以专业护士为主体的癌痛质控体系的效果评价
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摘要
目的:通过实施以专业护士为主体的癌痛质控体系,提高全院癌痛质量管理水平。方法:依托我院癌痛姑息专业小组,通过回顾文献及细读相关规章制度,制定了《癌痛护理质量评分标准》。在每个病区选拔一名癌痛专业护士,统一培训,负责运用《癌痛护理质量评分标准》对各病区癌痛护理质量进行检查、反馈、评价。结果:经过两年的实践,癌痛质量管理的病历年总数增加(1 273 vs 1 524),病历缺陷率下降(72.74%vs 50.52%),组织结构完整率(98.66%vs 99.87%)、护士评估合格率(87.51%vs 95.93%)、护理记录合格率(41.71%vs 75.00%)、护理计划合格率(74.63%vs 86.29%)、健康教育合格率(47.21%vs 84.06%)、疼痛筛查率(99.21%vs 99.93%)、8小时评估完成率(99.14%vs 99.93%)和出院随访率(77.30%vs 96.33%)均明显提高,差异有统计学意义(P<0.05)。结论:通过制定《癌痛护理质量评分标准》,以专业护士为主体对各病区进行质量管理取得了良好的效果,是一种值得推广的癌痛护理质量管理方式。
Objective: To improve the quality of cancer pain management in our hospital by implementing a professional nurse-centered cancer pain quality control system. Methods: Relying on the palliative care team, by reviewing literature and reading rules and regulations, we established the Standard for Cancer Pain Nursing Quality Assessment(the Standard), then selected a professional nurse in each ward and trained unitedly. They were responsible for inspection, feedback, and evaluation of the quality of cancer pain care in each ward. Results: After two years of practice, the total annual number of medical records of quality of care in cancer pain management increased(1 273 vs 1 524), the medical record defect rate declined(72.74% vs 50.52%), and organizational structure integrity(98.66% vs 99.87%), nurse qualification(87.51% vs 95.93%), nursing documentation quality(41.71% vs 75.00%), nursing plan quality(74.63% vs 86.29%), health education quality(47.21% vs 84.06%), the pain screening rate(99.21% vs 99.93%), the 8-hour evaluation completion rate(99.14% vs 99.93%) and the follow up rate(77.30% vs 96.33%) significantly improved. And the differences were statistically significant(P<0.05). Conclusion: By establishing the Standard, professional nurses have achieved good results in the quality control of cancer pain management in all wards. It is a cancer pain care management method worth promoting.
Objective: To improve the quality of cancer pain management in our hospital by implementing a professional nurse-centered cancer pain quality control system. Methods: Relying on the palliative care team, by reviewing literature and reading rules and regulations, we established the Standard for Cancer Pain Nursing Quality Assessment(the Standard), then selected a professional nurse in each ward and trained unitedly. They were responsible for inspection, feedback, and evaluation of the quality of cancer pain care in each ward. Results: After two years of practice, the total annual number of medical records of quality of care in cancer pain management increased(1 273 vs 1 524), the medical record defect rate declined(72.74% vs 50.52%), and organizational structure integrity(98.66% vs 99.87%), nurse qualification(87.51% vs 95.93%), nursing documentation quality(41.71% vs 75.00%), nursing plan quality(74.63% vs 86.29%), health education quality(47.21% vs 84.06%), the pain screening rate(99.21% vs 99.93%), the 8-hour evaluation completion rate(99.14% vs 99.93%) and the follow up rate(77.30% vs 96.33%) significantly improved. And the differences were statistically significant(P<0.05). Conclusion: By establishing the Standard, professional nurses have achieved good results in the quality control of cancer pain management in all wards. It is a cancer pain care management method worth promoting.
引文
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[12] Rabb H,Griffin MD,Mckay DB,et al.Inflammation in AKI:current understanding,key questions,and knowledge gaps[J].J Am Soc Nephrol,2016,27(2):371- 379.
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[14] 王文玲,杨静雯,蔡雷,等.疼痛护理专业技术小组在提高疼痛护理质量中的作用[J].中华现代护理杂志,2015,21(6):691- 693.
[15] Gullatte M,焦杰.中国肿瘤护士在癌症症状管理中的新角色[J].护士进修杂志,2017,32(14):1253- 1257.
[16] 朱美娟,林亚妹,唐文庄.专业小组质量控制模式对维持性血液透析病人预后的影响[J].护理研究,2016,30(21):2613- 2615.
[17] 崔灵灵,潘爱红,戴玲.静脉治疗专业小组在静脉输液持续质量改进中的实践[J].护理学报,2016,23(21):42- 45.
