前馈控制管理在预防手术室消极型结局护理中断事件中的应用

楼晨燕; 祝霞君; 余利霞; 徐舜

doi:10.16766/j.cnki.issn.1674-4152.003612

前馈控制管理在预防手术室消极型结局护理中断事件中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003612

1.
衢州市妇幼保健院手术室，浙江衢州 324000
2.
衢州市妇幼保健院护理部
3.
衢州市妇幼保健院党政办
4.
衢州市妇幼保健院妇科

基金项目:

浙江省医药卫生科技计划项目 2021KY1193

详细信息

通讯作者:
楼晨燕，E-mail：Lousss5566@163.com

中图分类号: R472.3
计量
- 文章访问数: 12
- HTML全文浏览量: 6
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-27
- 网络出版日期: 2024-09-05

Application of feed-forward control management in preventing nursing interruption events with negative outcomes in operating room

LOU Chenyan^{1
, ,},
ZHU Xiajun²,
YU Lixia³,
XU Shun⁴

1.
Operating Room, Quzhou Maternal and Child Health Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的分析前馈控制管理对手术室消极型结局护理中断事件的预防效果，为手术室管理提供新思路。方法采用便利抽样法，选取2023年1—11月在浙江省衢州市妇幼保健院进行手术的128例患者作为研究对象，将2023年1—5月进行手术的64例患者作为对照组，将2023年6月—11月进行手术的64例患者作为观察组。对照组患者应用常规护理模式，观察组在对照组基础上增加前馈控制管理。比较2组患者消极型结局护理中断事件发生率、持续时间及护理中断事件来源，比较2组患者手术室护理不良事件发生率及护理质量。结果观察组患者消极型结局护理中断事件发生率为75.9%(88/116)，低于对照组的84.6%(198/234)，且观察组护理中断持续时间为(2.12±0.76)min，低于对照组的(4.83±1.07)min，2组比较差异均有统计学意义(P < 0.05)。观察组患者手术室护理不良事件发生率为3.1%(2/64)，低于对照组[12.5%(8/64)，P < 0.05]。观察组患者护理质量总分为(47.81±1.62)分，高于对照组[(44.68±2.54)分，t=8.312，P < 0.001]。结论前馈控制管理在预防手术室消极型结局护理中断事件中具有积极作用，不仅能降低消极型结局护理中断事件发生率、持续时间及手术室护理不良事件发生率，还能提高手术室护理质量，值得临床应用。
- 手术室 /
- 前馈控制管理 /
- 消极型结局 /
- 护理中断事件 /
- 护理质量
Abstract: Objective To analyze the preventive effect of feed-forward control management on negative outcome nursing interruption events in the operating room, and provide new ideas for operating room management. Methods Convenience sampling was used to select 128 patients who underwent surgery in the operating room of Quzhou Maternal and Child Health Hospital in Zhejiang Province from January to November 2023 as the study subjects. Among them, 64 patients who underwent surgery from January to May 2023 were selected as the control group, and 64 patients who underwent surgery from June to November 2023 were selected as the observation group. The control group patients were treated with conventional nursing mode, while the observation group added the feed-forward control management on the basis of the control group. The incidence, duration, and sources of nursing interruption events with negative outcomes between two groups of patients were compared, and the incidence and quality of nursing adverse events in the operating room between the two groups of patients were compared. Results The incidence of negative outcome nursing interruption events in the observation group was 75.9% (88/116), lower than 84.6% (198/234) in the control group, and the duration of the observation group was (2.12±0.76) minutes, lower than (4.83±1.07) minutes in the control group, the comparison between the two groups of patients was statistically significant (P < 0.05). The incidence of adverse events in the operating room nursing of patients in the observation group was 3.1% (2/64), lower than the control group [12.5% (8/64), P < 0.05]. The total score of nursing quality for patients in the observation group was (47.81±1.62) points, which was higher than the control group [(44.68±2.54) points, t=8.312, P < 0.001]. Conclusion The concept of feed-forward control management plays a positive role in preventing negative outcome nursing interruptions in the operating room. It not only reduces the incidence and duration of nursing interruptions, but also reduces the incidence of adverse nursing events in the operating room. It can also improve the quality of operating room nursing and is worthy of clinical application.
- Operating room /
- Feed-forward control management /
- Negative outcomes /
- Nursing interruption events /
- Nursing quality

