本文選題：篩查工具　切入點(diǎn)：不良事件　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討適合我國新生兒病房的不良事件篩查工具并驗(yàn)證其可行性。方法:結(jié)合文獻(xiàn)生成包含29項(xiàng)篩查指標(biāo)的篩查工具,應(yīng)用專家咨詢法刪減后余10項(xiàng);通過2個(gè)月回顧性研究(2015.07.30-2015.09.30)驗(yàn)證篩查工具的可操作性:納入我院新生兒病房包括新生兒重癥監(jiān)護(hù)室(neonatal intensive care unit,NICU)住院≥48小時(shí)的患兒,記錄患兒出現(xiàn)的篩查指標(biāo)、不良事件及不良事件的嚴(yán)重程度,計(jì)算篩查指標(biāo)的陽性預(yù)測(cè)值。1個(gè)月實(shí)時(shí)觀察研究(2016.05.09-2016.06.09)驗(yàn)證本篩查工具的真實(shí)性及可靠性:納入在我院新生兒病房住院且篩查指標(biāo)陽性的患兒,每天實(shí)時(shí)追蹤納入患兒有無不良事件及其嚴(yán)重程度,計(jì)算篩查指標(biāo)的陽性預(yù)測(cè)值。結(jié)果:回顧性研究納入病例782例次,篩查指標(biāo)總計(jì)887例次(1.13例/人),獨(dú)立不良事件391例次(0.50例/人);篩查指標(biāo)發(fā)現(xiàn)的不良事件占78.8%,篩查工具陽性預(yù)測(cè)值為0.39,其中新生兒普病病房0.45,NICU 0.26,二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.001)。主要的不良事件有腹瀉(31.2%)、電解質(zhì)紊亂(12.5%)、環(huán)境溫度不適宜(11.0%)、皮膚完整性受損(7.9%)及醫(yī)院感染(6.6%),未被篩查工具發(fā)現(xiàn)的不良事件有83例次,29.4%的不良事件危害程度達(dá)F級(jí)及以上。實(shí)時(shí)研究納入篩查指標(biāo)417例次,獨(dú)立不良事件261例次,篩查工具總陽性預(yù)測(cè)值0.64,高于回顧性研究階段(0.45),其中陽性預(yù)測(cè)值有統(tǒng)計(jì)學(xué)差異的篩查指標(biāo)為 皮膚完整性受損‖及 抗生素應(yīng)用‖(P值均0.001)。結(jié)論:本研究的篩查工具對(duì)新生兒普病病房不良事件監(jiān)測(cè)具有較好的可行性,加強(qiáng)醫(yī)務(wù)工作者如實(shí)、及時(shí)記錄不良事件的培訓(xùn),可提高本篩查工具監(jiān)測(cè)效果。
[Abstract]:Objective: to explore and verify the feasibility of screening tools for adverse events in neonatal wards in China. Methods: combined with the literature to generate screening tools including 29 screening indicators, the remaining 10 items were deleted by expert consultation. The feasibility of the screening tool was verified by a 2-month retrospective study. The screening tool was included in the neonatal intensive care unit (NICU), including the neonatal intensive care unit (NICU) for more than 48 hours, and the screening indexes were recorded. The severity of adverse events and adverse events, and the positive predictive value of screening indexes were calculated. One month real-time observation and study was conducted to verify the authenticity and reliability of this screening tool. Daily real-time tracking included adverse events and their severity, and calculated the positive predictive value of screening indicators. Results: 782 cases were included in the retrospective study. A total of 887 cases were diagnosed 1.13 cases / person, 391 cases of independent adverse events were 0.50 cases / person, the adverse events detected by screening index accounted for 78.8%, and the positive predictive value of screening tool was 0.39, among which 0.45% of neonatal general illness ward was 0.26 in NICU, the difference between the two was significant. The main adverse events were diarrhea 31. 2%, electrolyte disturbance 12. 5%, ambient temperature unsuitable for 11.0%, skin integrity impaired 7. 9%) and nosocomial infection 6. 6%. There were 83 cases (29. 4%) of adverse events not detected by screening tools. The degree was F or above. 417 screening indexes were included in the real-time study. There were 261 cases of independent adverse events, The total positive predictive value of the screening tool was 0.64, which was higher than that of the retrospective study stage (0.45%). The screening indexes with statistical difference in the positive predictive value were the damaged skin integrity and the P value of antibiotics. Conclusion: in this study, the positive predictive value is 0.001. The screening tool is feasible for the monitoring of adverse events in the ward of general neonatal disease. Strengthening the training of medical workers to record adverse events in time can improve the monitoring effect of this screening tool.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.1

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