在护理实践漂移后恢复可靠的患者生理监测系统性能:持续质量改进的一个例子
Krystal M McGovern1, Susan P McGrath, Irina M Perreard
1Author Affiliations: Department of Quality Assurance and Safety (Dr McGovern), Value Institute (Dr McGovern), Surveillance Analytics Core (Drs McGovern, McGrath, Perreard, and Blike), Analytics Institute (Drs McGovern, McGrath, Perreard, and Blike), and Department of Anesthesiology and Analytics Institute (Dr Perreard), Dartmouth Hitchcock Medical Center, Lebanon; and Department of Anesthesiology (Dr McGrath) and Geisel School of Medicine (Dr Blike), Dartmouth College, Hanover, NH.
在生理监控系统中,高警报负担会导致警报疲劳. 调整警报值和标准化响应显著减少了警报,改善了护士的患者安全系统.
科学领域:
- 生物医学工程 生物医学工程
- 临床信息学 临床信息学
- 患者安全系统患者安全系统
背景情况:
- 生理监测系统的目的是提醒护士患者病情恶化.
- 高警报负担可能导致警报疲劳,降低系统效率和护士信心.
- 随着时间的推移,实践漂移可能会损害患者安全系统的可靠性.
研究的目的:
- 评估和改进受高警报负担影响的医院的患者安全系统.
- 了解影响监控系统性能的环境变化.
- 通过系统方法恢复可靠的系统性能.
主要方法:
- 实施系统方法来分析和修改护理环境.
- 调整了连续监控脉冲率警报值为每分钟40次.
- 将外周毛细管氧和警报值重新标准化为80%,并重置警报响应预期.
主要成果:
- 对于较低的外周毛细血管氧和度的床边报警降低了66.4% (P < .001).
- 对低脉率的床边报警降低了71.2% (P < .001).
- 对于外周毛细管氧和度低 (84.5%,P <.001) 和脉率低 (93%,P <.001) 两种情况,呼叫器通知显著下降.
结论:
- 临床过程标准化和持续的性能测量对于维持患者安全系统至关重要.
- 即使是稳定的系统也需要定期评估,以防止由于实践漂移而导致的性能下降.
- 这些干预措施有效地减少了警报负担,提高了关键患者监测的可靠性.
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