Guidelines for the uniform reporting of data for Medical Emergency Teams

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.     

CCU患者压力源分析与护理对策

目的 分析CCU患者压力源,提出护理对策,提高其生存质量.方法 应用SAS量表及自制压力源调查表对100例CCU患者进行评估,并提供针对性的护理.结果 统计结果示CCU患者压力源高计分16项.并在入院7 d采取护理干预后,患者SAS评分较入院时有明显降低,P＜0.01,有显著性差异.结论 CCU患者存在着多种压力源,必须引起CCU护士的足够重视,采取有效的护理措施,帮助其恢复身心平衡.     

CCU护理路径在急诊冠状动脉介入治疗患者中的应用

目的 设计急性心肌梗死(AMI)患者急诊冠状动脉介入治疗(PCI)后的CCU护理路径,并探讨其在绿色通道中应用的有效性、可行性.方法选取行急诊PCI的急性心肌梗死患者245例作为研究对象,分为对照组(140例)、实验组1(58例)、实验组2(47例),对照组采取资料回顾,以常规护理为标准;实验组1实施常规护理的同时,对CCU护士进行规范化培训、优化护理流程;实验组2在实验1的基础上设计、修订和完善护理路径,制定以时间为横轴、项目为纵轴的临床护理路径,按路径给予患者护理,配合救治.比较3组患者的平均住院日及术后并发症的发生情况.结果 3组平均住院日由对照组的(12.24±5.69)d降低至实验组2的(10.36±3.47)d;术后并发症:腰酸背痛、腹胀、便秘分别由对照组的67.4%、36.5%、46.3%降低至实验组2的32.6%、12.4%、15.3%;患者介入治疗术后尿潴留、失眠的发生率分别由对照组的17.7%、62.3%降低至实验组2的6.9%、28.5%,差异明显;院内心肌梗死复发率、院内再手术率分别由对照组的22.1%、27.1%降低至实验组2的4.3%、10.6%.结论在急诊冠状动脉介入术后患者中实施CCU护理路径,缩短了平均住院日,降低了患者术后并发症,提高了护理工作效率.     

120急救中心-CCU联合开展急性心肌梗死院前溶栓的研究

目的:对120急救中心-CCU联合开展急性心肌梗死院前溶栓治疗的急救模式进行讨论。方法:采集1998年2月~2002年11月由我急救中心在院前进行溶栓治疗,随即送入西京医院CCU监护室的急性心肌梗死(AMI)患者81例,对这些病例的冠状动脉再通率、死亡率、并发症发生率进行统计。结果:溶栓剂对冠状动脉再通率,死亡率,并发症发生率的影响,与开始使用溶栓剂的时间密切相关,症状发作后4h内溶栓受益最大。结论:120急救中心-CCU联合开展AMI院前溶栓治疗能提高冠状动脉再通率,降低病死率,出血并发症轻微。     

CCU患者睡眠障碍原因分析与护理对策

目的 分析冠心病重症监护病房(CCU)患者睡眠障碍的主要原因,探讨改善CCU患者睡眠质量的护理方法.方法 采用入院评估表、住院问卷调查表,对2007年10～12月收治我科CCU的63例患者自进入CCU至转出CCU的住院日睡眠情况进行调查和连续观察,观察采取护理干预后的睡眠状况.结果 实施护理干预对CCU患者睡眠改善有效率为72.3%.结论 护理干预措施能有效地改善CCU患者的睡眠.     

品管圈在提高CCU医护人员手卫生依从性中的应用

目的探讨品质管理对提高CCU医护人员手卫生依从性中的应用。方法在开展品管护理活动前组织理论知识的学习,对CCU医护人员手卫生的现状进行调查,分析CCU医护人员手卫生依从性差的原因,采取有效措施进行持续质量改进。结果品管圈活动的开展使CCU医护人员的洗手率得到显著提高。结论品管圈活动有效提高了CCU医护人员的手卫生依从性,不仅保护了自身的健康,也大大降低了CCU医院感染的发生率。     

