信息化联合专项改进管理模式降低住院患者跌倒、压力性损伤、非计划拔管发生率的研究 [中文引用][英文引用]

目的  探讨信息化联合专项改进管理降低住院患者跌倒、压力性损伤、非计划拔管发生率的效果，为临床提供一种有效的管理方法。 方法  本研究采用前后对照研究设计，选取 2018 年 1 月至 2023 年 12 月在本院住院的 779 249 例患者作为研究对象，将 2018 年 1 月至 2020 年 12 月住院患者 360 484 例设为实施前组；2021 年 1 月至 2023 年 12 月住院患者 418 765 例设为实施后组。实施前组采用常规护理安全管理模式，实施后组采用信息化联合专项改进管理模式。比较两组患者住院护理相关医疗质量（安全）不良事件总发生率与患者跌倒、压力性损伤、非计划拔管发生率。结果  实施后组与实施前组比较，住院护理相关医疗质量（安全）不良事件总发生率由 0.096 0% 下降至 0.060 2%，压力性损伤发生率由 0.012 2% 下降至 0.005 0%，非计划拔管率由 0.058 4‰下降至 0.029 7‰，前后比较，差异均有统计学意义（均 P<0.001）；跌倒发生率由 0.026 7‰下降至 0.026 3‰，前后比较，差异无统计学意义（P>0.05）。实施后组上述 4 个指标在实施信息化联合专项改进管理后均呈逐年下降趋势。结论 信息化联合专项改进管理能有效降低护理相关主要医疗质量（安全）不良事件发生率，保障患者安全。

Objective To evaluate the efficacy of an information-based collaborative special improvement management model in reducing the incidences of falls, hospital-acquired pressure injuries（HAPI）and unplanned extubation among inpatients, hence to offer an effective management strategy. Methods This before-after controlled study included 779, 249 inpatients from 1st January, 2018 to 31st December, 2023. A total 360, 484 inpatients were assigned to the pre-implementation group（January 2018-December 2020）and received conventional nursing safety management, while 418, 765 inpatients were assigned to the post-implementation group（January 2021-December 2023）and managed with an information-based collaborative special improvement management model. The two groups were compared with total incidence of nursing-related adverse events, rates of falls, HAPI, and unplanned extubation. Results In comparison with the pre-implementation group, the post-implementation group showed significant reductions in rates of total nursingrelated adverse event（from 0.0960% to 0.0602%, P<0.01）, HAPI（all unavoidable pressure injury）（from 0.0122% to 0.0050%, P<0.01）, and unplanned extubation（from 0.0584‰ to 0.0297‰, P< 0.01）. Falling rate decreased from 0.0267‰to 0.0263‰, but without significantly different（P>0.05）. All four indicators demonstrated an annually downward trends after implementation of the informationbased collaborative special improvement management model. Conclusion The information-based collaborative special improvement management model effectively reduces major nursing-related adverse events and enhances the safety of inpatient.