一个质量改进项目,以优化手术患者静脉维护液的处方
Jia Xuan Tan1, Hao Ming Tan2, Kishore Sasapu3
1General Surgery, Diana Princess of Wales Hospital, Grimsby, GBR.
Cureus
|November 3, 2025
概括
改善静脉注射 (IV) 液体的处方遵守国家卫生和护理卓越研究所 (NICE) 准则显著减少了医院患者的电解质失衡. 有针对性的干预措施提高了患者的安全性和流体管理协议.
科学领域:
- 医学科学 医学科学 医学科学
- 临床实践 临床实践
- 提高质量 提高质量
背景情况:
- 不适当的静脉注射 (IV) 液体处方是导致医院患者死亡的主要原因.
- 维护IV液必须满足生理需求,而不会导致电解质失衡或液体过载.
- 国家卫生和护理卓越研究所 (NICE) 的指导方针主张量身定制,低压,平衡的静脉注射液溶液.
研究的目的:
- 评估一般外科部门是否遵守NICE IV流体指南.
- 实施有针对性的干预措施,以改善静脉注射液处方实践.
- 重新审计和评估干预措施对准则遵守的影响.
主要方法:
- 一个分为三个阶段的质量改进项目利用了计划-做-研究-行动 (PDSA) 循环.
- 第1阶段:对紧急腹腔切除术患者 (n=21) 的静脉输液处方进行回顾性审计.
- 第二阶段:干预包括新的默认流体,教育课程和指导传播.
- 第三阶段:干预后一个月重新审计 (n=20).
主要成果:
- 干预前对NICE指南的遵守率很低 (9.5%).
- 观察到过多的和摄入量 (超过200%) 和缺乏 (83%低于目标).
- 干预后,适当的处方增加到45%,大大减少了和的使用,改善了和乳糖的供应.
结论:
- 多学科干预实质性地改善了对IV液体处方指南的遵守.
- 这些干预措施导致电解质过剩减少,并提高了患者的安全性.
- 持续的改进需要信任范围的政策,持续的教育和跨部门的实施.
相关概念视频
Acute Kidney Injury VI: Nursing Management
376
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
376
Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
172
Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
172
Hemodialysis III: Nursing Management
714
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
714
Parentral Nutrition: Centeral and Peripheral Parental Nutrition
723
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
723
Peritoneal Dialysis III: Nursing Management
633
Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
633
One-Compartment Open Model for IV Bolus Administration: Estimation of Clearance
335
Clearance is a key pharmacokinetic parameter that quantifies the volume of body fluid from which a drug is entirely removed within a specific time frame. It is crucial in assessing how a drug is eliminated from the body and has critical clinical applications.
In the one-compartment open model for intravenous (IV) bolus administration, clearance is estimated by dividing the elimination rate by the plasma drug concentration. This equation leverages the elimination rate constant and the apparent...
In the one-compartment open model for intravenous (IV) bolus administration, clearance is estimated by dividing the elimination rate by the plasma drug concentration. This equation leverages the elimination rate constant and the apparent...
335