风险管理在CCU危重病人护理中的应用

护理风险管理（Rick Management,RM）是一种管理程序,是对现有和潜在的护理风险的识别、评价和处理,以减少护理风险事件的发生及风险事件对病人、护理人员、医院的危害及经济损失”。CCU病房通常收治严重冠心病（如急性心肌梗死和不稳定心绞痛）、心源性休克、严重心律失常、各种复杂和新开展的心脏介入治疗术后以及合并严重酸碱、水、电解质失衡等心血管危重症病人。     

微泵在CCU病房中的应用及护理

CCU病房是心血管病危急重症患者的集中地,因患者病情危重,血流动力学不稳定,常常需使用多种血管活性药物,而传统的大瓶输液法不能满足治疗需要,微量输液泵(简称微泵)因其用量精确而得到广泛应用.现将微泵在CCU病房中的应用及护理体会介绍如下.     

The role of continuous monitoring in a 24/7 telecardiology consultation service—a feasibility study

Today's coronary care unit patients include those with complicated and uncomplicated myocardial infarction, decompensated heart failure and frank cardiogenic shock, severe valvular heart disease, high-grade conduction disturbances, and incessant ventricular arrhythmias. Increasingly in modern medicine, these conditions are not seen in isolation but rather in connection with a series of additional medical comorbidities.Increased life expectancy results in an increase in the prevalence of chronic cardiovascular diseases and an increased demand for health care services. Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. Telecardiology is one of the oldest applications in telemedicine and has been largely applied during the last 10 to 20 years.This study evaluated the feasibility of remote surveillance of coronary care unit and cardiology ward patient monitoring data by a “telecardiologist” with access to electronic health care record data and digitally stored 12-lead electrocardiograms. The remote access to the hospital intranet proved to be technically feasible. Also, the server applications used over the remote connection proved to be reliable and showed robustness against network performance variations. Extending remote patient surveillance to other hospitals is possible, provided that similar electrocardiogram and electronic health care record applications are available and a remote access can be arranged to them. However, the usability from cardiologist's perspective may be degraded if connecting with multiple applications and hospital networks is needed.The study indicated potential for speeding up the diagnostic and therapeutic processes in the hospital, although the study was limited in that the telecardiologist played a passive role and did not acutely impact patient care. In the future, the system could be expanded to surveillance of smaller hospitals. Telemedicine has the potential to aid in solving the conflict between aging of population, rise in the demand for critical care services, and shortage of professional personnel. This might, however, require a more active remote surveillance than the one tested in this study. Privacy- and security-related aspects are major components of building trust and confidence in telemedicine systems. In telecardiology, the real-time interactive telemedicine model with 24/7 service has potential superior performance compared with a store-and-forward telemedicine model.     

人工鼻在CCU气管插管患者中的应用

目的探讨人工鼻在CCU气管插管患者中的应用效果。方法将62例气管插管患者随机分为人工鼻组（n=32例）与电热恒温湿化组（n=32例）,比较两组患者痰液黏稠度、刺激性呛咳、气道管理耗时数、平均插管时间、气道耗材费用、呼吸机相关肺炎发生率等情况。结果人工鼻组发生刺激性呛咳28．1％、呼吸机相关肺炎发生率15．6％、气道管理耗时数（2．3±0．5）h、平均插管时间（112±6．5）h、气道耗材费用（44．2±6．7）元均优于电热恒温湿化组71．9％,37．5％,（3．5±0．6）h,（133±7．8）h,（56．3±1．5）元,差异均有统计学意义（X2分别为12.25,3．9250;t分别为8．6605,11．6998,8．2129;P〈0.01或P〈0.05）;人工鼻组痰液黏稠度Ⅰ度12．5％,Ⅱ度62．5％,Ⅲ度25．0％,电热恒温湿化组Ⅰ度46．9％,Ⅱ度25．0％,Ⅲ度28．1％,两组比较差异具有统计学意义（x2=11．5590,P〈0．01）。结论人工鼻应用于气管插管患者,可达到理想的气道湿化效果,并能有效提高气道管理效能,省时节力,降低呼吸机相关肺炎发生率,可在临床推广应用。