重症监护病房患者的活动能力及包括脸书群组在内的多方面干预措施的评估：一项准实验研究。
Patient mobilisation in the intensive care unit and evaluation of a multifaceted intervention including Facebook groups: A quasi-experimental study.
作者信息
Hauff Tonje, Petosic Antonija, Småstuen Milada Cvancarova, Wøien Hilde, Sunde Kjetil, Stafseth Siv K
机构信息
Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: https://twitter.com/@HauffTonje.
Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway. Electronic address: https://twitter.com/@AntonijaPetosic.
出版信息
Intensive Crit Care Nurs. 2023 Feb;74:103315. doi: 10.1016/j.iccn.2022.103315. Epub 2022 Oct 1.
AIMS
To describe prevalence and time to mobilisation in intensive care unit patients defined as a minimum sitting in an upright position in bed, and evaluate the impact of a multifaceted quality improvement campaign on likelihood of patients being mobilised.
RESEARCH METHODOLOGY/DESIGN: Quality improvement project using a quasi-experimental study design, comparing patient cohorts before (Before) and after (Intervention) a campaign including educational sessions, audit and feedback of intensive care unit quality indicators via closed Facebook-groups and e-mail and local opinion leaders. Secondary analysis of mobilisation data from adult intensive care patient stays extracted from electronical medical charts. Likelihood of being mobilised was analysed with Multivariate Cox-regression model and reported as Sub-hazard Ratio (SHR).
SETTING
Four intensive care units in a university hospital.
MAIN OUTCOME MEASURES
Prevalence and time to first documented mobilisation, defined as at least "sitting in bed" during the intensive care unit stay.
RESULTS
Overall, 929 patients were analysed, of whom 710 (76 %) were mobilised; 73 % (356/ 489) in Before vs 81 % (354/ 440) in Intervention (p = 0.007). Median time to mobilisation was 69.9 (IQR: 30.0, 149.8) hours; 71.7 (33.9, 157.9) in Before and 66.0 (27.1, 140.3) in Intervention (p = 0.104). Higher SAPS II-scores were associated with lower likelihood (SHR 0.98, 95 % CI 0.97-0.99), whereas admissions due to gastroenterological failure (SHR 2.1, 95 % CI 1.4-3.0), neurological failure (SHR 1.5, 95 % CI 1.0-2.2) and other causes (intoxication, postoperative care, haematological-, and kidney failure) (SHR 1.7, 95 % CI 1.13-2.6) were associated with higher likelihood of mobilisation vs respiratory failure.
CONCLUSION
A quality improvement campaign including use of Facebook groups is feasible and may improve mobilisation in intensive care unit patients. Most patients were mobilised within 72 hours following intensive care unit admission, and SAPS II scores and causes for intensive care unit admission were both associated with likelihood of being mobilised.
目的
描述重症监护病房患者的活动率及达到活动状态的时间（定义为至少在床上呈直立坐姿），并评估多方面质量改进活动对患者实现活动状态可能性的影响。
研究方法/设计：采用准实验研究设计的质量改进项目，比较在开展一项活动之前（“之前”组）和之后（“干预”组）的患者队列。该活动包括教育课程、通过封闭的脸书群组和电子邮件对重症监护病房质量指标进行审核与反馈，以及邀请当地意见领袖参与。对从电子病历中提取的成年重症监护患者住院期间的活动数据进行二次分析。使用多变量Cox回归模型分析实现活动状态的可能性，并报告为亚风险比（SHR）。
研究地点
一家大学医院的四个重症监护病房。
主要观察指标
首次记录到活动的发生率及时间，定义为在重症监护病房住院期间至少“在床上坐起”。
结果
总体上，分析了929例患者，其中710例（76%）实现了活动；“之前”组为73%（356/489），“干预”组为81%（354/440）（p = 0.007）。活动的中位时间为69.9小时（四分位间距：30.0，149.8）；“之前”组为71.7小时（33.9，157.9），“干预”组为66.0小时（27.1，140.3）（p = 0.104）。较高的简化急性生理学评分系统（SAPS）II分值与较低的活动可能性相关（SHR 0.98，95%置信区间0.97 - 0.99），而因胃肠功能衰竭入院（SHR 2.1，95%置信区间1.4 - 3.0）、神经功能衰竭入院（SHR 1.5，95%置信区间1.0 - 2.2）以及其他原因（中毒、术后护理、血液系统和肾脏功能衰竭）入院的患者与因呼吸功能衰竭入院的患者相比，活动可能性更高（SHR 1.7，95%置信区间1.13 - 2.6）。
结论
包括使用脸书群组在内的质量改进活动是可行的，可能会改善重症监护病房患者的活动情况。大多数患者在重症监护病房入院后72小时内实现了活动，SAPS II分值和重症监护病房入院原因均与活动可能性相关。
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