医护合作培训在重症医学科镇痛和镇静安全管理中的应用

摘要

Objective To study the application effect of medical cooperation training in the safety management of analgesic and sedation in intensive care unit (ICU).Methods We selected 61 medical staff in the ICU of our hospital, and gave them the medical cooperation training on the safety management of analgesic and sedation in ICU. The implementation status of procedural sedation and analgesia ( PSA ) and the core competence of medical staff before and after training were compared. The incidence rate of unplanned extubation ( UE) and ventilator associated pneumonia ( VAP ) in 1 095 patients from January to December 2014 and 1 217 patients from January to December 2015 were compared. Results The implementation rate of PSA after implementation ( 89. 0%) was higher than that before the implementation; the incidence of UE ( 3. 69‰) and and VAP ( 1. 03‰) in patients with analgesia and sedation in ICU, were all lower than that before the implementation [(70.66±13. 82),(91.46±21.74),P<0.05]; the core competence of nurses in ICU was significantly increased [(70.66±13.82),(91.46±21.74),t=15.079,P<0.05.Conclusions The medical cooperation training can significantly improve the core competence of nurses in ICU; improve the PSA implementation rate of patients in ICU;and reduce the UE and VAP incidence rate of patients.%目的：研究医护合作培训方法在重症医学科镇痛和镇静安全管理中的应用效果。方法选取在我院重症医学科工作的61名医护人员,进行关于镇痛和镇静安全方面的医护合作培训,比较培训前后程序化镇痛和镇静( PSA)落实情况及医护人员核心能力,并比较2014年1—12月收治患者1095例与2015年1—12月收入1217例患者非计划拔管( UE)与VAP发生率。结果实施后,重症医学科患者的PSA落实率为89.0％,高于实施前；重症医学科镇痛和镇静患者的UE发生率1.03‰与VAP发生率1.65‰,均低于实施前,差异均有统计学意义(χ2值分别为388.95,7.20,7.31；P<0.05),重症医学科护士核心能力评分均升高[(70.66±13.82),(91.46±21.74)分],差异有统计学意义(t＝15.079,P<0.05)。结论医护合作培训方法能够显著提高护士核心能力,提高重症医学科患者的PSA落实率,降低患者的UE与VAP的发生率。