在一个高可靠性组织的神经科学重症监护室中预防计划外输
Meagan Aladin1, Lauren Buckley1, Meghan Maloney2
1NYU Langone Health, NY, USA.
概括
一项质量改进计划显著减少了神经科学重症监护室的意外输出. 实施一种涉及沟通,镇静和束的实践标准,使出口率降低了75%以上.
科学领域:
- 关键护理医学 关键护理医学
- 神经科学 护理 护理
- 患者安全 患者安全
背景情况:
- 神经科学重症监护室 (ICU) 的输管患者面临意外输管的风险,这是ICU护理质量的关键指标.
- 无计划的输出管与肺炎的增加,更长时间的呼吸机使用,气管切除术和长时间的ICU/住院住院有关.
- 为了减轻这些风险,2021年5月实施了一项基于单位的多学科实践标准.
研究的目的:
- 评估一个新的多学科基于单元的实践标准对减少计划外输术的影响.
- 评估在实施质量改进倡议后,计划外抽率的变化.
主要方法:
- 从2020年6月到2021年5月的事件报告的回顾性审计 (事前倡议).
- 从2021年7月到2024年3月的事件报告的前性审计 (倡议后).
- 收集的数据包括患者人口统计,RASS目标,镇静/止痛,限制和持续观察.
主要成果:
- 预先倡议:在214名被直管的患者中,进行了9次非计划性输出输出管 (0.93/100通风器日).
- 倡议后:在576名被直管的患者中进行了6次非计划性输出管 (0.22/100通风器日).
- 在倡议后,所有非计划性输出的患者都达到了RASS目标≤-1并使用软手腕束.
结论:
- 实施的质量改进倡议,专注于实践标准,大大减少了神经科学重症监护室 (ICU) 的非计划性输出.
- 这些发现证明了结构化方法在提高患者安全和直管患者护理质量的有效性.
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