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预防皮肤染色:一种有效的铁输注方案。

Preventing skin staining: an effective iron infusion protocol.

机构信息

Mid-Western Intern Network, University Hospital Limerick, Limerick, Ireland.

Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland.

出版信息

Int J Health Care Qual Assur. 2020 Mar 6;ahead-of-print(ahead-of-print). doi: 10.1108/IJHCQA-10-2019-0177.

Abstract

PURPOSE

To implement a safe and effective intravenous iron infusion protocol to prevent skin staining.

DESIGN/METHODOLOGY/APPROACH: Mixed methods approach was utilised including education, auditing, self-reported survey, patient information leaflet and patient feedback. In total 25 healthcare professionals completed the survey and 15 patients provided feedback.

FINDINGS

No skin staining or severe adverse reactions were observed over eight weeks. Audit results found 53 per cent of staff were compliant with the recommended IV iron infusion protocol and 46 per cent informed patients of skin staining risk. Self-report surveys indicated 92 per cent flushed the cannula with sodium chloride before starting the infusion, 88 per cent flushed the cannula after the infusion and 76 per cent informed patients of skin staining risk. Patient feedback was largely positive and constructive.

RESEARCH LIMITATIONS

Limitations include self-reported bias, short audit time interval, missing data and discrepancy between audit and survey results.

ORIGINALITY/VALUE: This quality improvement project was developed following two skin staining incidences at our maternity hospital. Although rare, skin staining after intravenous iron infusion is potentially permanent and may be distressing for some patients. Intravenous iron is considered safe and effective to treat anaemia during pregnancy and is often prescribed for this patient cohort. To avoid medicolegal action and patient dissatisfaction, it is essential that patients are informed of potential skin staining and an evidence-based administration protocol is utilised.

摘要

目的

实施安全有效的静脉铁输注方案以预防皮肤染色。

设计/方法/途径:采用混合方法,包括教育、审核、自我报告调查、患者信息传单和患者反馈。共有 25 名医疗保健专业人员完成了调查,15 名患者提供了反馈。

发现

在八周内未观察到皮肤染色或严重不良反应。审核结果发现,53%的工作人员遵守了推荐的静脉铁输注方案,46%的工作人员告知了患者皮肤染色风险。自我报告调查显示,92%的人在开始输注前用生理盐水冲洗导管,88%的人在输注后冲洗导管,76%的人告知了患者皮肤染色风险。患者反馈大多是积极和建设性的。

研究局限性

局限性包括自我报告的偏见、审核时间间隔短、数据缺失以及审核和调查结果之间的差异。

原创性/价值:该质量改进项目是在我们的妇产科医院发生两例皮肤染色事件后开发的。虽然罕见,但静脉铁输注后皮肤染色可能是永久性的,并且可能会使一些患者感到困扰。静脉铁被认为在怀孕期间治疗贫血是安全有效的,并且经常为这一患者群体开处方。为了避免医疗法律诉讼和患者不满,必须告知患者潜在的皮肤染色,并使用基于证据的管理方案。

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