儿童早期预警评分结合电子病历系统及终端机信息化平台的设计与应用

目的设计儿童早期预警评分(PEWS)结合电子病历系统及终端机(PDA)信息化平台,形成系统的PEWS评估―提醒―处置流程,并评估其临床应用效果。方法筛选2021年7月至2022年12月阳江市人民医院收治的500例住院患儿作为研究对象,按照随机数字表法分为观察组和对照组,每组250例。对照组采用人工纸质评估,观察组采用电子病历系统及PDA评估。比较2组的评估耗时、评估准确率、危重患儿转儿科重症监护病房(PICU)率及整体满意率。结果观察组的评估耗时短于对照组,危重患儿转PICU率低于对照组(P均<0.05);观察组的评估准确率和整体满意率均高于对照组(P均<0.05)。结论PEWS结合电子病历系统及PDA信息化平台可缩短患儿的病情评估耗时,提高病情评估准确率和整体满意率,降低危重患儿转PICU率。     

以护理电子病历为基础的改良早期预警评分信息系统的开发与应用

目的探讨以护理电子病历为基础的改良早期预警评分（MEWS）信息系统的应用效果。方法选择725例患者为研究对象,按所在病区分为观察组360例和对照组365例。对照组常规按医嘱进行监测记录与观察,观察组在对照组的基础上增加MEWS信息化系统评分,根据得分情况按照《早期预警处理流程》启动不同级别的监护及处理方案。观察观察组患者护理级别及所对应的MEWS评分以及两组患者意外事件发生率、抢救成功率、病死率。结果观察组患者MEWS评分,特级护理MEWS评分最高（6．81±2．19）分,三级护理MEWS评分最低（1．80±0．72）分。观察组患者意外事件发生率低于对照组,抢救成功率高于对照组,差异具有统计学意义（P〈0．05）;观察组病死率低于对照组,但差异无统计学意义（P〉0．05）。结论以护理电子病历为基础的MEWS信息系统的开发可帮助临床医护人员对老年患者进行快速、准确的病情评估,早期识别“潜在危重病”患者,提高患者安全管理水平,保障了患者安全。     

儿童早期预警评分应用

早期预警评分(EWS)是对患者心率．收缩压．呼吸频率．体温和意识进行评分。应用早期预警评分可鉴别大量潜在危重病危险的患儿。在国外已被广泛用于急诊和急救系统以及ICU中。应用早期预警评分有助于对患者进行及时干预,争分夺秒地抢救患儿生命,使病人得到较好的转归。由于社会文化和人种多样性等原因,儿童早期预警运用还未在国内儿童医院内运用和研究,其对危重患儿的预测力有待研究。早期预警评分的预测能力是否与评估者的本身能力有很大关系,有待研究。应用于不同人群时,要慎重选择临界值。 在看到预警评分的正向作用时,我们也不能忽略它所存在的不足。早期预警评分不能代替一切,其使用价值是有限的,如果使用不当会导致错误估计病人的风险,不断改进工具,找出最佳临界值,不断完善,最终形成有预测力的早期预警评分,使患儿得到早期干预,得到较好的转归。     

改良早期预警评分系统在冠心病病房的应用

总结了2014年1月~2015年6月本科冠心病病房应用改良早期预警评分系统的体会,主要内容包括对患者进行体征评估与检查评估,认为通过改良早期预警评分系统可提高护士的临床观察及评估能力,大大减少不良意外事件及并发症的发生率,保障患者的安全。     

儿童早期预警评分系统在小儿普外科中的应用

目的：探讨儿童早期预警评分系统在小儿普外科住院患儿中的应用效果。方法选取2013年1—12月收治的724例普外科患儿作为研究对象,采用随机数字表法分为观察组362例和对照组362例。对照组实施常规的护理。观察组在常规护理基础上运用儿童早期预警评分系统（ PEWS）,依据分值采取不同级别的早期预警干预措施。比较分析两组患儿非计划入住ICU率、自动出院／死亡率、术后并发症发生率、平均住院日及医生对护士满意度。结果观察组患儿非计划入住ICU率、术后并发症发生率、平均住院日分别为1．93％,9．39％,（6．09±3．30） d,低于对照组的4．97％,16．30％,（6．93±4．60）d;差异均具有统计学意义（χ2／t值分别为5．01,8．63,2．84;P＜0．05）;观察组患儿自动出院／死亡率为0．28％,低于对照组的0．83％,差异无统计学意义（χ2＝0．25,P＞0．05）;医生对观察组护士满意度在护士是否能主动巡视患儿、护士是否能观察到患儿的病情变化并及时告知医生、护士的沟通能力如何、科室医护配合是否满意方面明显高于对照组,差异有统计学意义（ t值分别为4．11,4．25,3．10,2．17;P＜0．05）。结论 PEWS评分系统能帮助医护人员方便、快捷地识别、处理危重症／潜在危重症患儿,加强了医护间沟通病情的及时性、准确性,提升了患儿安全,有利于合理分配医疗资源;为提高护士工作的独立性、增强职业自信提供了可靠支持,值得在小儿外科病房中推广应用。     

