Street Maryann, Phillips Nicole M, Kent Bridie, Colgan Stephen, Mohebbi Mohammadreza
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia.
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
BMJ Open. 2015 Jun 1;5(6):e007200. doi: 10.1136/bmjopen-2014-007200.
While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs.
A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs.
This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs.
虽然手术术后不良事件的风险已被确认，但护理对这些事件早期发现的影响尚未明确。一项针对麻醉后护理的证据系统评价和专家共识研究确定了麻醉后护理单元（PACU）患者出院准备情况护理评估的基本标准。这些标准被纳入一种新的护理评估工具——麻醉后护理工具（PACT），并在一家大型医疗服务机构的麻醉后护理记录中得以应用。本研究的目的是测试PACT的临床可靠性，并评估使用PACT是否会：（1）加强对PACU中病情恶化风险患者的识别和应对；（2）改善从PACU护士到病房护士的交接记录；（3）带来更好的患者结局；（4）降低医疗成本。
采用前瞻性、非随机、实施前与实施后设计进行比较：（1）PACT实施前接受手术的患者（n = 750）；（2）PACT实施后接受手术的患者（n = 750）。本研究将通过观察患者护理和护理交接来考察该工具的使用情况。患者结局和成本效益将根据医疗服务数据和病历审核来确定。描述性统计将用于描述样本并比较两组患者（干预前和干预后）。两组患者结局的差异将使用 Cochr an-Mantel-Haenszel检验和回归分析进行比较，并以比值比及相应的95%置信区间报告。
本研究将测试PACT的临床可靠性和成本效益。假设PACT将使护士能够识别并应对病情恶化风险患者；改善向病房护士的交接；改善患者结局并降低医疗成本。
