Handover

移交
  • 文章类型: Journal Article
    本工作旨在绘制有关在急诊科背景下使用ISBAR工具在成人急病患者移交护理中的益处的现有科学证据。为此,进行了范围审查,根据乔安娜·布里格斯研究所(JBI)提出的指导方针,回答以下研究问题:“在急诊科背景下,使用ISBAR工具在成人急病患者的护理护理中有什么好处?”2023年8月和9月在以下电子数据库中进行了书目搜索:CINAHLComplete;MEDLINEComplete;Cochrane中央对照试验注册;Cochrane系统审查数据库;和Cochrane注册方法。只有在2013年至2023年之间出版的作品才被认为适合纳入。所有纳入的研究(9)表明,ISBAR方法,作为在急诊服务中转移护理的标准化工具,允许一个保险箱,clear,护理的简洁过渡。这些好处涉及患者和专业安全,连续性,和护理质量,以及耐心和专业的舒适,健康收益。
    The present work aims to map the available scientific evidence on the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients\' handover in an emergency department context. To this end, a scoping review was conducted, according to the guidelines proposed by the Joanna Briggs Institute (JBI), to answer the following research question: \"What are the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients\' handover in an emergency department context?\" The bibliographic search was carried out during August and September 2023 in the following electronic databases: CINAHL Complete; MEDLINE Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and Cochrane Methodology Register. Only works published between 2013 and 2023 were deemed fit for inclusion. All the included studies (9) show that ISBAR methodology, as a standardized tool for transferring nursing care in the emergency service, allows for a safe, clear, and concise transition of nursing care. The benefits relate to patient and professional safety, continuity, and quality of care, as well as patient and professional comfort, with health gains.
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  • 文章类型: Journal Article
    背景:尽管在重症监护病房(ICU)的检查表上发表了大量研究,尚未就重症监护室中检查表的更广泛作用发表评论,它们的实施和验证,以及推荐使用的临床背景。因此,有必要进行范围审查,以绘制当前文献并指导未来重症监护检查表的研究.这篇综述的重点是目前使用的清单,它们是如何使用的,检查表的制定和实施过程,以及与清单使用相关的结果。
    方法:对MEDLINE(Ovid)的系统搜索,Embase,Scopus,谷歌学者数据库进行了,然后是灰色文献搜索。筛选已确定研究的摘要。相关文章的全文进行了审查,随后对纳入研究的参考文献进行了额外相关文章的筛选.详细的研究特点,研究设计,检查表干预,并提取结果。
    结果:我们的搜索产生了2046项研究,其中167人被选中进行进一步分析。这些研究中确定的清单分为以下类型:四舍五入清单;谵妄筛查清单;转移和移交清单;中央线路相关血流感染(CLABSI)预防清单;气道管理清单;和其他。在报告的72项重要临床结果中,65是积极的,五个是阴性的,和两个混合。在报告的122项重要护理结果中,114为阳性,8为阴性。
    结论:检查表常用于重症监护病房,并出现在许多临床指南中。谵妄筛查检查表和四舍五入检查表在文献中得到了很好的实施和验证。与清单使用相关的临床和护理结果过程主要是积极的。未来对重症监护病房清单的研究应侧重于建立清单类型和使用干预后数据进行持续修改和改进的过程的临床指南。
    Despite the extensive volume of research published on checklists in the intensive care unit (ICU), no review has been published on the broader role of checklists within the intensive care unit, their implementation and validation, and the recommended clinical context for their use. Accordingly, a scoping review was necessary to map the current literature and to guide future research on intensive care checklists. This review focuses on what checklists are currently used, how they are used, process of checklist development and implementation, and outcomes associated with checklist use.
    A systematic search of MEDLINE (Ovid), Embase, Scopus, and Google Scholar databases was conducted, followed by a grey literature search. The abstracts of the identified studies were screened. Full texts of relevant articles were reviewed, and the references of included studies were subsequently screened for additional relevant articles. Details of the study characteristics, study design, checklist intervention, and outcomes were extracted.
    Our search yielded 2046 studies, of which 167 were selected for further analysis. Checklists identified in these studies were categorised into the following types: rounding checklists; delirium screening checklists; transfer and handover checklists; central line-associated bloodstream infection (CLABSI) prevention checklists; airway management checklists; and other. Of 72 significant clinical outcomes reported, 65 were positive, five were negative, and two were mixed. Of 122 significant process of care outcomes reported, 114 were positive and eight were negative.