儿童早期预警评分在心胸外科病房的应用分析

正在儿科医院内,8.5%~14.0%的儿童心脏骤停发生在病房,儿童心脏骤停存活率非常低,在幸存者中有35%的患儿带有明显神经系统症状~([1])。先天性心脏病术后,由于心输出量持续较低、急性失代偿事件、主动脉肺动脉分流阻塞、肺动脉高压、冠状动脉阻塞等原因,病情变化快,增加了心脏骤停的风险。对于危重患儿的病情评估,一直是衡量护理质量的指标,也是急救工作的重要环节~([2])。C-CHEWS评分系统能及时更好     

改良儿童早期预警评分在急诊预检分诊中的应用

正儿童早期预警评分(pediatric early warning score,PEWS)是在总结成人早期预警评分的基础上,结合儿童特点,使用简易方式对患儿呼吸、循环及意识状态进行评估,用于预测病情风险,对可能发生心肺功能衰竭的患儿进行早期识别,指导患儿及早收至重症监护病房或专科病房接受治疗,以有效降低患儿病死率的评分方法~([1])。我院将PEWS运用到儿内科急诊预检分诊,取得良好效果,现报道如下。     

儿童早期预警评分护理记录模板的设计及应用

目的 基于儿童早期预警评分制订路径式护理记录模板,并探讨其在危重呼吸系统疾病住院患儿病情观察中的应用效果。方法 选取安徽省某三级甲等儿童专科医院试点病区2017年1月—9月呼吸系统疾病住院患儿 110 例为试验组,2016年1月—9月呼吸系统疾病住院患儿 110例为对照组, 试验组临床应用儿童早期预警评分评估病情并采用护理记录模板记录,对照组常规进行病情观察和护理记录,比较两组患儿病重时数、心电监护时数、吸氧时数、住院天数、住院费用、转入儿童重症监护室例数和护理记录缺陷等指标。 结果 试验组住院费用、转入儿童重症监护室例数低于对照组（P＜0.05）;护理记录缺陷明显减少。 访谈护士结果显示,该模板可以减少单例患儿单次护理记录书写时间10~15 min。 结论 使用儿童早期预警评分护理记录模板记录患儿病情,可以提高护理记录书写质量,减少护士书写护理记录时间,增加护士直接评估病情和进行护理干预的时间,减少呼吸系统疾病患儿非计划儿童重症监护病房入住率,降低住院费用。     

儿童早期预警评分在儿科门诊患者病情评估中的应用

目的研究儿童早期预警评分(PEWS)在儿科门诊危重症患者病情评估中的应用价值。方法选取2014年10~12月与2015年10~12月在本院门诊内科就诊的980例患儿,分为两组即2014年组(490例)与2015年组(490例),2014年组以传统的本院门诊内科等级、"三区四级"的分类评估小儿病情,2015年组以本院门诊内科等级、"三区四级"的分类评估联合改良儿童早期预警评分评估小儿病情。比较两组病情评估的准确性。结果 2014年组护士识别危重症患儿33例(6.73%)送往急诊科,2015年组护士识别危重症患儿83例(16.93%)送往急诊科。结论改良儿童早期预警评分(PEWS)在儿童门诊内科患儿病情评估中具有较高的应用价值。     

儿童早期预警评分在川崎病患儿并发症预警中的应用

目的 探讨儿童早期预警评分在川崎病患儿冠状动脉并发症预警中的应用效果。方法 对湖南省某三甲医院2018年9月-2019年4月收治的80例川崎病患儿的临床资料进行回顾性分析,根据住院期间患儿生命体征监测值进行早期预警评分(pediatric early warning score,PEWS),构建ROC曲线,得出预警患儿冠状动脉损害的PEWS截断点。结果 PEWS评分为3分是预测川崎病患儿发生冠状动脉并发症的最佳截断点,PEWS的ROC曲线下面积为0.832(95%CI:0.712 ～0.951,P＜0.001),约登指数最大为0.62。结论 PEWS可用于对川崎病患儿并发症的早期预警,以便患儿得到及时治疗与护理,降低并发症的发生率,改善预后。     

临床电子护理病历的开发及使用

阐述了开发临床电子护理病历的意义,文章结合临床护理工作的实际。需要,提出了临床电子护理病历的实用书写方法。包括各护理模板的设计及其功能与使用方法,如：一般护理记录单,危重患者护理记录单,压疮预防监控传报单等的设计及使用方法。总结了临床电子护理病历使用效果和体会。     

