新生儿病房不良事件筛查工具初探

发布时间：2018-03-21 10:15

本文选题：筛查工具　切入点：不良事件　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨适合我国新生儿病房的不良事件筛查工具并验证其可行性。方法:结合文献生成包含29项筛查指标的筛查工具,应用专家咨询法删减后余10项;通过2个月回顾性研究(2015.07.30-2015.09.30)验证筛查工具的可操作性:纳入我院新生儿病房包括新生儿重症监护室(neonatal intensive care unit,NICU)住院≥48小时的患儿,记录患儿出现的筛查指标、不良事件及不良事件的严重程度,计算筛查指标的阳性预测值。1个月实时观察研究(2016.05.09-2016.06.09)验证本筛查工具的真实性及可靠性:纳入在我院新生儿病房住院且筛查指标阳性的患儿,每天实时追踪纳入患儿有无不良事件及其严重程度,计算筛查指标的阳性预测值。结果:回顾性研究纳入病例782例次,筛查指标总计887例次(1.13例/人),独立不良事件391例次(0.50例/人);筛查指标发现的不良事件占78.8%,筛查工具阳性预测值为0.39,其中新生儿普病病房0.45,NICU 0.26,二者比较差异有统计学意义(P0.001)。主要的不良事件有腹泻(31.2%)、电解质紊乱(12.5%)、环境温度不适宜(11.0%)、皮肤完整性受损(7.9%)及医院感染(6.6%),未被筛查工具发现的不良事件有83例次,29.4%的不良事件危害程度达F级及以上。实时研究纳入筛查指标417例次,独立不良事件261例次,筛查工具总阳性预测值0.64,高于回顾性研究阶段(0.45),其中阳性预测值有统计学差异的筛查指标为皮肤完整性受损‖及抗生素应用‖(P值均0.001)。结论:本研究的筛查工具对新生儿普病病房不良事件监测具有较好的可行性,加强医务工作者如实、及时记录不良事件的培训,可提高本筛查工具监测效果。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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