在新生儿重症监护病房中,成功地将中断警报转变为中断警报,对新生儿重症监护病房中中央线路连衣的变化进行非中断警报
Lindsey A Knake1,2, Rachel Asbury2, Shannon Penisten2
1Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.
Applied clinical informatics
|August 20, 2024
概括
将中断性警报转换为非中断性临床决策支持 (CDS) 工具,改善了对外围插入中央导管 (PICC) 敷料更换协议的遵守. 这通过减少逾期更换连衣和消除手动跟踪来增强患者护理.
科学领域:
- 临床信息学 临床信息学
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
背景情况:
- 断断续续的警报有助于临床医生的警报疲劳,需要评估表现不佳的警报,寻找替代解决方案.
- 对外围插入中央导管 (PICC) 带变化的中断警报的可操作性很低,在六个月内,在617个警报中,只有1.7%的警报得到了处理.
研究的目的:
- 通过将功能不良的中断警报转换为非中断警报,提高对机构PICC更衣换衣协议的遵守.
- 测量这种变化对最初PICC包装变化的百分比的影响,这些变化超出了推的48小时时间框架.
- 评估到第一次更换带的时间,并评估用新系统取代手动患者名单跟踪.
主要方法:
- 临床信息学团队与利益相关者合作,分析临床工作流程,并确定需要跟踪需要更换连衣的患者的需求.
- 一个非中断的临床决策支持 (CDS) 工具,集成到患者名单列,被开发来取代现有的中断警报.
- 从2022年1月到2022年11月进行了干预前后混合方法队列研究,以评估干预的有效性.
主要成果:
- 已逾期更换PICC带的患者的百分比显著下降,从21.9%降至7.8% (p < 0.001).
- 第一次PICC带更换的平均时间从40.8小时减少到30.7小时 (p = 0.02).
- 新的CDS工具实现了普遍采用,临床医生不再使用手册患者名单进行跟踪.
结论:
- 本案例报告表明,集成到患者名单列中的基于人口的,不中断的CDS工具可以改善采用和遵守.
- 这些发现表明,与之前的一些报告相反,在不间断的CDS格式中提供所需的功能可能是有效的.
- 成功实施突出了优化警报系统和改善对临床协议的遵守的可行战略.
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