心血管危重症患者院内转运执行单的设计及应用研究

doi:10.3761/j.issn.2096-7446.2022.05.001

摘要/Abstract

摘要： 目的设计并应用心血管危重症患者院内转运执行单,以提升转运安全。方法通过文献回顾及半结构式访谈形成心血管危重症患者院内转运执行单初稿;运用德尔菲法对12名专家进行2轮函询,形成心血管危重症患者院内转运执行单,并对执行单进行信效度评价。便利选取浙江省某三级甲等医院心脏大血管外科、心血管内科各1个护理单元,2021年9月—10月67例次转运患者为对照组,2021年11月—12月72例次转运患者为试验组。试验组在常规转运的基础上采用心血管危重症患者院内转运执行单,对照组采用常规转运护理。比较两组转运不良事件的发生率和转运用时的差异。结果 2轮专家函询问卷回收率均为100%;专家权威系数分别为0.811、0.856;专家协调系数分别为0.363和0.387（P<0.05）;执行单各条目Kappa值为0.733~1.000,平均为0.803（P<0.05）;执行单条目内容效度指数为0.810~1.000,整体内容效度指数为0.912。设计的心血管危重症患者院内转运执行单包含6项一级指标、22项二级指标、50项三级指标。临床应用后,试验组转运期间部分病情/技术相关不良事件发生率、转运前准备用时及途中用时均低于对照组（P<0.05）。结论心血管危重症患者院内转运执行单较为科学、可靠,可缩短转运用时,有助于转运关键环节的有效落实,进而提升转运安全。

关键词: 病人转送, 心血管疾病护理, 危重病护理, 表格和记录管理, 安全管理

Abstract: Objective To construct and apply intra-hospital transport checklist for critically ill cardiovascular patients to improve transport safety. Methods The preliminary draft of intra-hospital transport checklist for critically ill cardiovascular patients was developed based on literature review and semi-structured interviews,and the Delphi method was used to conduct 2 rounds of consultation with 12 experts,the final intra-hospital transport checklist for critically ill cardiovascular patients was formed. After evaluating the reliability and validity of the checklist,it was carried out in a cardiovascular surgical ward and a cardiovascular ward of a tertiary class A hospital in Zhejiang Province from September to December 2021. 67 cases of transport from September to October were regarded as control group,72 cases from November to December were experimental group. The experimental group used intra-hospital transport checklist for critically ill cardiovascular patients on the basis of routine transport,while the control group used routine transport nursing. The rate of adverse events and transport time were compared between the two groups. Results The response rate of the 2 rounds of expert consultation were 100%. Expert authority coefficients was 0.811 and 0.856. And expert coordination coefficients were 0.363 and 0.387（P<0.05）. Kappa value of each item ranged from 0.733 to 1.000, with average of 0.803（P<0.05）. The content validity index at the level of items ranged from 0.810 to 1.000, and the index of whole checklist was 0.912. The checklist contained 6 first-level indicators,22 second-level indicators,and 50 third-level indicators. After application of the checklist,the incidence of some disease/technology-related adverse events, the preparation time and transit time of experimental group were lower than those of control group（P<0.05）. Conclusion The construction of transport checklist was scientific and reliable. It can shorten the transport time,and is helpful for the effective implementation of the key link of transport,then improve transport safety.

Key words: Transportation of Patients, Cardiovascular Nursing, Critical Care Nursing, Forms and Records Control, Safety Management

冯洁惠, 徐建宁, 朱旭菁, 潘英, 盛运云, 尤奥林. 心血管危重症患者院内转运执行单的设计及应用研究[J]. 中华急危重症护理杂志, 2022, 3(5): 389-395.

FENG Jiehui, XU Jianning, ZHU Xujing, PAN Ying, SHENG Yunyun, YOU Aolin. Design and application of an intra-hospital transport checklist for critically ill cardiovascular patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(5): 389-395.

