Yang Lixiao, Wu Yanni, Zhou Chunlan, Xie Cuihua, Jiang Ya, Wang Run, Ye Xiaoling
Nanfang Hospital, Southern Medical University.
School of Nursing, Southern Medical University.
JBI Evid Implement. 2022 Dec 1;20(4):269-279. doi: 10.1097/XEB.0000000000000306.
Diabetic foot ulcer (DFU) is one of the most serious complications in patients with diabetes. Early identification of risk factors can prevent its occurrence and delay its progression. The aim of this project is to conduct an audit of DFU risk assessment protocols at a large tertiary hospital and evaluate the impact of any changes in compliance with the developed evidence-based best practice criteria.
Preimplementation and postimplementation audits based on JBI's Practical Application of Clinical Evidence System were conducted at the Department of Endocrinology and Metabolism of a tertiary hospital in China. The Getting Research into Practice audit tool was used to analyze the barriers and inadequacies encountered in practice. A total of 12 nurses and 30 patients with diabetes were included in the baseline and follow-up audits.
There were 15 baseline audits that indicated deficits in DFU risk assessment by nurses, with 0% compliance for three criteria and 50% compliance or less for seven others. Strategies developed by the project team to address the identified barriers to compliance were adopted, leading to significant improvement in compliance with most criteria at the follow-up audit compared with baseline with 11 criteria achieving at least 90% compliance.
The project showed that regular audits of foot ulcer risk assessment can help to identify barriers to their implementation. Advising patients of their risk status can support appropriate self-care practices. Further audits are needed to implement evidence-based practices in all aspects of diabetes patient care.
糖尿病足溃疡（DFU）是糖尿病患者最严重的并发症之一。早期识别风险因素可预防其发生并延缓其进展。本项目的目的是对一家大型三级医院的DFU风险评估方案进行审核，并评估遵循已制定的循证最佳实践标准所做的任何改变的影响。
在中国一家三级医院的内分泌代谢科，基于JBI临床证据系统的实际应用进行实施前和实施后审核。使用“将研究成果应用于实践”审核工具分析实践中遇到的障碍和不足之处。基线审核和随访审核共纳入12名护士和30例糖尿病患者。
15次基线审核表明护士在DFU风险评估方面存在缺陷，三项标准的依从率为0%，其他七项标准的依从率为50%或更低。项目团队制定了应对已识别的依从性障碍的策略并予以采用，与基线相比，随访审核时大多数标准的依从性显著提高，11项标准的依从率至少达到90%。
该项目表明，定期审核足部溃疡风险评估有助于识别其实施过程中的障碍。告知患者其风险状况有助于支持适当的自我护理措施。需要进一步审核以在糖尿病患者护理的各个方面实施循证实践。
