Nursing Department, Zhongshan Hospital, Fudan University.
The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence.
JBI Evid Implement. 2021 Jan 5;19(4):347-356. doi: 10.1097/XEB.0000000000000270.
The aim of this implementation project was to improve nutritional screening and nutritional interventions for patients scheduled for gastrointestinal surgery in a general surgical ward.
Malnutrition is common in hospitalized surgical patients and has many adverse outcomes affecting the patients' quality of life. Improving nutritional risk screening and nutritional support could reduce the incidence of malnutrition and its adverse outcomes.
The project used the JBI audit and feedback method to implement evidence into practice. JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for promoting change in general surgical wards. Six audit criteria were created based on an evidence summary, including using screening tool, patients' and caregivers' education, nurses' education on nutritional screening and support, preoperative nutrition support and postoperative early food intake. A baseline audit was conducted, followed by nursing information system improvement, education, multidisciplinary meetings targeted at clinicians and two cycles of follow-up audits.
Results from the baseline and follow-up audits showed improvement for all the criteria. Compliance for criteria 1-3 increased from 0 to 100%, and that for criterion 4 increased from 32 to 100%. These four criteria sustained 100% in follow-up cycle 2. Compliance for criterion 5 increased from 8 to 50% in follow-up cycle 1 audit, but decreased to 0% in follow-up cycle 2 audit, and similarly for criterion 6, compliance increased from 45 to 56% in follow-up cycle 1 audit, but decreased to 48% in follow-up cycle 2 audit.
The objectives related to nutritional risk screening, nurse knowledge, patients and families were successfully realized and sustained positive results. This project demonstrated that a nursing information system and long-term patient education are essential strategies to achieve and sustain positive results. The objectives related to preoperative nutritional support and postoperative early enteral food intake were challenges and represented barriers. In future, a multiple-pronged strategy will be implemented to achieve overall success and change according to best practice.
本实施项目旨在改善普通外科病房接受胃肠道手术患者的营养筛查和营养干预。
营养不良在住院外科患者中很常见，会导致许多不良后果，影响患者的生活质量。改善营养风险筛查和营养支持可降低营养不良及其不良后果的发生率。
该项目使用 JBI 审核和反馈方法将证据应用于实践。JBI 实用临床证据系统和获取研究实践审核工具用于促进普通外科病房的变革。基于证据总结，创建了 6 项审核标准，包括使用筛查工具、患者和照护者教育、护士营养筛查和支持教育、术前营养支持和术后早期进食。进行基线审核，随后改进护理信息系统，开展教育，为临床医生召开多学科会议，并进行两轮后续审核。
基线和后续审核的结果显示所有标准均有所改善。标准 1-3 的合规性从 0%提高到 100%，标准 4 的合规性从 32%提高到 100%。这四项标准在后续审核周期 2 中保持 100%的合规性。标准 5 的合规性在后续审核周期 1 审核中从 8%提高到 50%，但在后续审核周期 2 审核中降至 0%，标准 6 的合规性在后续审核周期 1 审核中从 45%提高到 56%，但在后续审核周期 2 审核中降至 48%。
与营养风险筛查、护士知识、患者和家属相关的目标成功实现并持续取得积极成果。该项目表明，护理信息系统和长期患者教育是实现和持续取得积极成果的必要策略。与术前营养支持和术后早期肠内进食相关的目标具有挑战性，代表了障碍。未来，将实施多管齐下的策略，根据最佳实践实现全面成功和变革。
