Henry S B
Department of Physiologic Nursing, University of California, San Francisco 94143-0604.
Heart Lung. 1991 Sep;20(5 Pt 1):469-77.
The purposes of this study were to describe the clinical decision making of critical care nurses managing computer-simulated tachydysrhythmias and to assess the major sources of error related to the management of two tachydysrhythmias: atrial flutter and ventricular tachycardia. In this descriptive study, 142 critical care nurses each completed four computerized clinical simulations (two atrial flutter and two ventricular tachycardia). Simulation performance was measured by proficiency score (comparison with expert performance), patient outcome (cure or die), and amount of data collected before the first intervention. Mean proficiency scores were 51% for atrial flutter and 35% for ventricular tachycardia. Thirteen percent of the atrial flutter and 35% of the ventricular tachycardia simulations ended in patient death. Failure to recognize ventricular tachycardia and unfamiliarity with second- and third-line treatments were major sources of error. Medication errors were the cause of death in 87% of the simulations ending in patient death. These results document the need for emphasis on dysrhythmia management in the critical care curriculum.
本研究的目的是描述重症监护护士处理计算机模拟快速心律失常的临床决策过程，并评估与两种快速心律失常（心房扑动和室性心动过速）管理相关的主要错误来源。在这项描述性研究中，142名重症监护护士每人完成了四次计算机化临床模拟（两次心房扑动和两次室性心动过速）。模拟表现通过熟练程度评分（与专家表现比较）、患者结局（治愈或死亡）以及首次干预前收集的数据量来衡量。心房扑动的平均熟练程度评分为51%，室性心动过速为35%。13%的心房扑动模拟和35%的室性心动过速模拟以患者死亡告终。未能识别室性心动过速以及对二线和三线治疗不熟悉是主要错误来源。在以患者死亡告终的模拟中，87%的死亡原因是用药错误。这些结果表明在重症护理课程中需要强调心律失常的管理。
