造口治疗师主导多学科合作伤口处理风险管理的实施与效果
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摘要
目的:探讨造口治疗师(ET)主导多学科合作伤口处理风险管理的实践与效果。方法:收集2013年5月—2017年4月4年来湘雅医院伤口中心接诊的患者资料,从2015年5月开始,接诊的患者均采用ET主导多学科合作的伤口处理风险管理流程,包括:风险评估、风险分析、风险识别与风险决策,将确认有治疗和操作难度、潜在纠纷的患者作为风险管理重点对象,联动多学科合作团队,采取一系列风险防控措施。比较该流程实施前后的患者人数、结构、来源及患者满意率、不良事件发生率。结果:与实施前比较,实施后的接诊患者总例次增加27.74%,医生转诊例次增加54.76%,慢性伤口例次增加51.34%,病房会诊例次增加52.63%;实施后不良事件发生率较实施前明显降低(0.05%vs.0.12%,P<0.05),实施后患者满意率较实施前明显提高[(95.36±0.52)%vs.(90.34±0.45)%,P<0.05]。结论:ET主导多学科合作的伤口处理风险管理有助于降低患者不良事件发生率,提高患者满意率,提升伤口处理水平,推荐临床采用。
Objective: To investigate the implementation of multidisciplinary collaboration led by enterostomal therapists(ET) for risk management of wound treatment and the effect. Methods: The data of all patients attending the Center of Wound Care of Xiangya Hospital from May 2013 to April 2017 were collected. The process of multidisciplinary collaboration led by ET for risk management of wound treatment was implemented in patients admitted since May 2015, which included risk assessment, risk analysis, risk identification, and risk decision, and in those regarded as important individuals due to obvious treatment and operative difficulties or potential medical disputes, a series of risk prevention and control measures were performed in partnership with multidisciplinary team. The number, constitution and source of patients as well as patients' satisfaction rate, and incidence of adverse events were compared before and after implementation of the process.Results: After implementation, the total number of admitted patients increased by 27.74%, the number of referrals from doctors increased by 54.76%, the number of patients with chronic wounds increased by 51.34%, and the number of ward consultations increased by 52.63% compared with those before implementation. The incidence of adverse events was significantly reduced(0.05% vs. 0.12%, P<0.05) and the patients' satisfaction rate was significantly increased [(95.36±0.52) % vs.(90.34±0.45) %, P<0.05] after implementation comparted with those before implementation. Conclusion: Implementation of multidisciplinary collaboration led by ET for risk management of wound treatment can reduce the incidence of adverse events, increase the patients' satisfaction rate and improve the wound treatment efficacy. So, it is recommended to be used in clinical practice.
Objective: To investigate the implementation of multidisciplinary collaboration led by enterostomal therapists(ET) for risk management of wound treatment and the effect. Methods: The data of all patients attending the Center of Wound Care of Xiangya Hospital from May 2013 to April 2017 were collected. The process of multidisciplinary collaboration led by ET for risk management of wound treatment was implemented in patients admitted since May 2015, which included risk assessment, risk analysis, risk identification, and risk decision, and in those regarded as important individuals due to obvious treatment and operative difficulties or potential medical disputes, a series of risk prevention and control measures were performed in partnership with multidisciplinary team. The number, constitution and source of patients as well as patients' satisfaction rate, and incidence of adverse events were compared before and after implementation of the process.Results: After implementation, the total number of admitted patients increased by 27.74%, the number of referrals from doctors increased by 54.76%, the number of patients with chronic wounds increased by 51.34%, and the number of ward consultations increased by 52.63% compared with those before implementation. The incidence of adverse events was significantly reduced(0.05% vs. 0.12%, P<0.05) and the patients' satisfaction rate was significantly increased [(95.36±0.52) % vs.(90.34±0.45) %, P<0.05] after implementation comparted with those before implementation. Conclusion: Implementation of multidisciplinary collaboration led by ET for risk management of wound treatment can reduce the incidence of adverse events, increase the patients' satisfaction rate and improve the wound treatment efficacy. So, it is recommended to be used in clinical practice.
