摘要
目的促进最佳证据在头颈癌住院手术患者营养管理中的应用,提高临床医疗护理质量。方法采用复旦大学循证护理中心制定的基于证据持续质量改进模式,对头颈癌住院手术患者营养管理主题进行系统检索和质量评价,形成14条最佳证据,通过基线调查了解障碍因素,并制定相应的行动策略,将证据应用到临床实践。根据最佳证据,制订了12条质量审查指标,在头颈癌住院患者手术病房开展基于循证的营养管理流程的优化和质量审查,实践变革前后分别纳入19例护士、125例患者和19例护士、149例患者作为研究对象。结果12条质量审查指标中,护士的执行率由基线审查时的0~48.8%提高到证据运用后的81.8%~100%。患者住院期间体质量下降例数由基线审查时的77.6%减少到证据运用后的56.3%,体质量增加由20%上升至40.3%,体质量不变由3%上升至5%;患者术后住院天数由12.48 d缩短至10.94 d;手术并发症发生率从11.2%减少至4.02%,差异均有统计学意义(P<0.05)。结论循证实践对开展头颈癌住院手术患者营养管理具有重要意义,可改善患者的临床结局,提高护理质量。
Objective To integrate the best practice evidence of nutrition management for inpatients undergoing head and neck cancer surgery into clinical practice,so as to improve the quality of nursing.Methods The evidence-based continuous quality improvement model developed by the evidence-based nursing center of Fudan University was adopted to systematically retrieve and evaluate the nutritional management of head and neck cancer inpatients,forming 14 best practice evidence.The obstacle factors were understood through baseline audit,and formulated strategies were developed to apply the evidence to clinical practice.Based on the best practice evidence,12 audit criteria were developed.19 nurses and 125 patients were enrolled in baseline audit,and 19 nurses and 149 patients were recruited for re-audit after evidence implementation.Results Twelve of the audit criteria that nurses showed poor compliance in the baseline audit(0%~48.8%),were significantly improved in the re-audit(81.8%~100%).The number of patients losing weight during hospitalization decreased from 77.6%at baseline to 56.3%after the re-audit,gaining weight increased from 20%to 40.3%,and retenting weight increased from 3%to 5%.The length of postoperative hospital stay decreased from 12.48 days to 10.94 days,and the incidence of surgical complications decreased from 11.2%to 4.02%,with statistically significant differences(P<0.05).Conclusion Evidence-based practice is of great significance for the nutritional management of head and neck cancer inpatients,improving patients'clinical outcome and improving the quality of nursing.
作者
蒋成芳
席淑新
沈丽娜
杨雪蓝
黄皛梦
Jiang Chengfang;Xi Shuxin;Shen Lina;Yang Xuelan;Huang Xiaomeng(Eye&ENT Hospital of Fudan Uiversity,Shanghai 200030)
出处
《护士进修杂志》
2020年第22期2028-2033,共6页
Journal of Nurses Training
基金
上海市护理学会级面上项目(编号:2018MS-B19)
复旦大学护理学院复星基金重点项目(编号:FNF201702)。
关键词
头颈癌
手术
营养管理
循证实践
Head and neck cancer
Surgery
Nutrition management
Evidence-based practice
