一个多方面的干预措施,以提高重症监护病房网络的质量:一个集群随机试验
Damon C Scales1, Katie Dainty, Brigette Hales
1Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. damon.scales@utoronto.ca
JAMA
|January 21, 2011
概括
社区重症监护室 (ICU) 的质量改善计划成功提高了基于证据的实践的采用率. 这项多中心试验通过基于视频会议的干预证明了患者护理的改善.
科学领域:
- 关键护理医学 关键护理医学
- 改善医疗保健质量 改善医疗保健质量
- 公共卫生 公共卫生
背景情况:
- 基于证据的实践对于改善重症监护室 (ICU) 的结果至关重要.
- 社区医院服务于大多数重症患者,往往缺乏专门的资源用于质量改善计划.
- 确保在资源有限的环境中持续提供基于证据的护理仍然是一个挑战.
研究的目的:
- 评估多中心质量改进计划的有效性,旨在增加社区医院ICU中六种基于证据的关键实践的实施.
- 评估结构化干预对重症监护最佳实践的采用率的影响.
主要方法:
- 在加拿大安大略省15家社区医院的重症监护病房中进行了一项实用的集群随机试验.
- 实施了一项涉及基于视频会议的论坛,审计和反,专家教育和算法传播的干预.
- 集中治疗室被随机分配,每个组每四个月接受一次针对新实践的干预,同时作为另一组的对照.
主要成果:
- 与对照ICU相比,质量改善干预显著增加了针对性基于证据的实践在干预ICU中的总体采用率 (OR的总结比率,2.79).
- 观察到半躺卧的位置有显著的改善,用于预防呼吸机相关的肺炎 (OR,6.35) 和预防中枢线相关的血液感染 (OR,30.06).
- 其他实践的采用率,特别是那些具有高基准遵守率的实践,显示了最小的变化.
结论:
- 通过协作网络提供的多方面的质量改进计划有效地提高了社区ICU中基本护理实践的采用.
- 这些发现支持了此类干预措施的可扩展性和有效性,以改善在不同医院环境中的重症监护服务.
相关概念视频
Nursing Clinical Information System
Nursing Clinical Information System (NCIS)
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Nursing Interventions II: Selecting and Classifying the Nursing Interventions
Creating and executing a nursing diagnosis helps nurses plan care and guide patient, family, and community interventions. They are developed based on a patient's physical evaluation and support measuring the outcomes. It is not recommended to select random interventions throughout the planning process. Instead, consider the following six essential factors when choosing interventions:
Acute Kidney Injury V: Interprofessional Care
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
Nursing Implementation
Implementation is the execution of the nursing care plan developed during the planning phase.
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
Chronic Kidney Disease III: Interprofessional Care
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