引文
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[17]沈月宏,韩春茂,陈国贤,等.伤口诊疗中心建设模式探讨[J].中华烧伤杂志,2011,27(1):45-48.doi:10.3760/cma.j.issn.1009-2587.2011.01.013.Shen YH,Han CM,Chen GX,et al.Probe into construction mode of wound care center[J].Chinese Journal of Burns,2011,27(1):45-48.doi:10.3760/cma.j.issn.1009-2587.2011.01.013.
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[2]Elster M,Grothier L.Developing a clinical risk management strategy[J].J Wound Care,2004,13(10):430.doi:10.12968/jowc.2004.13.10.26697.
[3]蒋琪霞,李晓华,刘云,等.军队医院伤口护理中心管理模式探究[J].解放军医院管理杂志,2012,19(8):770-773.doi:10.3969/j.issn.1008-9985.2012.08.033.Jiang QX,Li XH,Liu Y,et al.Management model of wound care center in military hospital[J].Hospital Administration Journal of Chinese People’s Liberation Army,2012,19(8):770-773.doi:10.3969/j.issn.1008-9985.2012.08.033.
[4]许珊珊,陈绵绵,王翠娥,等.三甲综合医院伤口门诊的建立和运行模式探讨[J].当代护士:中旬刊,2017,(4):182-184.Xu SS,Chen MM,Wang CE,et al.Discussion on establishment and running mode of wound outpatient service in class III Grade Ihospitals[J].Today Nurse,2017,(4):182-184.
[5]林属芳,周龙兰.伤口护理风险管理在门急诊的应用效果[J].国际护理学杂志,2015,34(19):2702-2705.doi:10.3760/cma.j.issn.1673-4351.2015.19.039.Lin SF,Zhou LL.Application effect of wound nursing risk management in outpatient and emergency departments[J].International Journal of Nursing,2015,34(19):2702-2705.doi:10.3760/cma.j.issn.1673-4351.2015.19.039.
[6]李建刚,杨震,孟馥,等.患者满意度及其测评工具研究综述[J].现代医院管理,2010,8(6):4-7.doi:10.3969/j.issn.1672-4232.2010.06.002.Li JG,Yang Z,Meng F,et al.A Summary of Patient Satisfaction Degree and Its Assessment Tools[J].Modern Hospital Management,2010,8(6):4-7.doi:10.3969/j.issn.1672-4232.2010.06.002.
[7]张其健,贺爱兰,戴薇薇,等.门诊慢性伤口患者满意度调查分析与对策[J].现代医院,2018,18(3):345-349.doi:10.3969/j.issn.1671-332X.2018.03.010.Zhang QJ,He AL,Dai WW,et al.Analysis of Satisfaction and Countermeasures of Outpatient Service of Chronic Wound Patients[J].Modern Hospital,2018,18(3):345-349.doi:10.3969/j.issn.1671-332X.2018.03.010.
[8]魏斌,田卓平.医疗不良事件SH9分类法及其现实意义[J].中国医院,2011,15(1):44-45.doi:10.3969/j.issn.1671-0592.2011.01.014.Wei B,Tian ZP.SH9 classification of medical adverse event and its practical significance[J].Chinese Hospitals,2011,15(1):44-45.doi:10.3969/j.issn.1671-0592.2011.01.014.
[9]郭春兰,付向阳,田玉凤,等.慢性伤口的风险评估及护理干预[J].护理学杂志,2010,25(16):40-42.doi:10.3870/hlxzz.2010.16.040.Guo CL,Fu XY,Tian YF,et al.Analysis of risk factors in chronic wound and nursing intervention[J].Journal of Nursing Science,2010,25(16):40-42.doi:10.3870/hlxzz.2010.16.040.