Validation of the National Early Warning Score in the prehospital setting

BackgroundEarly intervention and response to deranged physiological parameters in the critically ill patient improves outcomes. A National Early Warning Score (NEWS) based on physiological observations has been developed for use throughout the National Health Service (NHS) in the UK. Although a good predictor of mortality and deterioration in inpatients, its performance in the prehospital setting is largely untested. This study aimed to assess the validity of the NEWS in unselected prehospital patients.MethodsAll clinical observations taken by emergency ambulance crews transporting patients to a single hospital were collated along with information relating to hospital outcome over a two month period. The performance of the NEWS in identifying the endpoints of 48 h and 30 day mortality, intensive care unit (ICU) admission, and a combined endpoint of 48 h mortality or ICU admission was analysed.Results1684 patients were analysed. All three of the primary endpoints and the combined endpoint were associated with higher NEWS scores (p < 0.01 for each). The medium-risk NEWS group was associated with a statistically significant increase in ICU admission (RR = 2.466, 95% CI 1.0–6.09), but not in-hospital mortality relative to the low risk group. The high risk NEWS group had significant increases in 48 h mortality (RR 35.32 [10.08–123.7]), 30 day mortality (RR 6.7 [3.79–11.88]), and ICU admission (5.43 [2.29–12.89]). Similar results were noted when trauma and non-trauma patients were analysed separately.ConclusionsElevated NEWS among unselected prehospital patients is associated with a higher incidence of adverse outcomes. Calculation of prehospital NEWS may facilitate earlier recognition of deteriorating patients, early involvement of senior Emergency Department staff and appropriate critical care.     

电子病历提高城市院外急救功能

我国卫生部2009年7月颁布《电子病历基本内容架构与数据标准》征求意见稿通知中明确指出：电子病历是现代医疗机构临床工作开展所必需的业务支撑系统〔1〕。院外急救是急诊医学的一个重要范畴,是急诊医疗服务向社会大众的延伸。院外急救与院内治疗相比,具有流动性强、周转快、接诊时间短、病种多、治疗检查措施少、     

电子病历对护士工作影响的研究进展

护理工作是临床医疗工作的重要组成部分,电子病历在护理领域的应用范围及程度在很大程度上影响了整个医院电子病历的使用情况。文章从护理文书书写效率、医嘱执行率、护理质量3个方面介绍了电子病历对护士工作的影响,并对电子病历存在的不足进行了分析、探讨。     

Lactate improves the predictive ability of the National Early Warning Score 2 in the emergency department

AimsThe aim of this study was to compare the ability to predict 2-, 7-, 14-, and 30-day in-hospital mortality of lactate vs the National Early Warning Score 2 (NEWS2) vs the arithmetic sum of the NEWS2 plus the numerical value of lactate (NEWS2-L).MethodsThis was a prospective, multicentric, emergency department delivery, pragmatic cohort study. To determine the predictive capacity of lactate, we calculated the NEWS2 and NEWS2-L in adult patients (aged >18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon (Spain) between November 1, 2019, and September 30, 2020. The area under the receiver operating characteristic curve of each of the scales was calculated in terms of mortality for every time frame (2, 7, 14, and 30 days). We determined the cut-off point of each scale that offered highest sensitivity and specificity using the Youden index.ResultsA total of 1716 participants were included, and the in-hospital mortality rates at 2, 7, 14, and 30 days were of 7.8% (134 cases), 11.6% (200 cases), 14.2% (243 cases), and 17.2% (295 cases), respectively. The best cut-off point determined in the NEWS2 was 6.5 points (sensitivity of 97% and specificity of 59%), and for lactate, the cut-off point was 3.3 mmol/L (sensitivity of 79% and specificity of 72%). Finally, the combined NEWS2-L showed a cut-off point of 11.7 (sensitivity of 86% and a specificity of 85%). The area under the receiver operating characteristic curve of the NEWS2, lactate, and NEWS2-L in the validation cohort for 2-day mortality was 0.889, 0.856, and 0.923, respectively (p<0.001 in all cases).ConclusionsThe new score generated, NEWS2-L, obtained better statistical results than its components (NEWS2 and lactate) separately.     

Development of the National Early Warning Score-Calcium Model for Predicting Adverse Outcomes in Patients With Acute Pancreatitis

IntroductionThis study aimed to develop a new model on the basis of the National Early Warning Score to predict intensive care unit admission and the mortality of patients with acute pancreatitis.MethodsPatients diagnosed with acute pancreatitis in the emergency department were enrolled. The values of the National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis in predicting intensive care unit admission and mortality of patients with acute pancreatitis were evaluated.ResultsA total of 379 patients with acute pancreatitis were enrolled; 77 patients (20.3%) were admitted to the intensive care unit and 14 (3.7%) died. The National Early Warning Score and calcium level were identified as independent risk factors of intensive care unit admission. Serum calcium exhibited a moderate correlation with National Early Warning Score (r = -0.46; P < 0.001), Modified Early Warning Score (r = -0.37; P < 0.001), and Bedside Index of Severity in Acute Pancreatitis (r = -0.39; P < 0.001). A new model called National Early Warning Score-calcium was developed by combining National Early Warning Score and calcium blood test result, which had larger areas under the curve for predicting intensive care unit admission and mortality than the other 3 scoring systems.DiscussionA new model developed by combining National Early Warning Score and calcium exhibited better value in predicting the prognosis of acute pancreatitis than the models involving National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis alone.