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Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores 婴儿法洛氏四联症矫正手术后的术后机械通气:围手术期因素和放射学严重程度评分评估
Q2 Nursing Pub Date : 2024-11-16 DOI: 10.1016/j.pcorm.2024.100446
Panop Limratana , Wiriya Maisat , Lee Ferguson , Christopher W. Baird , Koichi Yuki
Early recovery from surgery for congenital heart disease (CHD) is becoming a trend. Tetralogy of Fallot/pulmonary stenosis (TOF/PS) is the most common cyanotic CHD with excellent long-term outcomes. We examined potential factors associated with early extubation in 249 patients who underwent TOF/PS complete repair in a tertiary pediatric medical center from January 2015 to December 2022. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were acquired from the electronic medical records. Valve sparing repair (VSR) tends to demonstrate earlier recovery profiles than transannular patch repair (TAP) irrelevant of the presence of monocusp valve (P < 0.0001) and the degree of right ventricular outflow pressure drop was significantly correlated with post-operative recovery profile (p = 0.0204). Because of intracardiac shunts and PaO2/FiO2 ratios being poor indicators of lung injury, Brixia scores were also used. Our data suggested that Brixia score could be an excellent alternative to evaluate post-operative lung status.
先天性心脏病(CHD)手术后早期康复已成为一种趋势。法洛氏四联症/肺动脉狭窄(TOF/PS)是最常见的紫绀型先天性心脏病,长期疗效极佳。我们研究了2015年1月至2022年12月在一家三级儿科医疗中心接受TOF/PS完全修复术的249名患者中与早期拔管相关的潜在因素。我们从电子病历中获取了患者的人口统计学特征、术前特征、术中变量、术后结果、手术类型、手术持续时间、心肺旁路(CPB)时间、交叉钳夹时间和血液制品量。与单瓣膜的存在无关,瓣膜疏通修复术(VSR)比经瓣膜修补修复术(TAP)更早显示恢复情况(P < 0.0001),右室流出压下降程度与术后恢复情况显著相关(P = 0.0204)。由于心内分流和 PaO2/FiO2 比值是肺损伤的不良指标,因此还使用了 Brixia 评分。我们的数据表明,Brixia 评分可作为评估术后肺部状况的最佳替代指标。
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引用次数: 0
Compliance evaluation in post-anesthesia care units at teaching hospitals in Alborz Province, Iran 伊朗阿尔伯兹省教学医院麻醉后护理病房的合规性评估
Q2 Nursing Pub Date : 2024-11-13 DOI: 10.1016/j.pcorm.2024.100445
Leila Sadati , Mohsen Khalilnejad , Dorrin Nikbakht , Sahar Karami , Fatemeh Tavakoli , Rana Abjar

Background

The post-anesthesia care unit (PACU) is a critical care unit where postoperative patients are monitored and cared for until full recovery. Evaluating standards in different domains is crucial for providing quality care. This study aims to assess the compliance of design, equipment, drugs, and staff performance standards in PACUs of teaching hospitals of Alborz Province, Iran.

Methods

This cross-sectional study was conducted between January 2023 and September 2023. Data were gathered using a 40-item checklist covering physical structure, equipment/drugs, and staff performance. For the latter, a 360-degree appraisal (self-assessment, internal evaluator, external evaluator) was done.

Results

Among the three standard domains, performance had the highest average compliance at 80.72 %, followed by equipment/drugs at 75.33 %. Design/structure had the lowest compliance at 54 %.

