多学科多阶段预防ICU患者呼吸机相关性肺炎的质量改进策略

doi:10.3761/j.issn.2096-7446.2024.07.014

摘要/Abstract

摘要： 目的探索多学科多阶段预防呼吸机相关性肺炎（ventilation associated pneumonia,VAP）质量改进策略（以下简称质量改进策略）对ICU患者VAP发生水平的影响。方法以新疆巴州某三级甲等综合医院ICU为研究场所,以2020年1月—2023年12月行有创机械通气的患者作为研究对象,每年作为一个研究时段。融合循证护理和实施科学的方法学,构建质量改进策略,根据每个研究时段有针对性地实施干预策略。结果 2021年—2023年,VAP发生水平均低于院级预警线,2023年VAP综合干预策略执行率均较基线有显著提高,差异具有统计学意义（P<0.05）;所有入组患者均未出现非计划性拔管;2023年平均机械通气日较2020年显著降低,差异具有统计学意义（W=6 786,P=0.008）。结论质量改进策略可有效降低ICU患者VAP发生水平,有效提升临床医疗和护理质量。

Abstract: Objective To explore the impact of multidisciplinary and multi-stage quality improvement strategies for the prevention of ventilator-associated pneumonia（VAP） on the occurrence of VAP in Intensive Care Unit（ICU） patients. Methods This study was conducted in the ICU of a tertiary comprehensive hospital in Bazhou,Xinjiang. Patients with invasive mechanical ventilation were included in the study. The study period was from January 2020 to December 2023,with each year considered as a study period. By integrating evidence-based nursing and implementing scientific methodologies,the quality improvement strategy was developed,with targeted interventions designed for each study period. Results Over the period from 2021 to 2023,the incidence of VAP was consistently lower than the hospital‘s warning line,and the implementation rate of the VAP prevention comprehensive intervention strategy in 2023 showed a significant improvement compared to the baseline（P<0.05）. There were no unplanned extubation cases among all enrolled patients,and the average days of mechanical ventilation in 2023 were lower than in 2020,with a statistically significant difference（W=6786,P=0.008）. Conclusion The quality improvement strategies can effectively reduce the occurrence of VAP in ICU patients and promote the effective advancement of clinical medical and nursing quality.

Key words: Intensive Care, Ventilation Associated Pneumonia, Quality Improvement, Evidence-Based Nursing, Implementation Science

秦薇, 王文超, 姚文杰, 古月, 郎琴, 许晓岚. 多学科多阶段预防ICU患者呼吸机相关性肺炎的质量改进策略[J]. 中华急危重症护理杂志, 2024, 5(7): 649-655.

QIN Wei, WANG Wenchao, YAO Wenjie, GU Yue, LANG Qin, Xu Xiaolan. Quality improvement strategies for the prevention of ventilator-associated pneumonia in ICU patients through multidisciplinary and multi-stage approaches[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(7): 649-655.

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