新生儿病房不良事件筛查工具初探

[摘要]目的：探讨适合我国新生儿病房的不良事件筛查工具并验证其可行性。方法：结合文献及专家咨询法形成筛查工具；通过2015年7月30日至2015年9月30日2个月回顾性研究及2016年5月9日至2016年6月9日一个月实时观察研究，记录筛查指标及不良事件，验证本工具可行性。结果：回顾性研究纳入病例782例，筛查指标总计887例次（1.13例/次），独立不良事件391例次（0.50例/次）；筛查指标发现的不良事件占78.8%，筛查工具阳性预测值为0.39，其中新生儿普通病房0.45，新生儿重症监护室（NICU）0.26，二者比较差异有统计学意义（P<0.01）。实时研究纳入筛查指标417例次，独立不良事件261例次，总阳性预测值0.64，高于回顾性研究阶段（0.45），其中阳性预测值有统计学差异的筛查指标为“皮肤完整性受损”及“抗生素应用”（P值均<0.01）。结论：本研究的筛查工具对新生儿普通病房不良事件监测具有较好的可行性，加强医务工作者如实、及时记录不良事件的培训，可提高本筛查工具的监测效果。

A Preliminary Study on Trigger Tool for Adverse Events in Neonatal Ward

[Abstract] Objective: To establish and test the neonatal-ward-focused trigger tool for adverse events detection in China. Methods: Trigger tool was established through the literature and expert consultation. Retrospective study from July 30th to Sept. 30th, 2015 and real-time observation study from May 9th to Sept. 9th, 2016 were conduct to record the triggers and adverse events, and the feasibility of trigger tool was verified. Results: During the retrospective study, 782 medical records revealed 887 triggers (1.13 per patient) and 391 unique adverse events (0.50 per patient); 79% adverse events were found by triggers, with a positive predictive value (PPV) of 0.39; and the neonatal general ward was 0.45, neonatal intensive care unit(NCIU) was 0.26 with statistically significant difference between two groups(P<0.01). During the real-time study, 420 triggers and 261 unique adverse events were included; the total PPV was 0.64, higher than that of the retrospective study (0.45). The PPV of triggers about impaired skin integrity and antibiotic application were statistically significant (P<0.01). Conclusion: This tool is a feasible trigger tool for monitoring of adverse events in newborn general ward. Strength on training of medical workers for accurately and timely record adverse events can improve the monitoring effectiveness of the trigger tool.