    Checklists are commonly used in the intensive care unit and appear in many clinical guidelines. Delirium screening checklists and rounding checklists are well implemented and validated in the literature. Clinical and process of care outcomes associated with checklist use are predominantly positive. Future research on checklists in the intensive care unit should focus on establishing clinical guidelines for checklist types and processes for ongoing modification and improvements using post-intervention data.
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  • 文章类型: Review
    背景:自医学研究所(IOM)于1999年发表《人类:建立更安全的卫生系统》以来[1],临床移交(或移交)及其与患者安全沟通的关系引起了公众的关注,监管机构和医生[2,3]。协议,指导方针,表格和记忆装置已经创建,以确保更安全的临床移交。最初的文献检索没有找到描述每个助记装置及其元件的临床过程和功能的框架。缺乏系统框架可能会阻碍已建立的临床移交记忆装置的研究和可重用性。本研究旨在开发一个通用框架,以描述交接期间对患者安全至关重要的临床过程和功能。
    方法:我们查询了PubMed.gov,获得了98篇与临床移交相关的文章。我们检查了这些文章中提到的助记符的引用来源。总共确定了42个具有238个元素的移交助记符。我们的评论指出,没有分类法来描述与临床交接记忆装置相关的临床功能和过程。我们使用扎根理论来解决这一差距,并从42个助记符中建立了新的分类法。研究人员阅读了所有助记符,开发了用于标记临床交接助记符的分类法,并将所有助记符元素分类为正确的过程和功能。之后,第二个研究员,医生,检查了分类法,并对所有助记元素的标记功能进行了建议的更正。两位研究人员都同意分类法以及不同记忆元素的标记过程和功能。
    结果:分类法包含临床移交中的三个过程和二十个功能。像医疗状况这样的临床过程,病史,医学评估,护理计划,出色的护理/任务/结果,和病人信息,作为一个行政过程,在临床交接助记符中被广泛采用。此外,在临床交接助记符列表中已确定了通信方式和信息验证的助记符元素。
    结论:尽管我们认识到由于大量的临床移交方案以及将其置于几个预定义的组之下的任务而带来的挑战,我们的研究结果表明,这样的分类法,正如为这项研究开发的那样,可以帮助医生设计一个临床交接助记符,以最适合他们的工作场所。
    Since the Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in 1999, clinical handovers (or handoffs) and their relationship with the communication of patient safety have raised concerns from the public, regulatory bodies, and medical practitioners. Protocols, guidelines, forms, and mnemonic devices have been created to ensure safer clinical handovers. An initial literature search did not find a framework to describe the clinical processes and functions of each mnemonic device and its elements. The absence of a systematic framework could hinder the study across and the reusability of the established clinical handover mnemonic devices. This study aims to develop a universal framework to describe the clinical processes and functions essential for patient safety during handover. We queried PubMed.gov and obtained 98 articles related to clinical handovers. We examined the citing sources of the mnemonics mentioned in these articles. A total of 42 handover mnemonics with 238 elements were identified. Our review noted that there was no taxonomy to describe the clinical functions and process associated with the clinical handover mnemonic devices. We used grounded theory to address this gap and built a new taxonomy from the 42 mnemonics. A researcher read all mnemonics, developed a taxonomy for tagging clinical handover mnemonics, and categorized all mnemonic elements into correct processes and functions. After that, the second researcher, a medical practitioner, examined the taxonomy and made suggested corrections for the labelled functions of all mnemonic elements. Both researchers agreed on the taxonomy and the labelled processes and functions of different mnemonic elements. The taxonomy contains three processes and twenty functions in clinical handovers. Clinical processes like \'medical condition\', \'medical history\', \'medical evaluation\', \'care plan\', \'outstanding care/tasks/results\', and \'patient information\', as an administrative process, were widely adopted in clinical handover mnemonics. Moreover, mnemonic elements on communication manner and information validation had been identified in the list of clinical handover mnemonics. Although we recognize challenges because of both the vast number of clinical handover scenarios and the task of placing them under a few predefined groups, our findings suggest that such a taxonomy, as developed for this study, could assist medical practitioners to devise a clinical handover mnemonic to best fit their workplace.
