实施以患者安全为重点的最新酒精戒断症状管理指令集。

Meghan Lorbiecki, Alexander Gidal, Mary Hagle, Tina Smith, Kelly Ragen-Pease, Kyle Peterson, Michael Matye, Mary-Anne Kowol, Elise Lampe
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引用次数: 0

摘要

背景:酒精戒断患者通常在精神健康住院病房接受治疗。其中一个病房的注册护士对现有的酒精戒断症状管理医嘱有一些担忧和疑问。为了解决这些问题,一个包括护士、精神科医生和药剂师在内的多学科团队成立了:该项目的目标是审查和修订现有的医嘱单、教育员工、实施更改并评估结果:方法:"计划-实施-研究-行动 "质量改进框架为项目提供了指导。修订医嘱单和实施共分五个阶段:对科室护士进行调查、社区实践评估和医嘱单修订。模拟逃生室促进了护理教育。对患者记录进行审查,以确定不良事件:结果:地西泮取代劳拉西泮成为主要用药选择,并增加了前负荷协议。医嘱集的清晰度有所提高,教育增强了护理人员的信心,使其能够胜任使用临床研究所戒断评估酒精量表修订版完成患者评估,实施后未发生患者不良事件:修订后的戒酒患者症状管理医嘱反映了最新的证据,同时维护了患者安全。所有护士都认为修订后的医嘱单清晰易懂;药剂师和医生对修订后的医嘱单表示满意。对领导者的启示包括:要有一个多学科团队、足够的资源来回答临床问题、所有相关学科定期讨论以审查任何不良事件和新发表的证据。建议在实施初期对患者进行密切监测,以发现不良事件。
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Implementing an Updated Alcohol Withdrawal Symptom Management Order Set Focused on Patient Safety.

Background: Patients experiencing alcohol withdrawal often receive care on inpatient mental health units. Registered nurses on one such unit had several concerns and questions about the existing alcohol withdrawal symptom management order set. To address these issues, a multidisciplinary team including nurses, psychiatrists, and pharmacists was formed.

Objectives: The aims for this project were to review and revise the existing order set, educate staff, implement the changes, and evaluate outcomes.

Methods: The Plan-Do-Study-Act quality improvement framework guided the project. Five phases were completed to revise the order set and implement: a survey of nurses on the unit, community practice evaluation, and order set revisions. A simulation escape room facilitated nursing education. Patient records were reviewed to identify adverse events.

Results: Diazepam replaced lorazepam as the primary medication choice, and a front-loading protocol was added. Order set clarity was improved, education increased nursing staff confidence to competently complete a patient assessment with the Clinical Institute Withdrawal Assessment Alcohol Scale Revised, and no adverse patient events occurred after implementation.

Conclusion: A revised order set for symptom management of patients experiencing alcohol withdrawal reflected up-to-date evidence while maintaining patient safety. All nurses agreed the revised order set was clear and easy to follow; pharmacists and physicians were satisfied with the revisions. Implications for leaders include having a multidisciplinary team, sufficient resources to answer clinical questions, and regular discussions by all involved disciplines to review any adverse events as well as newly published evidence. Close monitoring of patients early in implementation is recommended to detect adverse events.

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