非呼吸机相关性医院获得性肺炎发病率及护理错失机会的回顾性研究

A Retrospective Study of Non-Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care.

作者信息

Tesoro Mary, Peyser Diane J, Villarente Farley

机构信息

Author Affiliations: Assistant Director of Nursing (Dr Tesoro), Nursing Project Director for Magnet (Dr Peyser), Staff Nurse (Mr Villarente), Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York; Assistant Professor of Nursing at Lehman College (Dr Tesoro), The City University of New York, Bronx.

出版信息

J Nurs Adm. 2018 May;48(5):285-291. doi: 10.1097/NNA.0000000000000614.

DOI:10.1097/NNA.0000000000000614

PMID:29672375

Abstract

OBJECTIVE

To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities.

BACKGROUND

NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention.

METHODS

This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data.

RESULTS

Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time.

CONCLUSIONS

Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.

摘要

目的

确定非呼吸机相关性医院获得性肺炎（NV-HAP）的发病率，评估其对患者预后和成本的负面影响，并识别预防护理措施中被遗漏的机会。

背景

NV-HAP的研究尚不充分且报告不足。被遗漏的护理机会，尤其是口腔护理，可能有助于预防NV-HAP。

方法

本描述性、观察性、回顾性图表审查确定了成人NV-HAP病例以及相关的人口统计学和医院护理数据。

结果

蒙特菲奥里医疗中心1年内发生了205例NV-HAP病例，发病率为每1000患者日0.47例，估计额外费用为820万美元。15.6%的病例在肺炎发生后转入重症监护病房。出院时来自专科护理机构的护理需求增加（26.8%），而入院时为（17.6%）。大多数患者的护理记录不完整，60.5%的时间未记录口腔护理情况。