[10]付小兵.进一步重视体表慢性难愈合创面发生机制与防治研究[J].中华创伤杂志,2004,20(8):449-451.doi:10.3760/j:issn:1001-8050.2004.08.001.Fu XB.Attach further importance to studies on mechanism and prevention of chronic dermal ulcers[J].Chinese Journal of Trauma,2004,20(8):449-451.doi:10.3760/j:issn:1001-8050.2004.08.001.
[11]蒋小平,庞小兰.伤口的评估及护理[J].国外医学:护理学分册,2002,21(3):109-111.doi:10.3760/cma.j.issn.1673-4351.2002.03.020.Jiang XP,Pang XL.Assessment and nursing of wound[J].Foreign Medical Sciences,2002,21(3):109-111.doi:10.3760/cma.j.issn.1673-4351.2002.03.020.
[12]郑美春,王玲燕,张惠芹,等.中国造口治疗师的工作情况和专业发展的调查分析[J].中华护理杂志,2009,44(5):469-470.Zheng MC,Wang LY,Zhang HQ,et al.Enterostomal therapists’work situation and future development in China[J].Chinese Journal of Nursing,2009,44(5):469-470.
[13]彭闵,周秋红,许景灿,等.多学科团队诊疗模式在糖尿病足诊治中应用的进展[J].中国普通外科杂志,2017,26(12):1609-1617.doi:10.3978/j.issn.1005-6947.2017.12.016.Peng M,Zhou QH,Xu JC,et al.Progress on application of multidisciplinary team model in diagnosis and treatment of diabetic foot[J].Chinese Journal of General Surgery,2017,26(12):1609-1617.doi:10.3978/j.issn.1005-6947.2017.12.016.
[14]黄晓曼.郑雷教授:胰腺癌的多学科综合诊疗[J].中国普通外科杂志,2016,25(3):318-320.doi:10.3978/j.issn.1005-6947.2016.03.002.Huang XM.Professor Lei Zheng:Multidisciplinary management for pancreatic cancer[J].Chinese Journal of General Surgery,2016,25(3):318-320.doi:10.3978/j.issn.1005-6947.2016.03.002.
[15]荚卫东,刘文斌.《肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版)》解读[J].中国普通外科杂志,2017,26(7):815-820.doi:10.3978/j.issn.1005-6947.2017.07.001.Jia WD,Liu WB.Interpretation of Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus(2016 edition)[J].Chinese Journal of General Surgery,2017,26(7):815-820.doi:10.3978/j.issn.1005-6947.2017.07.001.
[16]Jiang YX,何海.多学科方法综合治疗胃癌[J].中国普通外科杂志,2015,24(10):1354-1355.doi:10.3978/j.issn.1005-6947.2015.10.002.Jiang YX,He H.Multidisciplinary approach for the treatment of gastric cancer[J].Chinese Journal of General Surgery,2015,24(10):1354-1355.doi:10.3978/j.issn.1005-6947.2015.10.002.
[17]沈月宏,韩春茂,陈国贤,等.伤口诊疗中心建设模式探讨[J].中华烧伤杂志,2011,27(1):45-48.doi:10.3760/cma.j.issn.1009-2587.2011.01.013.Shen YH,Han CM,Chen GX,et al.Probe into construction mode of wound care center[J].Chinese Journal of Burns,2011,27(1):45-48.doi:10.3760/cma.j.issn.1009-2587.2011.01.013.
[18]廖婧,沙丽艳,刘珩,等.护士团队合作研究现状与进展[J].中国护理管理,2016,16(2):227-230.doi:10.3969/j.issn.1672-1756.2016.02.021.Liao J,Sha LY,Liu H,et al.Study on current situation and research progress of nursing teamwork[J].Chinese Nursing Management,2016,16(2):227-230.doi:10.3969/j.issn.1672-1756.2016.02.021.
[19]Kevin Woo.伤口护理管理的新进展[J].护理管理杂志,2013,13(11):767-769.Kevin Woo.Key advances of wound care management for nursing practice[J].Journal of Nursing Administration,2013,13(11):767-769.
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