HTML全文

表 1 2组手术患者基本资料比较

Table 1. Comparison of basic information between two groups of patients

组别	例数	年龄 (x±s，岁)	BMI (x±s)	手术类型(例)		ASA分级(例)			手术时间(x±s，h)
组别	例数	年龄 (x±s，岁)	BMI (x±s)	妇科手术	产科手术	Ⅰ级	Ⅱ级	Ⅲ级	手术时间(x±s，h)
对照组	64	48.72±5.61	21.35±4.63	42	22	45	17	2	2.13±0.46
观察组	64	49.13±6.88	21.46±4.10	45	19	40	21	3	2.04±0.55
统计量		0.369^a	0.142^a	0.323^b		0.915^b			1.004^a
P值		0.712	0.887	0.570		0.633			0.317
注：^a为t值，^b为χ²值。ASA分级为美国麻醉医师协会(American Society of Anesthesiologists)分级。

下载: 导出CSV

表 2 2组手术患者护理中断事件次数及来源(次)

Table 2. Comparison of the number and sources of nursing interruption events between two groups of patients (times)

组别	例数	护理中断事件次数	来源
组别	例数	护理中断事件次数	环境	患者	护士同事	手术、麻醉医师
对照组	64	234	44	30	24	136
观察组	64	116	25	16	13	62

下载: 导出CSV

表 3 2组手术患者护理中断事件结局及持续时间比较

Table 3. Comparison of nursing interruption event outcomes and duration between two groups of patients

组别	护理中断事件次数	护理中断类型[次(%)]		持续时间 (x±s，min)
组别	护理中断事件次数	积极型	消极型	持续时间 (x±s，min)
对照组	234	36(15.4)	198(84.6)	4.83±1.07
观察组	116	28(24.1)	88(75.9)	2.12±0.76
χ²值	3.977			24.390
P值	0.046			< 0.001

下载: 导出CSV

表 4 2组手术患者手术室护理不良事件发生情况比较[例(%)]

Table 4. Comparison of adverse events in operating room nursing between two groups of patients[case(%)]

组别	例数	器械及物品管理问题	术前准备不全	标本登记错误	坠床、跌倒	总发生
对照组	64	1(1.6)	2(3.1)	3(4.7)	2(3.1)	8(12.5)
观察组	64	0	0	1(1.6)	1(1.6)	2(3.1)
注：2组患者手术室护理不良事件总发生率比较，χ²=3.905，P=0.048。

下载: 导出CSV

表 5 2组手术患者护理质量比较(x±s，分)

Table 5. Comparison of nursing quality between two groups of patients(x±s, points)

组别	例数	手术准备	器械管理	手术安全	环境管理	医护配合	总分
对照组	64	8.18±1.12	8.26±0.76	8.07±0.83	9.00±0.29	8.45±0.73	44.68±2.54
观察组	64	9.04±0.23	9.21±0.26	9.13±0.34	9.58±0.17	9.29±0.30	47.81±1.62
t值		6.017	9.462	9.454	13.803	8.515	8.312
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

下载: 导出CSV

参考文献(24)

