改善小儿/青壮年出血性疾病患者对 1-去氨基-8-D-精氨酸血管加压素 (DDAVP) 的挑战:质量改进研究。

IF 1 4区 医学 Q3 NURSING
Michelle Hallam, Amber Pruett, Charmaine Biega, Haley Miller, Tami Davis, Linda Casto, Amy L Dunn, Vilmarie Rodriguez
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引用次数: 0

摘要

背景:去氨加压素(1-脱氨基-8-D-精氨酸血管加压素 [DDAVP])已被证明是治疗遗传性出血性疾病患者的有效药物。由于个体对该药物的反应不一,建议在手术或治疗出血症状前建议使用该药物前完成一项挑战,以记录对该药物的适当止血反应。该项目旨在减少接受 DDAVP 挑战的出血性疾病患者止血反应评估中的错误(过程结果),尤其是抽取血样的时间和数量,从错误率基线 36% 降至 2021 年 12 月的 0%,并持续一年。方法:采用 "计划-实施-研究-行动 "的方法来实施这项定性改进措施。设计和实施的干预措施包括:根据出血性疾病的临床指征开具包含药物剂量和相应化验单的医嘱集、输液护士应遵循的临床程序指南、止血护士协调与患者的预约以及家属教育。结果完成 DDAVP 挑战的 22 名患者的基线数据显示,不涉及用药剂量的错误率为 36%。出现的错误包括:DDAVP 用药后化验室抽血时间不当、化验室评估不完整、化验单一次性而非按顺序发放导致化验结果显示错误。通过这些干预措施,DDAVP 挑战错误率降至 0%,并持续一年。结论改进对接受 DDAVP 挑战的患者的程序性用药和适当的实验室评估,可在用药后对止血反应进行全面、可靠的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improving 1-Deamino-8-D-Arginine Vasopressin (DDAVP) Challenges in Pediatric/Young Adult Patients With Bleeding Disorders: A Quality Improvement Study.

Background: Desmopressin (1-deamino-8-D-arginine vasopressin [DDAVP]) has demonstrated efficacy as a treatment option for patients with inherited bleeding disorders. Because of individuals' variable response to the medication, it is recommended to complete a challenge to document appropriate hemostatic response to the medication before recommending its use prior to surgical procedures or treatment of bleeding symptoms. The project aimed to reduce the errors in hemostatic response assessments for patients with bleeding disorders undergoing a DDAVP challenge (process outcome), particularly timing and number of blood samples drawn, from an error rate baseline of 36% to 0% by December 2021 and sustained for one year. Method: Plan-Do-Study-Act methodology was employed for this qualitative improvement initiative. Interventions designed and implemented included: an order set with medication doses and corresponding laboratory orders as clinically indicated for the bleeding disorder indication, clinical procedure guidelines for infusion nurses to follow, hemostasis nurse coordination of appointments with patients, and family education. Results: Baseline data on 22 patients who completed a DDAVP challenge demonstrated a 36% error rate not involving doses of medication administered. Errors encountered included improper timing of laboratory draw after DDAVP administration, incomplete laboratory evaluation, laboratory results displayed incorrectly due to testing orders released at once instead of in a sequential manner. These interventions resulted in a reduction of DDAVP challenge errors to 0% that were sustained for one year. Conclusion: Improvement in procedural medication administration and appropriate laboratory evaluation of patients undergoing a DDAVP challenge leads to a complete and reliable assessment of hemostatic response following medication administration.

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