Conclusion

Given the lack of full compliance in PACU design, equipment, and certain aspects of patient care, healthcare managers and policymakers must prioritize improving post-anesthesia care unit infrastructure, equipment provision, and staff training. Implementing continuous education programs with effective teaching methods is crucial for enhancing care quality and preparing future healthcare professionals in these teaching hospitals.
背景麻醉后护理病房(PACU)是一个重症监护病房,术后病人在这里接受监测和护理,直至完全康复。评估不同领域的标准对提供优质护理至关重要。本研究旨在评估伊朗阿尔伯兹省教学医院 PACU 在设计、设备、药物和员工绩效标准方面的达标情况。方法本横断面研究于 2023 年 1 月至 2023 年 9 月期间进行。数据收集采用了一份包含 40 个项目的核对表,内容涵盖物理结构、设备/药品和员工绩效。结果在三个标准领域中,绩效的平均达标率最高,为 80.72%,其次是设备/药品,为 75.33%。结论鉴于 PACU 的设计、设备和患者护理的某些方面未完全达标,医疗管理人员和政策制定者必须优先改善麻醉后护理单元的基础设施、设备供应和人员培训。在这些教学医院中,采用有效的教学方法实施继续教育计划对于提高护理质量和培养未来的医护专业人员至关重要。
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引用次数: 0
Anaesthetic management of caesarean section in a primigravida with pre-eclampsia, pleural effusion, consolidation, and lung collapse – a case report 对一名患有先兆子痫、胸腔积液、合并症和肺塌陷的初产妇进行剖腹产手术的麻醉管理--病例报告
Q2 Nursing Pub Date : 2024-11-02 DOI: 10.1016/j.pcorm.2024.100443
Shilpa A Naik, Prathvi B, Ranjan R K, Angela Abraham
Pregnancy complicated with preeclampsia, pleural effusion and lung infection presents unique challenges to the anaesthesiologist. An enlarged uterus in pregnant women, particularly in the third trimester restricts diaphragmatic movement, raising pleural fluid pressure and facilitating the development of pleural effusion. We present the safe and successful conduct of an emergency lower segment cesarean section (LSCS) in a severe pre-eclamptic patient, with bilateral pleural effusions and collapse and consolidation of the lungs. This was performed under spinal anaesthesia as a valuable alternative to general anaesthesia in the setting of numerous infrastructure constraints.
妊娠合并子痫前期、胸腔积液和肺部感染给麻醉医生带来了独特的挑战。孕妇子宫增大,尤其是在妊娠三个月时,会限制横膈膜的运动,使胸腔积液压力升高,有利于胸腔积液的形成。我们介绍了对一名严重的先兆子痫患者实施紧急下段剖宫产术(LSCS)的安全和成功案例,该患者伴有双侧胸腔积液、肺部塌陷和合并症。该手术是在脊髓麻醉下进行的,这是在众多基础设施限制的情况下替代全身麻醉的重要方法。
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引用次数: 0
The effect of surgical smoke on operating room workers, attitudes towards risks, and the implementation of preventive measures 手术烟雾对手术室工作人员的影响、对风险的态度以及预防措施的实施
Q2 Nursing Pub Date : 2024-10-28 DOI: 10.1016/j.pcorm.2024.100442
Derya Esenkaya , Emine İyigün
Amaç: Bu araştırma, cerrahi dumanın ameliyathane sahipleri üzerinde mevcutlukları, risklere karşı tutumlarını ve para harcamanlarını planlama amacıyla tanımlama olarak yapılmıştır. Gereç ve Yöntem: Kesitsel kalitede bu çalışma, Türkiye'de bir hastanenin ameliyathane ünitesinde Nisan-Mayıs 2022′de kayıtlı süre boyunca devam etmektedir. Araştırmanın boyutları, dahil edilme kriterlerini karşılayan 73 ameliyathane çalışanından oluşuyordu. Araştırmanın verileri Kişisel Bilgi Formu, AORN (Peri-Operatif Kayıtlı Hemşireler Derneği) rehberleri ve