救护车院际转运危重新生儿护理质量评价指标的构建

彭东风; 李飞飞; 仇宁; 王赟; 朱业芬; 陆莎莎; 陈韧

doi:10.16766/j.cnki.issn.1674-4152.003007

救护车院际转运危重新生儿护理质量评价指标的构建

doi: 10.16766/j.cnki.issn.1674-4152.003007

芜湖市第一人民医院护理部，安徽芜湖 241000

基金项目:

工业和信息化部办公厅国家卫生健康委办公厅5G+医疗健康应用试点项目工信厅联通信函[2021]220号

详细信息

通讯作者:
陈韧，E-mail: whsey@126.com

中图分类号: R473.72 R472
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出版历程
- 收稿日期: 2022-04-22

Construction of quality of care assessment system for critically ill neonates during interhospital ambulance transport

Department of Neonatology, the First People ' s Hospital of Wuhu, Wuhu, Anhui 241000, China

摘要

摘要: 目的构建救护车院际转运危重新生儿护理质量评价指标，为评价新生儿院际转运护理质量提供依据。方法基于护理质量的标准体系结构“要素质量-环节质量-终末质量”理论模型，结合我国院前急救和医院管理的相关政策和新生儿重症监护病房(NICU)感控的相关要求，参考儿童危急重症护理服务评价指标及2017版新生儿转运指南，通过文献研究、小组讨论、专家预函询初步拟定救护车院际转运危重新生儿护理质量评价指标并进行定义，于2021年7—12月采用德尔菲法进行2轮专家函询。取第2轮问卷函询指标赋分值，构建判断矩阵，采用SPSS AU层次分析法计算权重，确立了院际转运危重新生儿护理质量评价指标。结果来自上海、江苏、安徽3个省市6所三级甲等综合性医院或者儿童专科医院的16名专家问卷函询参与了研究，2轮咨询问卷回收率均为93.7%，专家权威系数为0.836、0.849，肯德尔和谐系数为0.134、0.174。定义的70个指标(一级指标3个，二级指标13个，三级指标54个)，第1轮函询中，一级、二级指标没有改动，三级指标删除了7条，合并了3条，修改了4条，增加了1条；第2轮函询中，删除2条，修改1条，合并1条。最终形成的救护车院际转运危重新生儿护理质量评价指标包含一级指标3项、二级指标13项、三级指标41项。结论构建的院际转运危重新生儿护理质量评价指标科学、客观、可靠，可作为评价院际转运危重新生儿护理质量的依据。
- 院际转运 /
- 危重新生儿 /
- 护理质量 /
- 评价指标 /
- 德尔菲法 /
- 层次分析法
Abstract: Objective To construct quality of care assessment system for critically ill neonates during interhospital ambulance transport (QCASCINIAT), to provide a basis for evaluating the nursing quality for neonates during interhospital transport. Methods Based on the standard system structure of nursing quality, the theoretical model of "element quality-link quality-terminal quality", combined with the relevant policies of pre hospital emergency and hospital management in China and the requirements of neonatal intensive care unit (NICU) infection control, referring to the evaluation indicators of pediatric critical care services and the 2017 version of Neonatal Transport Guidelines, through literature research, group discussions, and expert pre consultation, the QCASCINIAT were initially formulated and defined, and two rounds of expert consultation were conducted by Delphi method from July to December 2021. The score assigned to each item during the second round of consultation was used to construct a judgment matrix, and the weight of each item was calculated using the analytic hierarchy process on SPSS AU. After that, the QCASCINIAT was established. Results Sixteen experts from 6 grade A tertiary general hospitals or children ' s hospitals in Shanghai, Jiangsu and Anhui provinces were invited to participate in the consultation. The recovery rates of two rounds of consultation questionnaires were all 93.7%, with expert authority coefficients of 0.836 and 0.849, and Kendall cofficient of concordance of 0.134 and 0.174. According to the two rounds of consultation, the primary and secondary indicators in the initial system (totally 70 indicators, including 3 primary indicators, 13 secondary indicators and 54 tertiary indicators) were retained, but changes occurred in the tertiary indicators: 7 were deleted, 3 were merged, 4 were revised and 1 was added according to the first round of consultation, and 2 were deleted, 1 was revised and 1 was merged according to the second round of consultation. The final system includes 3 primary indicators, 13 secondary indicators and 41 tertiary indicators. Conclusion The QCASCINIAT is scientific, objective and reliable, which can be used as a basis for evaluating the nursing quality for critically ill neonates during interhospital transport.
- Inter-hospital transport /
- Severe neonatal /
- Nursing quality /
- Evaluation indicator /
- Delphi method /
- Analytic hierarchy process
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表 1 专家意见的协调程度