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  • 文章类型: Journal Article
    临床移交过程与患者安全直接相关。改善患者交接可以提高患者的安全性和最终结果;因此,本综述旨在研究现有的有关使移交更有效的干预措施的文献.
    在MEDLINE(EBSCO)中搜索可提高临床移交疗效的干预措施。如果研究无关紧要,就被排除在外,没有发表在同行评审的期刊上,不是用英文出版的,或者基于动物研究。共检索了1087份出版物,并按相关性进行了排序。通过阅读标题和摘要然后全文来确定文章的资格,和参考搜索。本文献综述选择了六项研究。
    探索了一些移交干预措施。一项干预措施是将移交地点更改为患者的床边;Bradley等人。发现床边切换减少了切换时间和患者不良事件。另一项干预措施是提供Sand-Jecklin等人的移交教育。与不良事件减少相关。此外,Lee等人。使用基于模拟的教育,发现它显著提高了护士的知识,绩效能力,和自我效能感。另一种干预措施是在床边转换护理(TCAB)框架,该框架纳入了多维策略,并强调将移交作为患者中心的一部分;这些策略提高了患者安全性,然而,结果不能完全归因于移交修改。同时,哈达等人。实施了多种干预措施,发现它们提高了患者的安全性并减少了不良事件。
    探索的干预措施是床边移交,提供移交教育和基于模拟的教育,强调以患者为中心作为TCAB策略的一部分,并实施多种干预措施。所有干预措施都减少了不良事件,虽然有些改善并不显著。由于支持干预措施对改善临床移交的有效性的证据有限,结果尚无定论。
    UNASSIGNED: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients\' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective.
    UNASSIGNED: MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review.
    UNASSIGNED: A number of handover interventions were explored. One intervention was changing the handover location to patients\' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses\' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events.
    UNASSIGNED: The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.
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  • 文章类型: Journal Article
    OBJECTIVE: Currently, there is no standardized handover pattern for patients undergoing general anesthesia when being transferred to the postanesthesia care unit (PACU).
    METHODS: A review of the literature.
    METHODS: In this study, a review of the literature was conducted to analyze the PACU handover status, factors for poor handover, and commonly used handover patterns.
    RESULTS: Important handover information was often omitted during the handover of PACU patients, and there were many factors influencing postoperative patient handover quality. This study analyzed and compared several commonly used handover patterns for patients. Among these, the Situation-Background-Assessment-Recommendation tool is relatively mature. However, there is currently no unified standardized patient handover pattern, and the validity and applicability of tools still need to be verified.
    CONCLUSIONS: PACU is an important place for the recovery of surgical patients. Anesthesia providers need to provide PACU nurses with complete and comprehensive postoperative handover information. A standardized handover model for clinical nurses is needed to improve patient safety management and work efficiency.
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  • 文章类型: Journal Article
    围手术期从考虑手术到在家恢复。手术路径上的患者将在他们的护理中经历多个转变点。随着我们转向更加协作的工作和照顾日益复杂的医学患者,我们必须建立强大的流程,以减轻这些多个过渡点对患者造成伤害的可能性。本文回顾了围手术期护理交接的最佳实践和指导。我们将研究医院环境以外的护理过渡模式,以及如何更好地利用社区资源可以使护理从医院过渡到持续康复。
    The perioperative period extends from the moment of contemplation of surgery through to recovery at home. Patients on a surgical pathway will experience multiple transition points in their care. As we move to more collaborative working and caring for increasingly medically complex patients, we must establish robust processes to mitigate against the potential for patient harm posed by these multiple transition points. This article reviews best practice and guidance on handover of care throughout the perioperative period. We will look at models of transition of care beyond the hospital environment and how better use of community resources can smooth the transition of care out of hospital for ongoing rehabilitation.
