目的:探索生命体征评估(完整和不完整的生命体征集),并根据政策和护理干预措施升级护理,以应对临床恶化。
方法:本队列研究是对来自“护士对恶化患者的优先反应观察”的数据的二次分析,该随机对照试验是对护士生命体征测量和恶化患者护理升级的促进干预措施。
方法:这项研究是在维多利亚州四家大都会医院的36个病房中进行的,澳大利亚。在同一周内三个随机选择的24小时期间,在三个时间点对来自研究病房的所有纳入患者的医疗记录进行了审计:干预前(2016年6月),以及干预后6(2016年12月)和12个月(1017年6月).描述性统计数据用于总结研究数据,变量之间的关系采用卡方检验。
结果:共进行了10,383次审核。在91.6%的审核中,每8小时至少记录一次生命体征测量,在83.1%的审计中,每8小时记录一组完整的生命体征。有医疗前急救小组,医疗急救小组或心脏骤停小组在25.8%的审计中触发。当触发器存在时,在26.8%的审计中出现了快速反应系统呼叫。在医疗急救团队(n=2403)或医疗急救团队触发因素(n=273)的审核中,有1350项记录的护理干预措施。一项或多项护理干预措施记录在29.5%的医疗急救小组前触发审计和63.7%的医疗急救小组触发审计。
结论:当记录快速反应系统触发时,根据政策,护理升级存在差距;然而,针对临床病情恶化,护士在其执业范围内采取了一系列干预措施.
结论:急诊病房的内科和外科病房护士经常进行生命体征评估。医疗和护理护士的干预可能发生在,或者与调用快速反应系统并行。护理干预是对恶化患者的组织反应的关键但未被认可的要素。
■护士从事一系列护理干预措施来管理恶化的患者,(除了快速反应系统激活),这些都没有得到很好的理解,迄今为止的文献中也没有很好的描述。
结论:这项研究解决了在现实世界环境中,护士在其实践范围内对恶化患者的管理(除了RRS激活)的文献中的差距。当快速反应系统触发器被记录时,根据政策,护理升级存在差距;然而,针对临床病情恶化,护士在其执业范围内采取了一系列干预措施.这项研究的结果与在内科和外科病房工作的护士有关。
■该试验是根据集群试验建议的统一试验报告标准扩展报告的,本文根据《加强流行病学观察研究报告》报告。
■没有患者或公共捐款。
OBJECTIVE: To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration.
METHODS: This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses\' vital sign measurement and escalation of care for deteriorating patients.
METHODS: The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test.
RESULTS: A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers.
CONCLUSIONS: When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration.
CONCLUSIONS: Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients.
UNASSIGNED: Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date.
CONCLUSIONS: This study addresses the gap in the literature regarding nurses\' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards.
UNASSIGNED: The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement.
UNASSIGNED: No Patient or Public Contribution.