Table 1. Coordination degree of expert opinions

项目	第1轮			第2轮
项目	Kendall’s W值	χ²值	P值	Kendall’s W值	χ²值	P值
一级指标	0.075	7.943	0.032	0.205	8.881	0.028
二级指标	0.263	65.166	0.019	0.161	21.260	0.036
三级指标	0.134	17.372	0.042	0.174	76.630	0.043

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表 2 救护车院际转运危重新生儿护理质量评价要素指标专家函询结果

Table 2. Results of expert letter consultation on factors of quality evaluation for critical newborn care in ambulance interhospital transport

编号及指标	重要性赋值(x±s)	满分比	变异系数	原始权重	组合权重	一致性系数(CR)
1要素指标	4.667±0.471	0.733	0.101	0.321	0.321	0.001
1.1转运护士队伍建设	4.933±0.249	0.933	0.051	0.255	0.082	0.005
1.1.1学历	3.800±0.833	0.267	0.219	0.176	0.014
1.1.2职称	4.400±0.712	0.533	0.162	0.201	0.016
1.1.3 NICU资质	4.600±0.509	0.600	0.106	0.210	0.017
1.1.4 NICU培训时数	4.667±0.471	0.667	0.101	0.212	0.017
1.1.5 NICU知识培训合格率	4.400±0.712	0.533	0.161	0.201	0.016
1.2规章制度	4.867±0.340	0.867	0.070	0.252	0.081	0.101
1.2.1制度完整率	4.733±0.442	0.733	0.093	0.338	0.027
1.2.2制度知晓率	4.533±0.618	0.600	0.136	0.324	0.026
1.2.3制度落实率	4.733±0.442	0.733	0.093	0.338	0.027
1.3转运车厢布局和环境	4.600±0.490	0.600	0.106	0.238	0.076	< 0.001
1.3.1温湿度	4.467±0.718	0.600	0.161	0.515	0.039
1.3.2光线	4.467±0.618	0.533	0.138	0.484	0.037
1.4车载抢救药品、物品和设备管理	4.933±0.249	0.933	0.051	0.255	0.082	0.002
1.4.1药品及管理合格率	4.533±0.805	0.667	0.178	0.321	0.026
1.4.2物品及管理合格率	4.867±0.499	0.933	0.105	0.335	0.027
1.4.3设备及管理合格率	4.933±0.249	0.933	0.051	0.344	0.028

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表 3 救护车院际转运危重新生儿护理质量评价环节指标专家函询结果

Table 3. Results of expert letter consultation on indicators of quality evaluation of critical newborn care in ambulance interhospital transport

