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Rebecca E Hay1,2, Dori-Ann Martin3, Gary J Rutas3
1Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada rebecca.elise.hay@gmail.com.
在儿科重症监护病房中,对临床护理指南的总体遵守率高达77.8%. 然而,合规性差异很大,简单的指南比复杂的指南更好地遵守,突出了基于证据的实践需要改进的领域.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 改善医疗保健质量 改善医疗保健质量
- 临床实践指南 临床实践指南
背景情况:
- 基于证据的临床护理指南对于加强医疗治疗,减少错误和改善患者结果至关重要.
- 虽然有个人准则遵守数据,但缺乏关于在儿科重症监护机构遵守多个细微的准则的全面数据.
研究的目的:
- 为了前性地评估儿童重症监护病房内多个基于证据的临床护理指南的整体遵守情况.
- 在这种情况下,确定影响准则遵守和不遵守的因素.
主要方法:
- 一项前性队列研究在高等学术儿科医疗外科重症监护病房进行.
- 在814名患者中评估了19个基于证据的临床护理指南的遵守,记录了4512个遵守事件.
- 记录了违规原因和相关结果.
主要成果:
- 在4512个合规事件和826个入院事件中,整体设施合规率高达77.8%.
- 在指导方针之间,合规程度差异很大,压力预防 (97.1%) 和输血 (97.4%) 显示了高的合规性,而呼吸机相关的肺炎预防 (28.7%) 和维生素K (34.8%) 的合规性较低.
- 使用更简单格式的指南 (二元决策点或流程图) 显示了更高的合规性 (90.6%). 对准则可信度和时间限制的不良认知与遵守程度较低有关.
结论:
- 测量指导方针的遵守,尽管是资源密集型,提供了对当前的临床实践有价值的见解.
- 该研究确定了需要机构改进的具体领域,以加强对儿科重症监护的基于证据的临床护理指南的遵守.
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