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  • 文章类型: Systematic Review
    背景:急诊医疗服务(EMS)提供者和急诊科(ED)护士之间的护理过渡对于患者护理和安全至关重要。然而,EMS提供者和ED护士之间的互动可能存在沟通差距,尚未得到广泛研究.这篇综述的目的是研究(1)影响从EMS提供者到ED护士的护理过渡的因素,以及(2)改善这些过渡的干预策略的有效性。方法:我们进行了一项混合方法的系统评价,包括电子数据库的搜索(DARE,MEDLINE,EMBASE,Cochrane中央控制试验登记册,CINAHL,乔安娜·布里格斯研究所EBP),灰色文献数据库,组织网站,询问急诊医学专家,以及纳入研究中引用的参考文献清单。任何设计的所有英语语言研究都有资格纳入。两名审稿人独立筛选标题/摘要和全文的包容性和方法学质量,以及从纳入研究中提取的数据。我们使用叙事和主题综合来整合和探索数据中的关系。结果:总的来说,筛选了8,348项研究,并选择了130项进行全文审查。最终的合成包括20项研究。在15项中等至高方法学质量的研究中,影响过渡的6个因素:不同的专业镜头,操作限制,专业关系,专业之间共享的信息,过渡过程的组成部分,以及患者的表现和参与。在6项方法学薄弱的研究中确定了三种干预措施:(1)过渡指南(DeMIST,Identification,机制/医疗投诉,与投诉有关的伤害/信息,迹象,治疗和趋势-过敏,药物治疗,背景历史,其他信息[IMIST-AMBO])通过培训,(2)基于移动Web的技术(EMS智能手机和地理信息系统位置数据),和(3)新的临床角色(ED救护车卸载护士致力于分类和评估EMS患者)。对于过渡指南的有效性和新的临床作用,有不同的发现。EMS提供商和ED护士都积极地认为移动技术有助于更好地描述院前环境和ED中的计划流程。结论:虽然多媒体应用可能会改善切换过程,未来的干预研究需要严格设计。我们建议对EMS和ED员工进行跨学科培训,以使用灵活的结构化协议,特别是考虑到审查发现,跨学科的沟通和关系可能是具有挑战性的。
    Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. Methods: We conducted a mixed-methods systematic review that included searches of electronic databases (DARE, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Joanna Briggs Institute EBP), gray literature databases, organization websites, querying experts in emergency medicine, and the reference lists cited in included studies. All English-language studies of any design were eligible for inclusion. Two reviewers independently screened titles/abstracts and full-texts for inclusion and methodological quality, as well as extracted data from included studies. We used narrative and thematic synthesis to integrate and explore relationships within the data. Results: In total, 8,348 studies were screened and 130 selected for full text review. The final synthesis included 20 studies. Across 15 studies of moderate-to-high methodological quality, 6 factors influenced transitions: different professional lenses, operational constraints, professional relationships, information shared between the professions, components of the transition process, and patient presentation and involvement. Three interventions were identified in 6 methodologically weak studies: (1) transition guideline (DeMIST, Identification, Mechanism/Medical complaint, Injuries/Information related to the complaint, Signs, Treatment and Trends - Allergies, Medication, Background history, Other information [IMIST-AMBO]) with training, (2) mobile web-based technology (EMS smartphone and geographic information system location data), and (3) a new clinical role (ED ambulance off-load nurse dedicated to triaging and assessing EMS patients). There were mixed findings for the effectiveness of transition guidelines and the new clinical role. Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given review findings that interdisciplinary communication and relationships can be challenging.
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  • 文章类型: Journal Article
    The purpose is to provide a descriptive overview of relevant material exploring improvement of handovers from the operating room (OR) to intensive care unit (ICU). An online search (MEDLINE, Cochrane, EMBASE, CINAHL, and Joanna Briggs), including gray literature and relevant reference lists, was completed. In all, 4574 unique citations were screened and 155 full-text reviews performed; 65 articles were included in the final analysis. The majority of articles discuss an ideal structure for handover (n = 63; 97%); 43 (66%) articles mentioned strategies for implementing such an approach. Only 21 (32%) explicitly described formal quality improvement (QI) methods. Few explored project sustainability and impact of a structured handover on patient safety outcomes (n = 15, 23%). Published literature suggests that there is a significant gap in evidence of measured patient outcomes from standardization of OR to ICU handover processes. Identifying formal QI strategies used to sustain standardized handover processes will allow accurate measurement of patient outcomes.
