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实施护士主导的多学科联合查房会议以改善 ICU 早期康复:一项医疗质量改进项目。

Implementation of a nurse-led multidisciplinary huddle meeting for improvement of early rehabilitation in ICU: a healthcare quality improvement project.

机构信息

Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, Japan

Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan.

出版信息

BMJ Open Qual. 2023 Sep;12(3). doi: 10.1136/bmjoq-2022-002215.

Abstract

The physical decline of critically ill patients affects their discharge from the intensive care unit (ICU) and their subsequent lives. Therefore, it is essential to actively provide rehabilitation at an early stage through multidisciplinary cooperation and protocols. This paper aims to describe the results of a project to improve the implementation rate of early rehabilitation. We established the ICU Early Rehabilitation Group, consisting of nurses, intensivists and physical therapists, and developed a protocol to perform early rehabilitation. According to this protocol, a nurse-led 'multidisciplinary rehabilitation huddle meeting' was introduced for early rehabilitation. Rehabilitation status, muscle strength and physical function were compared 9 months before and after the introduction of the huddle meeting. In addition, we assessed adverse events during rehabilitation. Since the introduction of huddle meetings, the implementation rate has been 100%. Furthermore, rehabilitation was implemented earlier and at a higher level after introducing huddle meetings. However, no significant difference was detected in muscle strength and physical function of the patients. In addition, no adverse events occurred during rehabilitation. This quality improvement project facilitated an earlier start to rehabilitation and a higher level of rehabilitation practice. Huddle meetings were smoothly introduced and settled in through multiprofessional communication. The lack of adverse events also suggested the programme's effectiveness in safely implementing this type of rehabilitation at an early and high level.

摘要

危重症患者的身体机能下降会影响他们从重症监护病房(ICU)出院后的生活。因此,通过多学科合作和制定方案,积极提供早期康复治疗至关重要。本文旨在介绍一个提高早期康复实施率的项目成果。我们成立了由护士、重症医生和物理治疗师组成的 ICU 早期康复小组,并制定了早期康复方案。根据该方案,引入了以护士为主导的“多学科康复碰头会”来进行早期康复。在引入碰头会前、后 9 个月,比较了康复状态、肌肉力量和身体功能。此外,还评估了康复期间的不良事件。碰头会引入后,实施率达到了 100%。此外,引入碰头会后,康复开始得更早,康复水平也更高。但是,患者的肌肉力量和身体功能没有显著差异。此外,康复期间没有发生不良事件。这个质量改进项目促进了更早开始康复和更高水平的康复实践。通过多专业沟通,碰头会顺利引入并得到实施。没有发生不良事件也表明该方案在早期和高水平安全实施这种康复的有效性。

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