Reed Sean, Remenyte-Prescott Rasa, Rees Ben
Resilience Engineering Research Group, University of Nottingham, Nottingham, UK.
Resilience Engineering Research Group, University of Nottingham, Nottingham, UK.
Int J Nurs Stud. 2017 Mar;68:73-82. doi: 10.1016/j.ijnurstu.2016.12.010. Epub 2016 Dec 29.
Healthcare aims to deliver good patient outcomes. For many clinical procedures there are multiple alternative task sequences that can be performed. These deviations can influence procedure reliability, efficiency of usage of hospital resources and risk to staff and patient safety. Venepuncture is one of the most common invasive procedures in healthcare. Literature of clinical practice shows evidence of wide variability in the procedure order and the duration of each step, which can depend on attributes, such as patient health, sampling method and staff skills.
To use a computer simulation model based on Petri nets to evaluate the impact on outcomes of commonly practiced deviations from the venepuncture procedure guideline and variations in key dependent variables. The outcomes considered include the probability of successfully obtaining a blood sample and the procedure completion time.
A computer simulation model was constructed using the Petri net technique which mimics the different variations of the venepuncture procedure. Qualitative and quantitative data for the model was collected from the literature and through interviews and questionnaire responses from doctors and phlebotomists. Statistics on the reliability and duration for different variations were then calculated from the model output.
A digital laboratory to model venepuncture in secondary care.
The model showed that the common practice of applying the tourniquet prior to vein identification and releasing it after sample tubes are filled may result in a ten-fold increase in sample haemolysis, compared to the recommended guideline procedure. Equipment layout on wards and patient vein prominence were identified as the two most important factors influencing time efficiency of blood sample collection.
Petri net computer models were shown to be an effective method for evaluating the success rate and completion time of the venepuncture procedure under alternative task sequences and variations in key dependent variables. The results obtained from the model showed a significant increase in the rate of sample laboratory rejection due to haemolysis when commonly practiced deviations from the guideline procedure were performed. The rate of failure to collect a sample and the mean time for performing the procedure increased significantly for patients with less prominent veins and when the procedure was performed on unfamiliar wards. These results highlight the need for healthcare providers to ensure guidelines are followed when performing venepuncture, equipment layouts are standardised across locations and that the vein prominence of different patient groups is considered when allocating resources for blood sample collection.
医疗保健旨在实现良好的患者治疗效果。对于许多临床操作而言，存在多种可执行的替代任务序列。这些偏差会影响操作的可靠性、医院资源的使用效率以及对医护人员和患者安全的风险。静脉穿刺是医疗保健中最常见的侵入性操作之一。临床实践文献表明，操作顺序和每个步骤的持续时间存在很大差异，这可能取决于患者健康状况、采样方法和医护人员技能等因素。
使用基于Petri网的计算机模拟模型，评估静脉穿刺操作指南中常见偏差以及关键相关变量变化对结果的影响。所考虑的结果包括成功采集血样的概率和操作完成时间。
使用Petri网技术构建计算机模拟模型，该模型模拟静脉穿刺操作的不同变化。模型的定性和定量数据从文献中收集，并通过对医生和采血人员的访谈及问卷调查获得。然后根据模型输出计算不同变化的可靠性和持续时间统计数据。
一个用于模拟二级医疗中静脉穿刺的数字实验室。
该模型表明，与推荐的操作指南程序相比，在识别静脉之前应用止血带并在装满采样管后松开止血带的常见做法可能会使样本溶血增加十倍。病房的设备布局和患者静脉的突出程度被确定为影响血样采集时间效率的两个最重要因素。
Petri网计算机模型被证明是评估替代任务序列和关键相关变量变化下静脉穿刺操作成功率和完成时间的有效方法。该模型获得的结果表明，当执行与指南程序的常见偏差时，由于溶血导致的样本实验室拒收率显著增加。对于静脉不太突出的患者以及在不熟悉的病房进行操作时，采集样本失败的比率和执行操作的平均时间显著增加。这些结果凸显了医疗保健提供者在进行静脉穿刺时确保遵循指南、跨地点标准化设备布局以及在分配血样采集资源时考虑不同患者群体静脉突出程度的必要性。
