摘要
目的：探讨团队资源管理在急诊卒中溶栓绿色通道的应用及效果。方法本研究采用历史对照研究，以2015年4－10月使用重组人组织型纤溶酶原激活物（rt-PA）静脉溶栓的急性缺血性脑卒中患者59例为试验组，运用团队资源管理拟定解决策略，重置卒中患者急诊绿色通道救治流程，使用团队资源管理的策略工具包。以2013年4月至2014年10月（实施团队资源管理之前）使用rt-PA静脉溶栓的急性缺血性脑卒中患者51例为对照组。用中文版患者安全态度文化调查问卷对急诊团队进行前测和后测。评价2组患者的急诊滞留时间（EDLOS）、就诊至溶栓时间（DNT）、发病至溶栓时间（OTT）、DNT≤60 min的比例及实施团队资源管理前后急诊护理质量及患者安全氛围。结果试验组急性缺血性脑卒中患者实施团队资源管理后EDLOS、DNT、OTT、DNT≤60 min比例分别为分别为54.88 min、79.95 min、173 min、23.7%（14/59），对照组分别为80.33 min、111.63 min、243 min、9.8%（5/51），2组比较差异有统计学意义（Z=-6.141、-2.733、-4.691，χ2=3.712，均P<0.05）；急诊护理团队实施团队资源管理前后C-SAQ总得分为（2.57±0.35）分和（3.39±0.41）分，有显著性提升（t=-3.704，P<0.05）。结论急诊卒中溶栓绿色通道中实施团队资源管理可缩短卒中溶栓患者急诊患者的EDLOS、DNT及OTT，提升DNT≤60 min的比例，减少院内延误，提高护理人员患者安全态度，提升急诊机构护理质量。
Objective To evaluate the effectiveness of applying team resource management (TRM) in emergency green track for acute ischemic stroke (AIS) patients treated by intravenous thrombolysis. Methods A historical control study was adopted in this study. During April to October in 2015, the experimental group consists of the acute ischemic stroke patients treated by intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). Applying TRM in emergency green track to settle strategies, recreate procedures of it, and make use of TRM′s skills. Length of stay in emergency department (EDLOS), door to needle time (DNT), onset to treatment time (OTT). the percentage of DNT≤60 min, and emergency nurses′ total Safety Attitude Questionnaire (SAQ) score (Before vs. after) were evaluated between the two group patients. Results After applying TRM in the experimental group for the AIS patients, the median EDLOS was 54.88 min, the median DNT was 79.95 min, the median OTT was 173 min, and the percentage of DNT≤ 60 min was 23.7% (14/59), comparing with the control group which the median EDLOS was 80.33 min, the median DNT was 111.63 min, the median OTT was 243 min, and the percentage of DNT≤ 60 min was 9.8% (5/51); the two groups had significantly differences (Z=-6.141,-2.733,-4.691,χ2=3.712,all P<0.05).The sore of emergency staff′s patient safety attitude increased significantly after applying TRM from 2.57 ± 0.35 to 3.39 ± 0.41(t=-3.704,P<0.05). Conclusions AIS patients′ EDLOS, DNT and OTT are significantly decreased after applying Team Resource Management, promoting staff′s SAQ-cores, patient safety as well as nursing quality.
出处
《中国实用护理杂志》
2016年第36期-,共6页
Chinese Journal of Practical Nursing