ilgili kaynaklarla kırsal Cerrahi Dumanın Ameliyathane Çalışanları Üzerindeki Etkileri, Risklere Yönelik Tutumlar ve Önleyici Tedbirlerin Uygulanması Anketi ile toplanmıştır. Bulgular: Ameliyathane çalışanlarının %91,8′i (n = 67) son beş yıl içerisinde cerrahi dumanla ilgili herhangi bir eğitime katılmadığını belirtti. Bunların %75,3′ü cerrahi dumana maruz kaldıklarını bildirdi. Ameliyathane çalışanlarının yaklaşık %50,7′si (n = 37) lazer dumanı tahliyesi için herhangi bir cihazın kullanılmadığını belirtirken, %39,7′si (n = 29) tahliye dumanı için kullanılan cihazlar hakkında bilgisinin olmadığını belirtti. Ameliyathane çalışanlarının %65,8′inin (n = 48) iş yerlerinde cerrahi dumanla ilgili herhangi bir protokolden haber yoktu. Cerrahi dumana maruz kalmanın sağlık üzerindeki etkilerine, maruziyete dayanıklına süt verdiklerini bildirdiler: sızıntı (%65,8), göz tahrişi (%65,8), gözlerde sulanma (%63,0), göz kuruluğu (%65,8)), uyku bozuklukları (%49,3) %), solunum problemleri (%37,0) ve baş ağrısı (%35,6). Araştırmada ameliyathane çalışanlarının elde edebilecekleri cerrahi dumandan korunmak için kişisel koruyucu önlemlerin alınması. Cerrahi maske (%100), aspirasyon sondası (%60,3), önlük (%41,1) ve gözlük (%35,6) belirlendi. Sağlık çalışanlarının cerrahi dumanın potansiyel tehlikelerine karşı tutumları değerlendirildi. Diğer sağlık çalışanlarının ameliyathane çalışanlarına göre daha fazla kaygı yaşadıkları belirlendi. Sonuç: Araştırmanın düzenine göre ameliyathane çalışanlarının sağlıklı duman tehlikelerine yönelik ilerlemeye yönelik tutumlarını geliştirecek yöntemlerin benimsenmesinin esasları. Ayrıca vakum dumanıyla ilgili tamamlayıcıları önlemek için politikalar ve kılavuzlar iletilmeli ve yöneticilerden uygun ekipman ve destek eğitimi.
目的:本研究旨在描述手术烟雾对手术室所有者的影响,以确定他们的存在、他们对风险的态度以及他们的资金支出计划。材料和方法:这项横断面研究于 2022 年 4 月至 5 月期间在土耳其一家医院的手术室进行。研究对象包括符合纳入标准的 73 名手术室工作人员。研究数据通过个人信息表、AORN(围手术期注册护士协会)指南和相关资源以及农村手术烟雾对手术室工作人员的影响、对风险的态度和预防措施实施情况调查表收集。结果91.8%(n = 67)的手术室工作人员表示在过去五年中没有参加过任何有关手术烟雾的培训。其中 75.3% 的人表示接触过手术烟雾。约 50.7%(n = 37)的手术室工作人员表示没有使用激光排烟装置,而 39.7%(n = 29)的工作人员表示不了解排烟装置。65.8%(n = 48)的手术室工作人员不知道其工作场所有任何与手术烟雾有关的规程。他们报告了接触手术烟雾对健康造成的影响:泄漏(65.8%)、眼睛刺激(65.8%)、眼睛流泪(63.0%)、眼睛干涩(65.8%)、睡眠障碍(49.3%)、呼吸系统问题(37.0%)和头痛(35.6%)。在这项研究中,手术室工作人员采取了个人防护措施,以防止手术烟雾。确定了手术口罩(100%)、吸入探针(60.3%)、围裙(41.1%)和护目镜(35.6%)。评估了医护人员对手术烟雾潜在危害的态度。结果表明,其他医护人员比手术室工作人员更焦虑。结论根据研究结果,必须采取措施改善手术室工作人员对健康烟雾危害的态度。此外,应传达政策和指导方针,以防止与真空烟雾有关的补品,并提供适当的设备和管理人员的支持培训。
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引用次数: 0
Procedure-adjusted incidences of postoperative hospital admissions are not associated with differences in the quality of anesthesiologists’ clinical supervision or nurse anesthetists’ work habits 经手术调整的术后住院发生率与麻醉师临床监督质量或麻醉护士工作习惯的差异无关
Q2 Nursing Pub Date : 2024-10-24 DOI: 10.1016/j.pcorm.2024.100441
Franklin Dexter , Bradley J. Hindman , Richard H. Epstein , Andrea Vannucci , Rashmi N. Mueller

