摘要
背景实施性研究是指系统地将循证实践纳入到临床工作中,提高卫生服务质量和有效性,弥补证据与临床实践的鸿沟的一类研究,但目前针对指南推荐意见的实施性研究受到的关注不多。目的 基于《儿童静脉输液治疗临床实践循证指南》(简称指南)中住院患儿静脉输液装置(VAD)选择的推荐意见制定实施策略,评价证据的实施对患儿相关结局、医护人员的循证实践行为及医院组织环境的改变,以期发现不同临床情景推荐意见与临床实践的冲突。设计实施科学研究。方法 在复旦大学附属儿科医院,从4个层面(传播策略、实施过程策略、整合策略、能力建设策略)制定促进证据实施的策略和相应的个体化行动方案,并应用于输液治疗中VAD选择环节。基于RE-AIM框架,从覆盖人群、干预的效果、机构内采用情况和干预的实施4个维度评价实施过程和实施效果。主要结局指标VAD选择错误率、护士VAD选择行为依从性。结果 实施时间为2022年5月30日至10月30日,干预组患儿2 343例次,对照组患儿2 309例次。(1)覆盖人群维度:实施期间符合纳入和排除标准的患儿4 652例次,接受实施策略和个体化行动方案的患儿2 343例次。(2)干预效果维度:两组患儿性别差异无统计学意义,但年龄、是否急诊入院、是否手术和科别差异均有统计学意义。调整了年龄、是否急诊入院、是否手术和科别后,与对照组相比,干预组VAD选择的错误率降低了26%(OR=0.745,95%CI:0.612~0.906);对照组较干预组静脉外渗/渗出发生率差异无统计学意义(OR=1.070,95%CI:0.822~1.393);护士VAD选择的知识水平,干预组(83.9±12.4)高于对照组(56.0±13.1),差异有统计学意义。依从性5条审查指标在实施前、中、后的依从性均为100%,4条审查指标在实施前、中、后的依从性显著提升,7条审查指标在实施前、中、后的依从性差异无统计学意义。(3)机构内
Background Implementation research refers to systematically integrating evidence-based practice into clinical scenarios to improve the quality and effectiveness of healthcare services and bridge the gap between evidence and clinical practice.However,this type of research has not received much attention.Objective To develop implementation strategies of the recommendations for venous access devices(VADs)selection in hospitalized children from Clinical Practice Guideline on Infusion Therapy in Children,to evaluate the impact of evidence implementation on patient outcomes,the evidence-based practice behaviors of healthcare workers,and organization environment changes in the hospital,and to identify conflicts between recommendations and clinical practice in different clinical settings.Design Implementation study.Methods We developed strategies to promote evidence implementation at Children's Hospital of Fudan University from four perspectives:dissemination,implementation process,integration,and capacity building.These strategies,along with correspongding individualized action plans,were applied in the VAD selection for children's infusion therapy.The implementation process and outcomes were evaluated from four aspects:reach,effectiveness(or efficacy),adoption,and implementation according to the RE-AIM framework.Main outcome measures VAD selection error rate,and compliance of VAD selection among nurses.Results The implementation period was from May 30,2022,to October 30,2022.We enrolled 2,343 patients in the intervention group and 2,309 patients in the control group.(1)Reach:During the implementation period,4,652 pediatric patients met the inclusion criteria.Out of these,2,343 patients received the implementation strategy and individualized action plan.(2)Effectiveness:Among the hospitalized children in the 10 wards,there was no statistically significant gender difference between the two groups.However,there were significant differences in patient age,emergency admission status,surgical status,and department.After adju
作者
王颖雯
张青青
胡静
孔梅婧
顾莺
WANG Yingwen;ZHANG Qingqing;HU Jing;KONG Meijing;GU Ying(Nursing Department,Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2024年第2期81-87,共7页
Chinese Journal of Evidence Based Pediatrics
基金
中华护理杂志社2023年静脉治疗护理专项科研项目:ZHHLZZS-2023040
2023年度市级医院诊疗技术推广及优化管理项目(原临床科技创新项目):SHDC22023240。
关键词
儿童
静脉输液
输液装置选择
实施性研究
Children
Infusion therapy
Selection of venous access devices
Implementation evaluation