[1]	HE Y Y, CHEN J, CHEN Y F, et al. Effect of operating room nursing management on nosocomial infection in orthopedic surgery: a meta-analysis[J]. J Healthc Eng, 2022: 4193932. DOI: 10.1155/2022/4193932.
[2]	邱小丹, 王乐洁, 张敏, 等. 基于格林模式的手术烟雾干预策略在手术室医护人员中的应用效果[J]. 中华全科医学, 2022, 20(11): 1960-1964. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202211039.htm QIU X D, WANG L J, ZHANG M, et al. Effect of surgical smoke intervention strategy based on Green model on medical staff in operating room[J]. Chinese Journal of General Practice, 2022, 20(11): 1960-1964. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202211039.htm
[3]	吴程程, 张成欢, 韩小云. 手术室护士护理中断事件培训现状及需求调查分析[J]. 护理学杂志, 2021, 36(18): 46-47, 50. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202118013.htm WU C C, ZHANG C H, HAN X Y. Operating room nurses'training needs for interruptions in nursing practice[J]. Journal of Nursing Science, 2021, 36(18): 46-47, 50. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202118013.htm
[4]	韩白雪, 李达, 林家嘉, 等. 结直肠癌根治术后老年患者睡眠障碍的前馈控制[J]. 护理学杂志, 2022, 37(21): 19-22. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202221005.htm HAN B X, LI D, LIN J J, et al. Feedforward control for postoperative sleep disturbance in elderly patients undergoing radical resection of colorectal cancer[J]. Journal of Nursing Science, 2022, 37(21): 19-22. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202221005.htm
[5]	宋薇, 刘淑贤. 前馈控制对飞秒激光辅助白内障手术取消率的影响[J]. 中华现代护理杂志, 2020, 26(10): 1302-1303, 1305. SONG W, LIU S X. Effects of feedforward control on cancellation rate in femtosecond laser assisted cataract surgery[J]. Chinese Journal of Modern Nursing, 2020, 26(10): 1302-1303, 1305.
[6]	王辉, 续梅莹. 基于智慧病房护理管理系统的多角度干预在护理中断事件观察中的应用效果[J]. 中华现代护理杂志, 2021, 27(1): 85-88. WANG H, XU M Y. Effects of multi-angle intervention based on the smart ward nursing management systems in the observation of nursing interruptions[J]. Chinese Journal of Modern Nursing, 2021, 27(1): 85-88.
[7]	MCGILLIS HSLL L, PEDERSEN C, HUBLEY P, et al. Interruptions and pediatric patient safety[J]. J Pediatr Nurs, 2010, 25(3): 167-175.
[8]	汪笑妹, 胡紫燕, 孙文静, 等. 国外手术中断研究现状及管理对策[J]. 中国护理管理, 2021, 21(3): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202103032.htm WANG X M, HU Z Y, SUN W J, et al. Status quo and management strategies for interruptions in surgery in foreign countries[J]. Chinese Nursing Management, 2021, 21(3): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202103032.htm
[9]	邹振亚, 周晓阳, 段红香, 等. 医疗失效模式与效应分析在预防手术室消极型结局护理中断事件中的应用[J]. 中国实用护理杂志, 2023, 39(14): 1041-1047. ZOU Z Y, ZHOU X Y, DUAN H X, et al. Application of healthcare failure mode and effect analysis in preventing nursing interruption with negative outcome in operating room[J]. Chinese Journal of Practical Nursing, 2023, 39(14): 1041-1047.
[10]	付素娟, 贺亚栋, 陈丽. 基于前馈控制的康复护理在早期喉癌根治术手术室护理中的应用[J]. 海南医学, 2021, 32(14): 1902-1904. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202114037.htm FU S J, HE Y D, CHEN L. Application of rehabilitation nursing based on feedforward control in operation room nursing of patients with early laryngeal cancer undergoing radical operation[J]. Hainan Medical Journal, 2021, 32(14): 1902-1904. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202114037.htm
[11]	方陈, 李亚菲, 张琼, 等. 手术安全核查的SWOT分析[J]. 解放军医院管理杂志, 2019, 26(4): 301-305. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201904004.htm FANG C, LI Y F, ZHANG Q, et al. SWOT analysis of surgical safety verification[J]. Hospital Administration Journal of Chinese People ' s Liberation Army, 2019, 26(4): 301-305. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201904004.htm
[12]	YU X L, HU D, CHEN L, et al. Evidence-based nursing in the operating room of obstetrics and gynecology departments alleviates patients ' adverse moods and improves their quality of life[J]. Am J Transl Res, 2022, 14(7): 4768-4775.
