麻醉后护理单元中一种新设计的观察、反应及出院图表对患者预后的影响：澳大利亚的一项准实验研究
Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia.
作者信息
Street Maryann, Phillips Nicole M, Mohebbi Mohammadreza, Kent Bridie
机构信息
School of Nursing and Midwifery, Deakin University, Geelong, Australia.
Eastern Health-Deakin University Nursing and Midwifery Research Centre, Box Hill, Australia.
出版信息
BMJ Open. 2017 Dec 3;7(12):e015149. doi: 10.1136/bmjopen-2016-015149.
OBJECTIVES
This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes.
METHODS
A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT).
RESULTS
Nursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT.
CONCLUSION
This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.
目的
本研究旨在评估使用麻醉后护理单元（PACU）患者护理评估的出院标准工具是否会提高护士对病情恶化风险患者的识别和反应能力，并改善患者预后。
方法
在澳大利亚的三家医院进行了一项前瞻性非随机干预前后研究。参与者为接受择期手术的成年人，在实施麻醉后护理工具（PACT）之前（n = 723）和之后（n = 694）。
结果
使用PACT时，护士对病情恶化风险患者的反应更高，PACU护士发起的医疗会诊更多（19%对30%，P<0.001），并且在PACU期间有更多患者的医疗急救团队启动标准被麻醉师修改（6.5%对13.8%，P<0.001）。镇痛药物的给药率更高（37.3%对54.2%，P = 0.001），出院前对疼痛的护理评估和持续镇痛的记录更多（55%对85%，P<0.001）。引入PACT后，PACU记录的不良事件更多（8.3%对16.7%，P<0.001）。PACU出院后的不良事件发生率保持不变（16.5%），但使用PACT后，PACU出院后的心脏事件发生率（5.1%对2.6%，P = 0.021）和临床恶化发生率（8.7%对4.3%，P = 0.001）显著降低。尽管第二阶段不良事件患者数量增加，但医疗费用并未显著增加。实施PACT后，PACU中发生不良事件的患者的PACU住院时间和住院时间显著缩短。
结论
本研究发现，使用结构化的出院标准工具PACT可提高护士对临床恶化患者的识别和反应能力，缩短PACU中发生不良事件患者的住院时间，且具有成本效益。
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