Background

Anesthesia departments may benefit from automated computerized methods to monitor the clinical performance of individual anesthesia practitioners. Hospital admission (>1 night stay) after ambulatory surgery may be a suitable metric, with higher incidences potentially being associated with poor clinical performance. If valid, there should be a small but statistically significant association of postoperative admission with previously validated measures of quality of intraoperative anesthesia care.

Methods

This retrospective cohort study used eight fiscal years of data from one hospital with daily assessments of two different measures of quality of anesthesia clinical care. One variable was anesthesiologists’ clinical supervision evaluated by trainees, principally residents. The second independent variable was nurse anesthetists’ work habits, evaluated by anesthesiologists. These independent variables were binary, the proportions of rater-leniency-adjusted evaluations with maximum performance for all items, calculated annually. The dependent variable was the proportion of ratees’ cases (anesthesiologist or nurse anesthetist) with postoperative length of stay ≤ 1 day, adjusted for surgical suite and procedure category. Thus, for both independent and dependent variables, larger (positive logits) were “good” and smaller (negative logits) were “bad.”

Results

There were no significant associations for either supervision (P =0.14, N=561 anesthesiologist-years) or work habits (P =0.74, N=598 nurse anesthetist-years). Estimated signs of the slopes were for increases in the logits of the quality of clinical supervision to be associated with non-significant decreases in the logits of the probabilities of the patients having lengths of stay ≤1 day. Similarly, increases in the logits of nurse anesthetists’ work habits had negative-signed non-significant associations with the logits of the probabilities of the patients having lengths of stay ≤1 day.