[13]	夏涛, 汤军, 张纯, 等. 基于前馈控制理念的风险预警在确保手术室护理安全中的应用效果分析[J]. 川北医学院学报, 2021, 36(11): 1528-1531. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH202111030.htm XIA T, TANG J, ZHANG C, et al. Application effect analysis of risk early warning based on feedforward control concept in ensuring nursing safety in operating room[J]. Journal of North Sichuan Medical College, 2021, 36(11): 1528-1531. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH202111030.htm
[14]	BRETONNIER M, MICHINOV E, MORANDI X, et al. Interruptions in surgery: a comprehensive review[J]. J Surg Res, 2020, 247: 190-196.
[15]	韩小云, 张成欢, 吴程程. 手术室护理中断事件现状及护士感受的调查分析[J]. 护士进修杂志, 2022, 37(24): 2278-2282. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202224016.htm HAN X Y, ZHANG C H, WU C C. Investigation and analysis of the status quo and nurses'feelings about nursing interruptions in operating room[J]. Journal of Nurses Training, 2022, 37(24): 2278-2282. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202224016.htm
[16]	徐芸菲, 裴峥, 许晨莹. 核查清单在提高妇科腹腔镜护士专科培训效果和护理质量的效果分析[J]. 现代临床护理, 2022, 21(11): 69-73. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202211011.htm XU Y F, PEI Z, XU C Y. Effect of checklists on improvement of specialised training and quality of surgery cooperation for nurses in assisting gynaecological laparoscopy in operating room[J]. Modern Clinical Nursing, 2022, 21(11): 69-73. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202211011.htm
[17]	YAO X Y, ZHU H, WANG Y F, et al. Study on the effect of PDCA circulation method on nursing quality management in the day operating room[J]. Contrast Media Mol Imaging, 2022: 3503095. DOI: 10.1155/2022/3503095.
[18]	王君慧, 覃梦霞, 潜艳, 等. 肺部手术患者术后恶心呕吐的前馈控制管理[J]. 护理学杂志, 2021, 36(24): 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202124009.htm WANG J H, QIN M X, QIAN Y, et al. Feed-forward control management for postoperative nausea and vomiting in patients undergoing pulmonary surgery[J]. Journal of Nursing Science, 2021, 36(24): 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202124009.htm
[19]	孙玲玲. 基于前馈控制的护理干预对胸腔镜肺癌根治术患者苏醒期不良反应的影响研究[D]. 湖州: 湖州师范学院, 2021. SUN L L. A study on the impact of nursing intervention based on feedforward control on adverse reactions during the recovery period of patients undergoing thoracoscopic radical surgery for lung cancer[D]. Huzhou: Huzhou University, 2021.
[20]	孙玉梅, 刘粤, 杨晨, 等. 多学科协作模式对老年髋部骨折患者术后应激性高血糖的影响[J]. 医药论坛杂志, 2023, 44(10): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX202310001.htm SUN Y M, LIU Y, YANG C, et al. Effect of multidisciplinary cooperation mode on stress hyperglycemia in elderly patients with hip fracture after operation[J]. Journal of Medical Forum, 2023, 44(10): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX202310001.htm
[21]	于红艳, 张培松, 李敏, 等. 团队支持护理用于甲状腺癌患者围手术期的效果观察[J]. 中国基层医药, 2023, 30(3): 470-473. YU H Y, ZHANG P S, LI M, et al. Effects of team support nursing in the perioperative period of patients with thyroid cancer[J]. Chinese Journal of Primary Medicine and Pharmacy, 2023, 30(3): 470-473.
[22]	郑倩, 张雅玲. 基于FOCUS-PDCA理论的风险管理改善手术室麻醉护理质量的作用观察[J]. 浙江临床医学, 2022, 24(4): 599-601. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202204041.htm ZHENG Q, ZHANG Y L. Risk management based on the theory of the FOCUS-PDCA to improve the effect of surgery anesthesia nursing quality observation[J]. Zhejiang Clinical Medical Journal, 2022, 24(4): 599-601. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202204041.htm
[23]	陆培培, 李娜, 张丽娜. 前馈控制模式在手术室护理管理中的应用对护士护理差错行为及护理态度的影响[J]. 山西医药杂志, 2022, 51(13): 1535-1538. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202213034.htm LU P P, LI N, ZHANG L N. The application of feedforward control mode in operating room nursing management and its impact on nursing error behavior and attitude of nurses[J]. Shanxi Medical Journal, 2022, 51(13): 1535-1538. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202213034.htm
[24]	CHU Y M, LIU F T, LIU F F, et al. Clinical study on nursing quality control in the operating room with comprehensive evaluation method[J]. Minerva Med, 2022, 113(6): 1056-1058.