[18] 刘光英,卢振玲,高辉.手术室护理质量管理中质控小组与专业小组联合的实践[J].中国护理管理,2017,17(7):902- 906.
[19] 黄敏,王国蓉,秦英.多学科专业小组对静脉输液质量的作用[J].中华护理杂志,2012,47(12):1088- 1090.
[20] 方良玉,唐碧云,陈洁,等.以病区疼痛护士为主体的疼痛管理实践[J].护理与康复,2018,17(1):79- 83.
[21] 宋莉,卢帆,田杰,等.四川省癌痛规范化诊疗现状的调查分析[J].中国疼痛医学杂志,2017,23(1):49- 54.
[22] 薛迎利,聂磊,薛璐璐,等.规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响[J].中国肿瘤临床与康复,2017,24(6):730- 733.
[23] 张海燕,陈杰,吴晓英,等.全国40家医院疼痛护理管理现状[J].中国护理管理,2014,14(11):1121- 1124.
[2] Caraceni A,Portenoy RK.An international survey of cancer pain characteristics and syndromes[J].Pain,1999,82(3):263- 274.
[3] 周克明,蒋建军,首峰,等.农村癌痛患者临终关怀直接经济负担分析[J].肿瘤预防与治疗,2018,31(1):57- 61.
[4] 敖存芳,韦翠萍,蒋兆定,等.护理干预对癌痛影响的研究进展[J].齐鲁护理杂志,2016,22(21):45- 47.
[5] Charalambous,A.Evidence- based practice beliefs and behaviors of nurses providing cancer pain management[J].Eur J Oncol Nurs,2015,19(3):325- 326.
[6] Luckett T,Davidson PM,Green A,et al.Assessment and management of adult cancer pain:A systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care[J].J Pain Symptom Manage,2013,46(2):229- 253.
[7] Oldenmenger WH,Sillevis Smitt PAE,van Dooren S,et al.A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them:A critical appraisal[J].Eur J Cancer,2009,45(8):1370- 1380.
[8] 曲瑞敏,吕娇,王雅莉.疼痛护理查检表的编制及在癌症患者疼痛质量控制中的应用[J].齐鲁护理杂志,2018,24(23):123- 125.
[9] 钱自亮,陈秉学,曾维安.无痛医院的建设与实践[J].实用疼痛学杂志,2017,13(1):68- 70.
[10] National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology:Adult Cancer Pain (Version 2.2016)[EB/OL].[2018- 08- 08].https://oralcancerfoundation.org/wp- content/uploads/2016/09/pain.pdf
[11] Ekim A,Ocakci AF.Knowledge and attitudes regarding pain management of pediatric nurses in Turkey[J].Pain Manag Nurs,2013,14(4):e262- e267.
[12] Rabb H,Griffin MD,Mckay DB,et al.Inflammation in AKI:current understanding,key questions,and knowledge gaps[J].J Am Soc Nephrol,2016,27(2):371- 379.
[13] Brockopp DY,Downey E,Powers P,et al.Nurses’ clinical decision- making regarding the management of pain[J].Int J Nurs Stud,2004,41(6):631- 636.
[14] 王文玲,杨静雯,蔡雷,等.疼痛护理专业技术小组在提高疼痛护理质量中的作用[J].中华现代护理杂志,2015,21(6):691- 693.
[15] Gullatte M,焦杰.中国肿瘤护士在癌症症状管理中的新角色[J].护士进修杂志,2017,32(14):1253- 1257.
[16] 朱美娟,林亚妹,唐文庄.专业小组质量控制模式对维持性血液透析病人预后的影响[J].护理研究,2016,30(21):2613- 2615.
[17] 崔灵灵,潘爱红,戴玲.静脉治疗专业小组在静脉输液持续质量改进中的实践[J].护理学报,2016,23(21):42- 45.
[18] 刘光英,卢振玲,高辉.手术室护理质量管理中质控小组与专业小组联合的实践[J].中国护理管理,2017,17(7):902- 906.
[19] 黄敏,王国蓉,秦英.多学科专业小组对静脉输液质量的作用[J].中华护理杂志,2012,47(12):1088- 1090.
[20] 方良玉,唐碧云,陈洁,等.以病区疼痛护士为主体的疼痛管理实践[J].护理与康复,2018,17(1):79- 83.
[21] 宋莉,卢帆,田杰,等.四川省癌痛规范化诊疗现状的调查分析[J].中国疼痛医学杂志,2017,23(1):49- 54.
[22] 薛迎利,聂磊,薛璐璐,等.规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响[J].中国肿瘤临床与康复,2017,24(6):730- 733.
[23] 张海燕,陈杰,吴晓英,等.全国40家医院疼痛护理管理现状[J].中国护理管理,2014,14(11):1121- 1124.