Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Yuexiu District, Guangzhou, China.
Nursing department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Yuexiu District, Guangzhou, China.
BMC Neurol. 2022 Aug 11;22(1):297. doi: 10.1186/s12883-022-02826-8.
Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP).
The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP.
The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine.
A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle.
Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.
肺部感染是脑卒中患者的常见并发症，会对临床结局产生不利影响，增加住院时间和费用，并加重国家医疗保健系统的经济负担。早期识别和管理高危患者对于降低卒中相关性肺炎（SAP）的发生率是必要且必要的。
该循证实践项目评估了标准护理包干预在预防 SAP 发生中的有效性。
该项目在一家教学医院的神经内科进行。鉴于评估和管理标准的差异，采用循证实践（EBP）方法制定了质量改进流程。进行了彻底的文献检索，以确定管理和预防 SAP 的循证干预措施。对文献进行了彻底的批判性评价并综合了证据。建立了系统的管理流程和护理包干预措施。护理包包括干预措施，如使用 SAP 风险筛查工具；吞咽困难筛查和康复；饮食调整、口腔护理、气道管理、体位管理和中医护理技术。
与实施前组相比，实施后组患者 SAP 的预防有显著改善（14.0%对 37.2%，p=0.025）。此外，在实施护理包后，住院时间明显缩短，误吸率降低，白蛋白和口腔卫生得到改善。
循证护理包成功地赋予护士权力，降低 SAP 的发生率。SAP 预防管理流程可在未来推广到神经内科的其他单位。该项目的结果反映了在急性护理环境中实施 EBP 的能力，EBP 方法可用于解决其他临床问题。
