通过改善护理来学习安全实践：在呼吸病房中由学生主导的氧气处方干预。

Specialty Registrar, University of Dundee Medical School, UK.

Scott Med J. 2013 Nov;58(4):204-8. doi: 10.1177/0036933013508062.

BACKGROUND AND OBJECTIVE

The primary aim of this intervention was to improve oxygen prescribing in accordance with the 2008 British Thoracic Society guidelines for the prescription of emergency oxygen in adults.

METHODS

Eight final year medical students reviewed the drug charts of all patients admitted to the respiratory ward on a daily basis in order to collect data on five audit questions: (1) Has oxygen (O2) been prescribed? (2) Has an O2 target saturation level been indicated? (3) Has O2 been prescribed as an 'as required' (PRN) or 'continuous therapy'? (4) Has the prescription been signed? (5) Has O2 been signed for in every drug round since the original prescription? Following an initial audit cycle an educational poster was distributed to all clinical staff via email and hard copies of the poster were placed strategically throughout the ward before its effectiveness was measured.

RESULTS

During the pre-intervention phase, compliance with all five measures varied from 0 to 25%. There was an increase in the variation in compliance after the poster intervention to 14-44%; however, this masked better overall compliance with all five investigative questions with figures of 44%, 39% and 42% being recorded in three of the four post-intervention days. Overall there was increased compliance with four of the five audit questions. Indeed compliance with question 3 rose from 14% to 83%.

CONCLUSIONS

The poster intervention was marginally effective while also showing that students can improve prescribing in a clinical setting.

背景与目的

本次干预的主要目的是根据 2008 年英国胸科学会（British Thoracic Society）成人急诊氧气处方指南改善氧气处方。

方法

8 名临床医学专业的最后一年学生每天审查呼吸病房所有患者的药物图表，以收集五个审核问题的数据：（1）是否开具了氧气（O2）？（2）是否指明了 O2 目标饱和度水平？（3）是否将 O2 开具为“按需”（PRN）或“持续治疗”？（4）处方是否已签署？（5）自最初处方以来，每次药物治疗轮次是否都开具了 O2？在初始审核周期之后，通过电子邮件向所有临床工作人员分发了教育海报，并在病房内战略性地放置了海报的硬拷贝，然后测量其效果。

结果

在干预前阶段，所有五项措施的合规性从 0 到 25%不等。海报干预后，合规性的变化幅度增加到 14-44%；然而，这掩盖了所有五个调查问题的总体合规性更好，在干预后的四天中的三天中，记录的数字分别为 44%、39%和 42%。五项审核问题中的四项总体上的合规性都有所提高。实际上，第 3 个问题的合规性从 14%提高到了 83%。