PDF(Pubmed)
Abstract：
OBJECTIVE: The early identification and diagnosis of transplant-associated thrombotic microangiopathy (TA-TMA) are essential yet difficult in patients underwent hematopoietic stem cell transplantation (HSCT). To develop an evidence-based, nurse-leading early warning model for TA-TMA, and implement the healthcare quality review and improvement project.
METHODS: This study was a mixed-methods, before-and-after study. The early warning model was developed based on quality evidence from literature search. The healthcare quality review and improvement project mainly included baseline investigation of nurse, improvement action and effectiveness evaluation. The awareness and knowledge of early parameter of TA-TMA among nurses and the prognosis of patients underwent HSCT were compared before and after the improvement.
RESULTS: A total of 1 guideline, 1 evidence synthesis, 4 expert consensuses, 10 literature reviews, 2 diagnostic studies, and 9 case series were included in the best evidence. The early warning model including warning period, high-risk characteristics and early manifestation of TA-TMA was developed. The improvement action, including staff training and assessment, suspected TA-TMA identification and patient education, was implemented. The awareness and knowledge rate of early parameter of TA-TMA among nurses significantly improved after improvement action (100% vs. 26.7%, P < 0.001). The incidence of TA-TMA was similar among patients underwent HSCT before and after improvement action (2.8% vs. 1.2%, P = 0.643), while no fall event occurred after improvement action (0 vs. 1.2%, P < 0.001).
CONCLUSIONS: The evidence-based early warning model and healthcare quality improvement project could enhance the awareness and knowledge of TA-TMA among healthcare providers and might improve the prognosis of patients diagnosed with TA-TMA.
METHODS: This study was a mixed-methods, before-and-after study. The early warning model was developed based on quality evidence from literature search. The healthcare quality review and improvement project mainly included baseline investigation of nurse, improvement action and effectiveness evaluation. The awareness and knowledge of early parameter of TA-TMA among nurses and the prognosis of patients underwent HSCT were compared before and after the improvement.
RESULTS: A total of 1 guideline, 1 evidence synthesis, 4 expert consensuses, 10 literature reviews, 2 diagnostic studies, and 9 case series were included in the best evidence. The early warning model including warning period, high-risk characteristics and early manifestation of TA-TMA was developed. The improvement action, including staff training and assessment, suspected TA-TMA identification and patient education, was implemented. The awareness and knowledge rate of early parameter of TA-TMA among nurses significantly improved after improvement action (100% vs. 26.7%, P < 0.001). The incidence of TA-TMA was similar among patients underwent HSCT before and after improvement action (2.8% vs. 1.2%, P = 0.643), while no fall event occurred after improvement action (0 vs. 1.2%, P < 0.001).
CONCLUSIONS: The evidence-based early warning model and healthcare quality improvement project could enhance the awareness and knowledge of TA-TMA among healthcare providers and might improve the prognosis of patients diagnosed with TA-TMA.
摘要：
目的：移植相关血栓性微血管病（TA-TMA）的早期识别和诊断对造血干细胞移植（HSCT）患者至关重要，但困难。为了开发一个基于证据的，护士主导的TA-TMA预警模型,并实施医疗质量审查和改进项目。
方法：这项研究是一种混合方法，研究前后。基于文献检索的质量证据建立了预警模型。医疗质量审查和改进项目主要包括护士的基线调查，改进行动和有效性评估。比较改良前后护士对TA-TMA早期参数的知晓率和知识水平以及HSCT患者的预后。
结果：共1个指南，1证据综合，4专家共识，10篇文献综述，2诊断研究，和9个病例系列被纳入最佳证据。预警模型包括预警期,出现了TA-TMA的高危特征和早期表现。改进行动，包括员工培训和评估，疑似TA-TMA鉴定和患者教育，已实施。改善后护士对TA-TMA早期参数的知晓率和知晓率显著提高(100%vs.26.7%,P<0.001)。在改善前后接受HSCT的患者中，TA-TMA的发生率相似（2.8％vs.1.2%,P=0.643),而改善措施后没有发生跌倒事件(0与1.2%,P<0.001)。
结论：基于证据的早期预警模型和医疗质量改善项目可以提高医疗保健提供者对TA-TMA的认识和认识，并可能改善诊断为TA-TMA的患者的预后。
方法：这项研究是一种混合方法，研究前后。基于文献检索的质量证据建立了预警模型。医疗质量审查和改进项目主要包括护士的基线调查，改进行动和有效性评估。比较改良前后护士对TA-TMA早期参数的知晓率和知识水平以及HSCT患者的预后。
结果：共1个指南，1证据综合，4专家共识，10篇文献综述，2诊断研究，和9个病例系列被纳入最佳证据。预警模型包括预警期,出现了TA-TMA的高危特征和早期表现。改进行动，包括员工培训和评估，疑似TA-TMA鉴定和患者教育，已实施。改善后护士对TA-TMA早期参数的知晓率和知晓率显著提高(100%vs.26.7%,P<0.001)。在改善前后接受HSCT的患者中，TA-TMA的发生率相似（2.8％vs.1.2%,P=0.643),而改善措施后没有发生跌倒事件(0与1.2%,P<0.001)。
结论：基于证据的早期预警模型和医疗质量改善项目可以提高医疗保健提供者对TA-TMA的认识和认识，并可能改善诊断为TA-TMA的患者的预后。
