ICU医疗器械相关性压力性损伤闭环管理系统的构建及应用

目的 构建ICU医疗器械相关性压力性损伤（medical device-related pressure injuries,MDRPI）闭环管理系统,探讨其在临床中的应用效果。 方法 构建由风险评估、临床护理决策、质量与安全管理模块组成的ICU MDRPI闭环管理系统,于2019年7月在广东省某三级甲等医院ICU病房中使用,比较闭环管理系统应用前后6个月患者入ICU时MDRPI评估率、MDRPI住院评估率、MDRPI高风险患者筛查率、临床护理决策实施率、MDRPI发生率。 结果 闭环管理系统应用后,患者入ICU时MDRPI评估率从64.3%上升至96.8%,MDRPI住院评估率从44.9%上升至98.2%,MDRPI高风险患者筛查率从51.3%上升至98.9%,临床护理决策实施率从39.6%上升至95.8%,MDRPI发生率从15.9%下降至7.3%,差异均具有统计学意义﹙P<0.001﹚。 结论 ICU MDRPI闭环管理系统能帮助ICU护士科学、客观地评估MDRPI,并作出合理的护理决策,可规范MDRPI管理流程,有效降低MDRPI发生率。

Construction and application of closed loop management system for medical device-related pressure injuries in ICU

Objective A closed-loop management system for ICU medical device-related pressure injuries（MDRPI）was developed,so as to explore the effects of its application in clinical management. Methods The closed-loop management system of ICU MDRPI was constructed and it was composed of risk assessment,clinical nursing decision-making,quality and safety management. It is convenient to extract critically ill patients from ICU wards of a tertiary hospital in Guangdong province. The data before and after the implementation of the closed-loop management system for 6 months was compared,including the assessment rate of MDRPI in ICU,the assessment rate of MDRPI hospitalization,the screening rate of high-risk patients,the implementation rate of clinical nursing decision-making,and the incidence rate of MDRPI in ICU. Results Before and after the implementation of the closed-loop management system,the evaluation rate of MDRPI of ICU patients increased from 64.3% to 96.8%;the evaluation rate of MDRPI hospitalization increased from 44.9% to 98.2%;the screening rate of high-risk MDRPI patients increased from 51.3% to 98.9%;the implementation rate of clinical nursing decision increased from 39.6% to 95.8%;the incidence rate of MDRPI in ICU decreased from 15.9% to 7.3%. The differences were statistically significant（P<0.001）. Conclusion The construction and application of ICU MDRPI closed-loop management system can help ICU nurses scientifically and objectively evaluate and make decisions on MDRPI nursing programs,standardize ICU MDRPI management process,and effectively reduce the incidence of ICU MDRPI.