Dartey W, Borase H, Organ A, Evans T, Fox R
Division of Women's and Children's Health, Taunton and Somerset Hospital, Taunton, UK.
J Obstet Gynaecol. 2010 Feb;30(2):166-70. doi: 10.3109/01443610903443939.
Over the last decade, nurse-led services have been introduced as an alternative pathway of patient care, in part to undertake work performed by trainee medical staff before the reduction in working hours. In response to the loss of trainee hours resulting from implementation of the European Working Time Directive, we set up a new service with a highly experienced gynaecology nurse who underwent additional training in preoperative assessment and consenting. The service was founded on the nurse-practitioner's expertise, together with the use of an integrated care pathway and 12 preformatted consent sheets. We undertook a case note review of 100 consecutive patients. The review of the service showed a high level of compliance for performance of laboratory and radiological investigations, both in terms of completion and the avoidance of unnecessary tests. In addition, the nurse-practitioner was able to obtain written consent from almost 87% of women undergoing surgery using a range of just nine preformatted sheets. No serious medical issues were overlooked and no operations were cancelled on the day of surgery. The quality of documentation was exemplary and there were no complaints or clinical incidents related to the nurse-practitioner in 4 years of service. The quality of patient care can be maintained, if not improved, by integrating nurse-led preoperative assessment into the departmental clinical pathway for women choosing elective surgery.
在过去十年中，引入了由护士主导的服务作为患者护理的替代途径，部分原因是为了承担实习医务人员在工作时间减少之前所做的工作。为应对因实施《欧洲工作时间指令》导致的实习时间减少，我们设立了一项新服务，由一位经验丰富的妇科护士负责，她接受了术前评估和同意方面的额外培训。该服务基于执业护士的专业知识，同时使用综合护理路径和12份预先格式化的同意书。我们对100例连续患者的病历进行了回顾。对该服务的审查表明，在实验室和放射学检查的执行方面，无论是在完成情况还是避免不必要的检查方面，都有很高的合规性。此外，执业护士能够使用仅九份预先格式化的表格，从近87%接受手术的女性那里获得书面同意。没有忽视任何严重的医疗问题，手术当天也没有手术被取消。文件记录的质量堪称典范，在四年的服务期内，没有与执业护士相关的投诉或临床事件。通过将由护士主导的术前评估纳入选择择期手术的女性的部门临床路径，即使不能提高患者护理质量，也可以维持该质量。