Conclusions

The results show with substantial certainty that higher-performing anesthesia practitioners do not have briefer lengths of stay. Anesthesiologists and nurse anesthetists should not be compared among one another based on whether their patients have a greater than predicted risk of procedure-adjusted hospital admission after ambulatory surgery.
背景麻醉部门可能会受益于自动化的计算机方法来监控麻醉医师的临床表现。非住院手术后入院(住院一晚)可能是一个合适的衡量标准,较高的发生率可能与较差的临床表现有关。方法这项回顾性队列研究使用了一家医院八个财政年度的数据,对麻醉临床护理质量的两种不同指标进行了每日评估。其中一个变量是由受训人员(主要是住院医师)评估麻醉医师的临床监督情况。第二个自变量是麻醉护士的工作习惯,由麻醉医师进行评估。这些自变量均为二元变量,即每年计算的评分者宽松度调整后所有项目最高绩效的评价比例。因变量是根据手术室和手术类别调整后,术后住院时间少于 1 天的受评病例(麻醉师或麻醉护士)的比例。因此,对于自变量和因变量而言,对数越大(正对数)表示 "好",对数越小(负对数)表示 "坏"。斜率的估计符号为临床监督质量对数的增加与患者住院时间≤1 天的概率对数的非显著下降相关。同样,麻醉护士工作习惯对数的增加与患者住院时间≤1 天的概率对数呈负相关,但不显著。麻醉医师和麻醉护士之间的比较不应以其病人在非住院手术后经手术调整后入院的风险是否高于预测值为依据。
{"title":"Procedure-adjusted incidences of postoperative hospital admissions are not associated with differences in the quality of anesthesiologists’ clinical supervision or nurse anesthetists’ work habits","authors":"Franklin Dexter ,&nbsp;Bradley J. Hindman ,&nbsp;Richard H. Epstein ,&nbsp;Andrea Vannucci ,&nbsp;Rashmi N. Mueller","doi":"10.1016/j.pcorm.2024.100441","DOIUrl":"10.1016/j.pcorm.2024.100441","url":null,"abstract":"<div><h3>Background</h3><div>Anesthesia departments may benefit from automated computerized methods to monitor the clinical performance of individual anesthesia practitioners. Hospital admission (&gt;1 night stay) after ambulatory surgery may be a suitable metric, with higher incidences potentially being associated with poor clinical performance. If valid, there should be a small but statistically significant association of postoperative admission with previously validated measures of quality of intraoperative anesthesia care.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used eight fiscal years of data from one hospital with daily assessments of two different measures of quality of anesthesia clinical care. One variable was anesthesiologists’ clinical supervision evaluated by trainees, principally residents. The second independent variable was nurse anesthetists’ work habits, evaluated by anesthesiologists. These independent variables were binary, the proportions of rater-leniency-adjusted evaluations with maximum performance for all items, calculated annually. The dependent variable was the proportion of ratees’ cases (anesthesiologist or nurse anesthetist) with postoperative length of stay ≤ 1 day, adjusted for surgical suite and procedure category. Thus, for both independent and dependent variables, larger (positive logits) were “good” and smaller (negative logits) were “bad.”</div></div><div><h3>Results</h3><div>There were no significant associations for either supervision (P =0.14, N=561 anesthesiologist-years) or work habits (P =0.74, N=598 nurse anesthetist-years). Estimated signs of the slopes were for increases in the logits of the quality of clinical supervision to be associated with non-significant <u>decreases</u> in the logits of the probabilities of the patients having lengths of stay ≤1 day. Similarly, increases in the logits of nurse anesthetists’ work habits had negative-signed non-significant associations with the logits of the probabilities of the patients having lengths of stay ≤1 day.</div></div><div><h3>Conclusions</h3><div>The results show with substantial certainty that higher-performing anesthesia practitioners do not have briefer lengths of stay. Anesthesiologists and nurse anesthetists should not be compared among one another based on whether their patients have a greater than predicted risk of procedure-adjusted hospital admission after ambulatory surgery.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100441"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of Granisetron in preventing hypotension after spinal anaesthesia with Levobupivacaine in rheumatic patients undergoing elective cesarean section: A randomized controlled trial 格拉司琼在使用左旋布比卡因进行脊髓麻醉后对接受择期剖宫产术的风湿病患者预防低血压的作用:随机对照试验
Q2 Nursing Pub Date : 2024-10-18 DOI: 10.1016/j.pcorm.2024.100439
Marwa Mahmoud AbdelRady , Ghada Mohammad AboElfadl , Mohamed Nassar Ibrahim , Hany Ahmed Ibraheem El-Morabaa , Ahmad Mohamed Aboelfadl , Ahmed Aboulfotouh

Background

Heart disease, which carries a high risk, is the main factor contributing to maternal death and morbidity during pregnancy. In this trial, we examined how well intravenous (IV) granisetron prevented bradycardia and hypotension in rheumatic patients undergoing elective cesarean delivery.

Patients and methods

There were 102 patients total in the study, 51 in each of the two groups. Patients in Group G received 1 mg of IV granisetron diluted to 5 ml before the start of spinal anaesthesia, while those in Group S received 5 ml of 0.9 % normal saline. It has been recorded how much atropine and vasopressor were used overall. The Apgar scores at one and five minutes were also examined.

Results

In Group S, the prevalence of hypotension was 60.7 %, compared to 33.3 % in Group G (p < 0.05). As a result, patients in Group S needed considerably more ephedrine (p < 0.05). Patients in Group G had their hemodynamic parameters well maintained for the duration of the research. The Apgar score measured the neonatal outcome at 0-, 1-, and 5 min following birth, and it was equivalent between the two study groups.

