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腹部手术后患者静脉血栓栓塞的预防:一项最佳实践实施项目

Prevention of venous thromboembolism in postoperative abdominal patients: a best practice implementation project.

作者信息

Zhao WenWen, McArthur Alexa, Yu ZhengHong, Hu Yan, Luo Jing

机构信息

Fudan University Centre for Evidence-based Nursing: a Joanna Briggs Institute Centre of Excellence.

ZhongShan Hospital of Fudan University, Department of Medical, Fudan University, Faculty of Nursing, Shanghai, China.

出版信息

JBI Database System Rev Implement Rep. 2018 Sep;16(9):1887-1901. doi: 10.11124/JBISRIR-2017-003665.

Abstract

OBJECTIVES

This project's aim was to ensure that venous thromboembolism assessment was performed accurately, and that adequate prophylaxis was followed-up, resulting in a decrease in the incidence of venous thromboembolism postoperatively and enhancing recovery after surgery.

INTRODUCTION

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients. Evidence suggests that the majority of hospital patients are at risk for VTE, but the prophylaxis recommended for their risk factors are not adequately utilized. Venous thromboembolism prevention is primarily based on an adequate risk stratification.

METHODS

A baseline audit on VTE prevention utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System program was undertaken and involved 21 nurses and 30 patients. An intervention including VTE education, clinical practice and prophylaxis was conducted, following which a post-implementation re-audit was undertaken.

RESULTS

The baseline audit results showed that four audit criteria results were found to under 30%, which indicated poor compliance with the current evidence. After implementing the strategies, including education, VTE video, etc., there was a huge improvement, with most of the audit criteria achieving 100% compliance.

CONCLUSIONS

Overall the project achieved a significant improvement in evidence-based practice in the prevention of VTE, implemented in two wards. Sustaining best practice should be planned for the future.

摘要

目的

本项目旨在确保准确进行静脉血栓栓塞评估,并对充分的预防措施进行跟踪,以降低术后静脉血栓栓塞的发生率并促进术后恢复。

引言

静脉血栓栓塞(VTE)包括深静脉血栓形成和肺栓塞,是住院患者发病和死亡的主要原因。有证据表明,大多数住院患者有发生VTE的风险,但针对其风险因素推荐的预防措施未得到充分利用。静脉血栓栓塞的预防主要基于充分的风险分层。

方法

利用乔安娜·布里格斯研究所临床证据系统实际应用程序对VTE预防进行了基线审核,涉及21名护士和30名患者。开展了包括VTE教育、临床实践和预防在内的干预措施,之后进行了实施后的重新审核。

结果

基线审核结果显示,四项审核标准的结果低于30%,这表明对当前证据的依从性较差。在实施包括教育、VTE视频等策略后,有了巨大改善,大多数审核标准的依从率达到了100%。

结论

总体而言,该项目在两个病房实施的VTE预防循证实践方面取得了显著改善。应规划在未来维持最佳实践。

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