重新设计重症监护病房查房以改善军队医院的协作。

IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE
Kiffin R Smallegan, Samantha J Smith, Heather L Wilder, Gabriylle E Payne, Sorana Raiciulescu, Carolyn M Capps
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引用次数: 0

摘要

背景:团队沟通对于安全提供卫生保健至关重要。在一家大型军事治疗设施的成人重症监护室,护士没有始终出现在每天的病人查房中,并表示团队沟通可以得到改善。这个临床问题被提出:在重症监护人员中,与目前的实践相比,标准化的每日舍入脚本如何影响36周期间的跨学科交流?证据回顾:当前文献包括3个主题:回合应该是跨学科的;包括ABCDEF组(疼痛评估、自发觉醒和呼吸试验、镇痛和镇静选择、谵妄评估、早期活动能力和家庭参与);使用标准化的脚本。这些因素可以改善对轮次合作的看法。实施情况:在一家军队医院的2个成人重症监护室实施了为期36周的跨学科舍入脚本。干预前后,采用“护理决策的协作与满意度调查”评估护士对合作的认知;对关键要素进行了观察。评价:实施后,平均调查得分(两个单位合并)提高了1.5个单位,护士出勤率提高了21.6% (P = 0.01),护士对查房的贡献提高了31.1% (P = 0.001),所有包要素的复核率提高了18.9% (P = 0.07),护理总结率提高了53.6% (P < 0.001),医嘱复读率提高了69.8% (P < 0.001)。可持续性:在军事治疗设施中继续使用该脚本将需要对其进行调整以适应实践变化并培训新工作人员使用该脚本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Redesigning Intensive Care Unit Rounds to Improve Collaboration at a Military Hospital.

Background: Team communication is essential to delivering health care safely. Nurses in the adult intensive care unit at a large military treatment facility were not consistently present in daily patient rounds and stated that team communication could be improved. This clinical question was developed: among critical care staff members, how does a standardized daily rounding script, compared with current practice, impact interdisciplinary communication over a 36-week period?

Review of evidence: Current literature includes 3 themes: rounds should be interdisciplinary; include the ABCDEF bundle (pain assessment, spontaneous awakening and breathing trials, analgesia and sedation choice, delirium assessment, early mobility, and family engagement); and use a standardized script. These elements can improve perceptions of collaboration in rounds.

Implementation: An interdisciplinary rounding script was introduced across 2 adult intensive care units at a military hospital over 36 weeks. Before and after the intervention, the Collaboration and Satisfaction About Care Decisions survey was used to assess nurses' perceptions of collaboration; rounds were observed for key elements.

Evaluation: After implementation, the mean survey score (both units combined) rose by 1.5 units, nurse presence at rounds increased by 21.6% (P = .01), nurse contributions to rounds increased by 31.1% (P = .001), all bundle elements were reviewed 18.9% more often (P = .07), a summary of care was given 53.6% more often (P < .001), and order read back was completed 69.8% more often (P < .001).

Sustainability: Continued use of the script in the military treatment facility will require adapting it to practice changes and training new staff members on its use.

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来源期刊
Critical care nurse
Critical care nurse 医学-护理
CiteScore
2.80
自引率
0.00%
发文量
68
审稿时长
>12 weeks
期刊介绍: Critical Care Nurse (CCN) is an official publication of the American Association of Critical-Care Nurses (AACN). Authors are invited to submit manuscripts for consideration and peer review. Clinical topics must meet the mission of CCN and address nursing practice of acute and critically ill patients.
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