住院患者肠外营养护理质量评价指标体系的构建

目的 构建住院患者肠外营养护理质量评价指标体系,指导护士行为,确保肠外营养被安全执行,促进患者康复。方法 系统检索中国指南网、Up To Date、美国肠外肠内营养学会、欧洲肠外肠内营养学会、Joanna Briggs Institute（JBI）等数据库,严格筛选、评价文献,综合证据,结合医院近2年临床数据分析结果,形成初始问卷。应用德尔菲法对30名专家进行2轮函询,确定各指标内容及重要性,使用层次分析法确定各指标权重。结果 共纳入9篇文献,其中临床决策2篇、证据总结1篇、指南2篇、专家共识4篇。经过2轮专家函询后,得到住院患者肠外营养护理质量评价指标体系,为聚焦于过程的肠外营养规范落实率,包括4项一级指标,即营养风险护理评估落实率、肠外营养护理评估落实率、肠外营养溶液配制规范落实率和肠外营养输注护理规范落实率,以及17项二级指标。结论 住院患者肠外营养护理质量评价指标体系具有科学性、实用性和可操作性,能有效规范护士的行为、评价肠外营养护理质量。

Establishment of evaluation index system for quality of parenteral nutrition nursing for hospitalized patients

Objective To establish an evaluation index system for quality of parenteral nutrition nursing for hospitalized patients,to ensure the safe implementation of parenteral nutrition and promote health of patients.Methods Databases were systematically searched including Chinese Guideline Network,Up To Date,ASPEN,ESPEN,JBI,etc. All studies were screened and evaluated strictly. The initial questionnaire was developed combining the best evidence,and clinical data analysis of our hospital in the past two years. Two rounds of Delphi survey were conducted among 30 experts to determine the content and importance of each indicator. Analytic hierarchy process was used to determine the weight of each indicator.Results Nine studies were included,including 2 clinical decisions,1 evidence summary,2 guidelines and 4 expert consensuses. After two rounds of expert consultation,rates of parenteral nutrition criteria implementation focusing on process quality were determined：4 first-level indicators including rate of nutritional risk nursing assessment implementation,rate of parenteral nutrition assessment implementation,rate of parenteral nutrition solution preparation criterion implementation,and rate of parenteral nutrition infusion nursing criterion implementation,and 17 second-level indicators.Conclusion The evaluation index system of patient on parenteral nutrition is scientific,practical and operational,and can effectively guide nurses’ correct behavior and evaluate quality of parenteral nutrition nursing.