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  • 文章类型: Journal Article
    在急诊医疗服务(EMS)从业人员和急诊科(ED)护士之间进行有效和高效的护理过渡至关重要,因为护理的不良临床过渡可能会使患者面临不良事件的风险增加,例如在时间敏感的情况下延迟治疗(例如,心肌梗塞)或状态恶化(例如,脓毒症)。护理中的这种转变是复杂的,并且容易出现沟通错误,这主要是由于与不同的专业观点相关的误解导致的,从而导致误解,这些误解进一步容易受到上下文因素和不同的专业镜头的影响。在这次系统审查中,我们旨在研究(1)减轻或改善护理过渡的因素,特别是从EMS从业人员到ED护士,(2)干预策略的有效性,导致改善沟通和减少不良事件。
    我们将搜索电子数据库(DARE,MEDLINE,EMBASE,科克伦,CINAHL,乔安娜·布里格斯研究所EBP;交流文摘);灰色文献(灰色文献数据库,组织网站,查询急诊医学专家);和参考列表,并对纳入的研究进行前瞻性引用搜索。如果研究包括(1)EMS从业人员或ED护士参与到达EMS患者的过渡,则所有英语初级研究都有资格纳入;(2)干预措施,以改善护理过渡或描述影响护理过渡的因素(障碍/促进者,感知,经验,信息交换的质量)。两名审稿人将独立筛选标题/摘要和全文,以确保收录和方法质量。我们将使用叙事和主题综合来整合和探索数据中的关系。如果数据允许,将进行荟萃分析。
    这项系统评价将有助于确定在护理过渡期间影响EMS和ED护士之间沟通的因素,并确定可改善沟通和减少不良事件的干预策略。这些发现可用于开发护理工具中的循证转换,以确保有效传输准确的患者信息,护理的连续性,提高患者安全,避免重复服务。这篇综述还将找出现有文献中的差距,为未来的研究工作提供信息。
    PROSPEROCRD42017068844。
    Effective and efficient transitions in care between emergency medical services (EMS) practitioners and emergency department (ED) nurses is vital as poor clinical transitions in care may place patients at increased risk for adverse events such as delay in treatment for time sensitive conditions (e.g., myocardial infarction) or worsening of status (e.g., sepsis). Such transitions in care are complex and prone to communication errors primarily caused by misunderstanding related to divergent professional perspectives leading to misunderstandings that are further susceptible to contextual factors and divergent professional lenses. In this systematic review, we aim to examine (1) factors that mitigate or improve transitions in care specifically from EMS practitioners to ED nurses, and (2) effectiveness of interventional strategies that lead to improvements in communication and fewer adverse events.
    We will search electronic databases (DARE, MEDLINE, EMBASE, Cochrane, CINAHL, Joanna Briggs Institute EBP; Communication Abstracts); gray literature (gray literature databases, organization websites, querying experts in emergency medicine); and reference lists and conduct forward citation searches of included studies. All English-language primary studies will be eligible for inclusion if the study includes (1) EMS practitioners or ED nurses involved in transitions for arriving EMS patients; and (2) an intervention to improve transitions in care or description of factors that influence transitions in care (barriers/facilitators, perceptions, experiences, quality of information exchange). Two reviewers will independently screen titles/abstracts and full texts for inclusion and methodological quality. We will use narrative and thematic synthesis to integrate and explore relationships within the data. Should the data permit, a meta-analysis will be conducted.
    This systematic review will help identify factors that influence communication between EMS and ED nurses during transitions in care, and identify interventional strategies that lead to improved communication and decrease in adverse events. The findings can be used to develop an evidence-informed transitions in care tool that ensures efficient transfer of accurate patient information, continuity of care, enhances patient safety, and avoids duplication of services. This review will also identify gaps in the existing literature to inform future research efforts.
    PROSPERO CRD42017068844.
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  • 文章类型: Journal Article
    The aim of this study is to explore the different handover models and processes available and their efficacy in improving handover communication within nursing practice. The handover of information is a key nursing responsibility that ensures patient outcomes through continuity of care. This process is widely recognised as an opening for error that may comprise patient safety. This paper is an integrative literature review that employed an inductive exploratory design. A computerised database search was employed including CINAHL, PubMed and Science Direct and a manual citation search with included papers limited to papers published 2005-2016, in English with full text freely available. This included a systematic search strategy, a critical appraisal of the papers utilising the Critical Appraisal Skills Programme, an inductive data extraction and thematic analysis. Sixteen papers were included in this review. The results detailed that there are various handover models in use, yet there is no evidence that any one model displays superior efficacy. The iSoBAR model and its adaptations remain the only model employed across various specialties. More research is warranted to determine if any handover model displays superior efficacy or transferability.
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