参考文献

[1] 《中国心血管健康与疾病报告》编写组. 《中国心血管健康与疾病报告2020》要点解读[J]. 中国心血管杂志,2021,26(3):209-218.
The Writing Committee of the Report on Cardiovascular Health. Interpretation of report on cardiovascular health and diseases in China 2020[J]. Chin J Cardiovasc Med,2021,26(3):209-218.
[2] Murata M,Nakagawa N,Kawasaki T,et al.Adverse events during intrahospital transport of critically ill patients:a systematic review and meta-analysis[J]. Am J Emerg Med,2022,52:13-19.
[3] Ignatyeva Y,Nguyen AP,Schmidt U,et al.Transport of critically ill cardiovascular patients[J]. Crit Care Nurs Q,2018,41(4):413-425.
[4] Intensive Care Society. Guidelines for the transport of the critically ill adult(2019 edition)[EB/OL]. [2020-05-10]. https://www.ics.ac.uk/ICS/ICS/GuidelinesAndStandards/ICSGuidelines.aspx.
[5] 急诊危重症患者院内转运共识专家组. 急诊危重症患者院内转运共识:标准化分级转运方案[J]. 中华卫生应急电子杂志,2017,3(5):257-261.
Expert Group of Consensus on In-hospital Transport of Emergency Critically Ill Patients. Consensus on in-hospital transport of emergency critical patients—standardized graded transport scheme[J]. Chin J Hygiene Rescue(Electronic Edition),2017, 37(6):481-485.
[6] 邓先锋,杨霞,喻姣花,等. 急诊危重症患者院内转运安全管理最佳证据总结[J]. 护理学杂志,2020,35(19):56-60.
Deng XF,Yang X,Yu JH,et al.Evidence summary for safety management of intrahospital critical patient transport from the emergency department[J]. J Nurs Sci,2020,35(19):56-60.
[7] Williams P,Karuppiah S,Greentree K,et al.A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines[J]. Aust Crit Care,2020,33(1):20-24.
[8] Canellas M,Palma I,Pontífice-Sousa P,et al.Checklist for a safe intra-hospital transport of critically ill patients:a scoping review[J]. Enfermería Global,2020,19(4):557-572.
[9] 刘学英,黄丽华,邹翼霜,等. 转运核查单的编制及在院内危重患者转运中的应用[J]. 中华护理杂志,2016,51(12):1469-1473.
Liu XY,Huang LH,Zou YS,et al.The impact of intra-hospital transport checklist on transport safety of critically ill pationts[J]. Chin J Nurs,2016,51(12):1469-1473.
[10] 刘佳惠,熊钰. 国内急危重症患者院内预警分级转运效果的Meta分析[J]. 护士进修杂志,2021,36(2):128-133.
Liu JH,Xiong Y.Meta analysis of the effect of domestic emergency and critically ill patients' early warning graded transport[J]. J Nurs Train,2021,36(2):128-133.
[11] 曹滢,郭松奇,李靓,等. 心血管重症患者的安全转运及护理[J]. 中华现代护理杂志,2017,23(14):1918-1921.
Cao Y,Guo SQ,Li L,et al.Safety and nursing interventions of intra-hospital transport for critical cardiovascular patients[J]. Chin J Mod Nurs,2017,23(14):1918-1921.
[12] 赵伟英,金静芬,王志娟. 移动ICU的构建和应用效果[J]. 中华护理杂志,2013,48(7):607-609.
Zhao WY,Jin JF,Wang ZJ.The construction and effects of mobile intensive care units for intra-hospital transport of critically ill patients[J]. Chin J Nurs,2013,48(7):607-609.
[13] Panchal AR,Bartos JA,Cabañas JG,et al.Part 3:adult basic and advanced life support:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation,2020,142(16_suppl_2):S366-S468.
[14] 刘翠,魏丽丽,朱福香,等. 主动脉夹层护理质量评价指标体系的构建及应用[J]. 中华急危重症护理杂志,2020,1(4):313-317.
Liu C,Wei LL,Zhu FX,et al.Construction and application of nursing quality indicator system for patients with aortic dissection[J]. Chin J Emerg Crit Care Nurs,2020,1(4):313-317.
[15] 王慧芳,宋蕾,修麓璐,等. 危重患者院内转运护理质量评价指标体系的构建及应用[J]. 中华急危重症护理杂志,2020,1(1):31-36.
Wang HF,Song L,Xiu LL,et al.The construction and clinical application of nursing quality evaluation index system for intrahospital transport of critically ill patients[J]. Chin J Emerg Crit Care Nurs,2020,1(1):31-36.
[16] 张艳,王凤珍,鲁玉凤,等. ICU患者病情管理交接单的编制及应用[J]. 中华急危重症护理杂志,2021,2(1):7-13.
Zhang Y,Wang FZ,Lu YF,et al.Development and application of handover sheet for ICU patient condition management[J]. Chin J Emerg Crit Care Nurs,2021,2(1):7-13.
[17] 高春华,卫建华,冯洁惠,等. “ICU重症患者外出转运查检单”的设计及应用[J]. 中国实用护理杂志,2013,29(31):69-72.
Gao CH,Wei JH,Feng JH,et al.Design and application of checklist of transportation for ICU patients[J]. Chin J Pract Nurs,2013,29(31):69-72.
[18] Fanara B,Manzon C,Barbot O,et al.Recommendations for the intra-hospital transport of critically ill patients[J]. Crit Care,2010,14(3):R87.