Conclusion

Before spinal anaesthesia, intravenous granisetron 1 mg can lower hypotension in cardiac parturients without negatively affecting the mother or the baby.
背景心脏病具有高风险,是导致妊娠期产妇死亡和发病的主要因素。在这项试验中,我们研究了静脉注射(IV)格拉司琼对接受择期剖宫产的风湿病患者心动过缓和低血压的预防效果。G 组患者在脊髓麻醉开始前静脉注射 1 毫克稀释至 5 毫升的格拉司琼,而 S 组患者则注射 5 毫升 0.9 % 的生理盐水。阿托品和血管加压剂的总体使用量已记录在案。结果 S 组的低血压发生率为 60.7%,而 G 组为 33.3%(p < 0.05)。因此,S 组患者需要更多的麻黄碱(p < 0.05)。在研究期间,G 组患者的血液动力学参数保持良好。Apgar评分衡量了新生儿在出生后0分钟、1分钟和5分钟的预后,两个研究组的评分相当。结论在脊髓麻醉前,静脉注射格拉司琼1毫克可降低心脏病产妇的低血压,而不会对母亲或婴儿产生负面影响。
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引用次数: 0
Countermeasures and management schemes for improving the quality of continuing medical education in hospitals 提高医院继续医学教育质量的对策与管理方案
Q2 Nursing Pub Date : 2024-10-17 DOI: 10.1016/j.pcorm.2024.100440
Weiwei Zhou , Fangfang Liang , Jiajia Qin , Hui Wei , Arshad Mehmood , Yourong Cao , Qijia Huang , Zhong Lin , Yi Mo

Background

This paper analyzes the urgency, importance, and current situation of continuing medical education in hospitals.

Methods

To solve the existing problems in continuing medical education, a series of countermeasures and management schemes to improve the quality of continuing medical education were put forward.

Results

These solutions include setting up specialized agencies in the field of continuing medical education, strengthening the construction of teaching staff, perfecting the teaching contents and methods, normative training management measures, and improving the participation willingness of the medical staff.

Conclusion

These countermeasures and management schemes will help the hospital improve the quality of continuing medical education, promote academic exchanges and cooperation with medical staff, improve the quality of medical services, and promote the healthy development of the medical industry.
背景本文分析了医院开展继续医学教育的紧迫性、重要性及现状。方法针对继续医学教育中存在的问题,提出了一系列提高继续医学教育质量的对策和管理方案。结果建立继续医学教育专门机构、加强师资队伍建设、完善教学内容和方法、规范培训管理措施、提高医务人员参与积极性等对策和管理方案有助于医院提高继续医学教育质量,促进与医务人员的学术交流与合作,提高医疗服务质量,促进医疗事业健康发展。
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引用次数: 0
The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle Acero 围手术期皮肤包:直观的围手术期压伤预防包
Q2 Nursing Pub Date : 2024-10-15 DOI: 10.1016/j.pcorm.2024.100436
Lilibeth Acero , Mandy Spitzer
Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.
美国每年进行的大型手术超过 4000 万例,围手术期护理区是发生压力损伤 (PI) 的高风险环境。在围手术期,由于长时间不动和在相对较硬的表面上定位,预防压伤面临着一系列独特的挑战。Acero Perioperative Skin Bundle(APSB)的开发旨在促进风险评估,并在一家拥有 500 多张病床的安全网教学医院应用适当的干预措施。在实施 APSB 之前,围手术期获得性皮肤病的发病率为 1.9%,占所有医院获得性皮肤病的 38%。在实施捆绑计划后的 24 个月内,该医院的围手术期获得性 PI 发生率一直保持在 0% (p = .0001)。这份质量改进报告展示了标准化风险评估的实施和循证干预措施的应用是如何实现成本效益并显著降低围手术期护理中获得的 PI 的。
{"title":"The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle","authors":"Lilibeth Acero ,&nbsp;Mandy Spitzer","doi":"10.1016/j.pcorm.2024.100436","DOIUrl":"10.1016/j.pcorm.2024.100436","url":null,"abstract":"<div><div>Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of Clinical Nurse Specialist and the safety management in operating theatre during the COVID-19 pandemic: An integrative scoping review 在 COVID-19 大流行期间,临床专科护士的作用和手术室的安全管理:综合范围审查
Q2 Nursing Pub Date : 2024-10-05 DOI: 10.1016/j.pcorm.2024.100437
Marco Sguanci , Stefano Mancin , Sara Morales Palomares , Giovanni Cangelosi , Mauro Parozzi , Michela Piredda , Maria Grazia De Marinis

Background

The global health crisis caused by the COVID-19 pandemic has prompted discussions regarding the best approach to safely manage COVID-19 positive patients in the operating room.