编号及指标	重要性赋值(x±s)	满分比	变异系数	原始权重	组合权重	一致性系数(CR)
2环节指标	4.933±0.249	0.933	0.051	0.339	0.339	0.001
2.1新生儿复苏技术	4.867±0.340	0.867	0.070	0.200	0.068	< 0.001
2.1.1心肺复苏技术	4.667±0.789	0.800	0.169	0.119	0.008
2.1.2气管插管配合术	4.933±0.249	0.933	0.051	0.126	0.009
2.1.3 T-组合复苏技术	4.933±0.249	0.933	0.051	0.126	0.009
2.1.4呼吸机使用技术	4.933±0.249	0.933	0.051	0.126	0.009
2.1.5静脉穿刺技术	4.933±0.249	0.933	0.051	0.126	0.009
2.1.6识别早期休克技术	4.933±0.249	0.933	0.051	0.126	0.009
2.1.7掌握儿科急救用药的计量和方法	4.933±0.249	0.933	0.051	0.126	0.009
2.1.8仪器使用和数据评估	4.933±0.249	0.933	0.051	0.126	0.009
2.2护理评估和措施	5.000±0.000	1.000	0.000	0.206	0.070	< 0.001
2.2.1血糖	4.933±0.249	0.933	0.051	0.169	0.012
2.2.2维持体温在36.5~37.5 ℃	4.733±0.573	0.800	0.121	0.162	0.011
2.2.3保持呼吸道通畅	4.867±0.340	0.867	0.070	0.166	0.012
2.2.4评估BP、HR及SPO₂	4.867±0.340	0.867	0.070	0.166	0.012
2.2.5评估疼痛	4.933±0.249	0.933	0.051	0.169	0.012
2.2.6稳定家属情绪	4.933±0.249	0.933	0.051	0.169	0.012
2.3转运车厢环境卫生检测	4.533±0.718	0.667	0.158	0.186	0.063	< 0.001
2.3.1空气及厢内物表培养合格率100%	4.867±0.340	0.867	0.070	0.497	0.031
2.3.2车载暖采样检测合格率100%	4.933±0.249	0.933	0.051	0.504	0.032
2.4转运记录	4.933±0.249	0.933	0.051	0.203	0.069	< 0.001
2.4.1转运交接单	4.867±0.340	0.867	0.070	0.497	0.034
2.4.2危重评分表	4.933±0.249	0.933	0.051	0.504	0.035
2.5转运途中安全与保障	5.000±0.000	1.000	0.000	0.206	0.070	< 0.001
2.5.1转运车完好率100%	4.800±0.400	0.800	0.083	0.330	0.023
2.5.2车内急救设备完好率100%	4.867±0.340	0.867	0.070	0.335	0.023
2.5.3手卫生执行率100%	4.933±0.249	0.933	0.051	0.335	0.023

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表 4 救护车院际转运危重新生儿护理质量评价终末指标专家函询结果

Table 4. Results of expert letter consultation on the end index of care quality evaluation for critical newborns in ambulance interhospital transport

编号及指标	重要性赋值(x±s)	满分比	变异系数	原始权重	组合权重	一致性系数(CR)
3终末指标	4.867±0.340	0.867	0.070	0.339	0.339	0.001
3.1转运时间	4.333±0.942	0.600	0.218	0.242	0.082	< 0.001
3.1.1转运准备时间在5 min	4.800±0.400	0.800	0.083	0.497	0.041
3.1.2转运过程总时长	4.867±0.340	0.867	0.070	0.503	0.041
3.2资料完整性	4.667±0.471	0.667	0.101	0.260	0.088	< 0.001
3.2.1转运交接单填写完整率100%	4.733±0.442	0.080	0.121	0.493	0.044
3.2.2危重评分表填写准确率100%	4.867±0.340	0.867	0.070	0.507	0.045
3.3转运有效性	4.467±0.884	0.667	0.198	0.249	0.085	< 0.001
3.3.1转运前后的危重评分	4.933±0.249	0.933	0.051	1.000	0.085
3.4转运满意度	4.467±0.884	0.667	0.198	0.249	0.086	< 0.001
3.4.1家属满意度	4.933±0.249	0.933	0.051	0.500	0.042
3.4.2转运机构满意度	4.933±0.249	0.933	0.051	0.500	0.042

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