延伸护理服务对提高患者腹膜透析换液操作正确率的影响

陈艺延 冯晓秋 黄爱治

【摘要】 目的：分析延伸护理服务对提高患者腹膜透析换液操作正确率的影响。方法：科室成立持续质量改进（CQI）小组，选取笔者所在医院2013年6月-2017年3月居家腹膜透析患者48例，提供延伸护理服务，针对患者对腹膜炎相关知识掌握不全、操作前不洗手、七步洗手法不正确、操作时不戴口罩、未按规范连接短管、制定落实针对性的改进对策。结果：改进后，患者能掌握腹膜透析相关知识、规范进行七步洗手法操作、换液操作前进行洗手、操作时戴口罩、正确连接短管，达标率均达到100%，高于改进前，差异有统计学意义（P<0.05）。改进后12个月，腹膜炎发生率为12.5%，低于改进前的37.5%，差异有统计学意义（P<0.05）。改进后，患者护理满意率、医护人员信任率与门诊随访率均较改进前提高，差异有统计学意义（P<0.05）。结论：延伸服务提高患者腹膜透析换液操作正确率，有助于降低腹膜炎等并发症发生风险，获得了患者的好评。

【关键词】 腹膜透析; 换液; 自我护理; 延伸护理服务; 护理质量

doi：10.14033/j.cnki.cfmr.2019.27.034 文献标识码 B 文章编号 1674-6805（2019）27-00-03

Extending Nursing Service to Improve the Correct Rate of Peritoneal Dialysis Fluid Exchange/CHEN Yiyan，FENG Xiaoqiu，HUANG Aizhi.//Chinese and Foreign Medical Research，2019，17（27）：-81

【Abstract】 Objective：To analyze the value of extending service to improve the correct rate of peritoneal dialysis exchange.Method：A continuous quality improvement（CQI） group was set up in our department.48 peritoneal dialysis patients from June 2013 to March 2017 in our hospital were selected to provide extension services，aiming at the incomplete knowledge of peritonitis，do not wash hands before operation，seven-step washing techniques incorrect，do not wear masks during operation，do not connect short tubes according to norms，formulate and implement targeted improvement measures.Result：After the improvement，the patients could master the relevant knowledge of peritoneal dialysis，standardize the operation of seven-step washing manipulation，and carry out fluid hand washing before the operation，wearing mask during operation，connecting short tube correctly，reaching the standard rate of 100%，were significantly higher than before improvement（P<0.05）.At 12 months after improvement，the incidence of peritonitis was 12.5%，which was lower than that before improvement（37.5%），the difference was statistically significant（P<0.05）.After improvement，the patients nursing satisfaction rate，the trust rate of medical staff and the follow-up rate of outpatient service were all higher than those before improvement，and the difference was statistically significant（P<0.05）.Conclusion：The extended service improves the correct rate of peritoneal dialysis exchange，and helps to reduce the risk of peritonitis and other complications.

【Key words】 Peritoneal dialysis; Fluid exchange; Self-care; Extended nursing service; Nursing quality

First-authors address：Xiamen Haicang Hospital，Xiamen 361026，China

持續腹膜透析是治疗终末期肾脏病患者的重要方法，与血液透析相比各有优劣，适合血管条件欠佳的对象，通常患者出院后仅通过回院复诊来获得治疗或获取与疾病相关的康复信息，其健康需求远得不到满足[1]。多数患者对腹膜透析和终末期肾脏病认知能力差，尽管在初始透析时都曾进行全面规范培训，但出院后缺乏医护人员监管，腹膜透析换液操作不规范，反复出现腹膜炎甚至出现严重并发症而退出腹膜透析。延伸护理是为了满足出院患者的实际需求，提供的一种不间断的、有序的、协调性的护理服务，使患者能够得到持续的、规范化的、必要的居家护理服务。为此，科室尝试通过成立持续质量改进（CQI）小组，尝试为选取2013年6月-2017年3月居家腹膜透析患者48例腹膜透析患者提供延伸服务，研究结果报道如下。……