危重症成年患者的院内转运：标准化评估方案
Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan.
作者信息
Jones Honey M, Zychowicz Michael E, Champagne Mary, Thornlow Deirdre K
机构信息
Honey M. Jones, DNP, ACNP-BC, is an acute care nurse practitioner at Duke University Medical Center and the University of North Carolina at Chapel Hill. She also serves as clinical associate faculty for the MSN program at the Duke University School of Nursing. Her primary role is providing care for critically ill adults, and her clinical experience includes neurocritical care, cardiothoracic surgery, electrophysiology, and cardiac catheterization lab. She received her doctoral degree from Duke University, and her research interests include intrahospital transport of critically ill adults and neurocritical care practice issues. Michael E. Zychowicz, DNP, ANP, ONP, FAANP, is an associate professor and director of the MSN Program at DUSON. He is certified as both an adult nurse practitioner and an orthopedic nurse practitioner. His specialty is orthopedic nursing, with subspecialties in sports medicine, spine surgery, and general orthopedics. He received his doctoral degree from Case Western Reserve University. His research and clinical interests include occupational back injuries and the impact of health beliefs on return to work time. Mary Champagne, PhD, RN, FAAN, is Laurel Chadwick Distinguished Professor and dean emerita of DUSON. She has a secondary appointment as professor in the Department of Community and Family Medicine of the Duke University School of Medicine and is also a Senior Fellow of the Duke Center for the Study of Aging and Human Development. She received her doctoral degree from the University of Texas at Austin. Her research interests involve improving health in low-income seniors living locally in subsidized housing, quality and safety in the Duke Healthcare system, wound and ostomy care and quality of life of individuals with stomas, and the prevention of acute confusion in hospitalized elderly patients. Deirdre K. Thornlow, PhD, RN, CPHQ, is an assistant professor at DUSON, a John A. Hartford Foundation Claire M. Fagin Fellow, and a Senior Fell
出版信息
Dimens Crit Care Nurs. 2016 May-Jun;35(3):133-46. doi: 10.1097/DCC.0000000000000176.
BACKGROUND
Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events.
OBJECTIVE
The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units.
METHODS
Nurses at a level I trauma/academic center captured clinical data throughout transport. Outcome measures included compliance with the organization's transport policy and unexpected events.
RESULTS
There were 502 transports audited. Most nurses were compliant with the policy, except for the stabilization process (n = 174, 34.7%). Forty-one transports (8.2%) had an unexpected event, and 11 of these transports (26.8%) were aborted. Most of the events were hemodynamic (12), sedation (11), respiratory (10), and gastrointestinal (5). Fewer events occurred with the transport team (P = .036) and among nurses with a bachelor of science in nursing or higher degree (P = .002). Events were higher among transporting nurses with only 0 to 2 years of intensive care unit experience (P = .002), "stabilized" transports (P = .022), and patients with higher Acute Physiology and Chronic Health Evaluation scores (P = .009).
CONCLUSIONS
Health care organizations should have a policy that includes both transport and evaluation plans for intrahospital transport. Guidelines should be revised with specific criteria for the stabilization process and unexpected events. Revision should also have a standardized evaluation plan that includes an audit tool to measure incidence of unexpected events and a rapid change quality improvement method.
背景
危重症成年患者在医院内转运存在固有风险，可能表现为意外事件。
目的
本研究旨在评估针对成年重症监护病房患者院内转运的标准化评估计划的实施情况。
方法
一所一级创伤/学术中心的护士在整个转运过程中收集临床数据。结果指标包括对机构转运政策的遵守情况和意外事件。
结果
共审核了502次转运。除了稳定过程（n = 174，34.7%）外，大多数护士遵守政策。41次转运（8.2%）发生了意外事件，其中11次转运（26.8%）中止。大多数事件为血流动力学方面（12例）、镇静方面（11例）、呼吸方面（10例）和胃肠道方面（5例）。转运团队发生的事件较少（P = 0.036），在拥有护理学理学学士或更高学位的护士中事件也较少（P = 0.002）。在重症监护病房工作经验仅0至2年的转运护士中（P = 0.002）、“稳定”转运过程中（P = 0.022）以及急性生理与慢性健康状况评分较高的患者中（P = 0.009）事件较多。
结论
医疗机构应制定一项包含医院内转运的转运和评估计划的政策。应根据稳定过程和意外事件的具体标准修订指南。修订还应包括一个标准化评估计划，其中包括用于衡量意外事件发生率的审核工具和快速变化质量改进方法。
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