Objective

This study aimed to highlight the importance of "standardised clinical practice" and the role of the "Clinical Nurse Specialist" in treating COVID-19 positive patients in the operating room. Methods: A scoping review based on Arksey and O'Malley's methodology was conducted. Searches were conducted in Cochrane Library, PubMed, Embase, CINAHL, Scopus, and Web of Science for studies on perioperative management and the Clinical Nurse Specialist's role in COVID-19 surgeries. Manual searches included reference lists and Google Scholar. Two reviewers independently screened, selected, and included articles, assessing the risk of bias and methodological quality.

Results

From 278 identified records, 24 studies were included. Two key aspects emerged: clinical safety procedures and the Clinical Nurse Specialist's role in the perioperative setting. Standardised practice in the operating room is crucial, and the Clinical Nurse Specialist has significant potential in managing COVID-19 patients.

Conclusions

Healthcare organizations should prioritize standardized practices for surgical assistance of COVID-19 patients. While global implementation of the Clinical Nurse Specialist is limited, their inclusion in perioperative settings could enhance care efficiency.
背景 COVID-19 大流行引发的全球健康危机促使人们讨论在手术室安全管理 COVID-19 阳性患者的最佳方法。研究方法根据Arksey和O'Malley的方法进行了范围界定综述。在 Cochrane Library、PubMed、Embase、CINAHL、Scopus 和 Web of Science 中检索有关围手术期管理和临床专科护士在 COVID-19 手术中的作用的研究。人工检索包括参考文献列表和谷歌学术。两名审稿人对文章进行了独立筛选、甄别和收录,并对偏倚风险和方法学质量进行了评估。出现了两个关键方面:临床安全程序和临床专科护士在围手术期环境中的作用。结论医疗机构应优先考虑 COVID-19 患者手术援助的标准化实践。虽然临床专科护士在全球范围内的应用有限,但将其纳入围手术期环境可提高护理效率。
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引用次数: 0
The fault in our nature: Error rates in a human observation study on surgical instrument errors in the OR 我们本性中的错误关于手术室手术器械错误的人体观察研究中的错误率
Q2 Nursing Pub Date : 2024-10-02 DOI: 10.1016/j.pcorm.2024.100438
Abner M.P. Barbosa , Mark J. Saari , Peter F. Nichol

Background

Errors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors.

Methods

A previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases.

Results

While the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (p = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (p = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (p = 0.284).

Conclusions

Human observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.
背景手术器械无菌处理过程中的错误导致了手术室收费时间的浪费。有关这一问题的数据主要是通过人工观察和报告得出的。鉴于人类任务固有的错误率,我们假设在为期六周的纵向研究中,随着观察者对环境越来越熟悉,识别错误的能力越来越强,每天每例手术器械错误的观察率会增加。由于住院病例的错误率是门诊病例的两倍,因此将每天每个病例的错误率与每个日期住院病例的百分比进行了比较。结果虽然每天每个病例的平均错误率从 0.28 增加到 0.62,表明随着时间的推移可能会增加,但没有发现有统计学意义的趋势 (p = 0.157)。住院病人百分比与出错率之间呈正相关,但相关性不大(Pearson 相关性 = 0.344),接近统计学意义(p = 0.068)。住院病例百分比随着时间的推移保持稳定,未发现明显趋势(p = 0.284)。虽然每天每个病例的错误率逐渐增加,但这种可变性不能归因于观察者对环境的初步适应。未来的研究应评估相互评级的可靠性,并探索其他自动观察方法,以便更准确地测量观察到的错误数量。
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Perioperative Care and Operating Room Management
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