孔海燕 杨惠芳 方振红 蔡晓丹 张其霞 潘景业

[摘要] 目的 探討医护质控小组团队管理模式对降低ICU患者身体约束的应用效果。 方法 采用方便抽样法，选取2017年4～6月入住我院ICU的患者作为对照组，采用护士个人经验性判断护理模式;选取2017年7～9月入住我院ICU的患者作为观察组，实施医护质控小组团队管理模式。比较两组患者的身体约束率、平均约束时间、非计划拔管率、约束不良事件发生率、患者或家属对约束的理解度、患者或家属对治疗护理的满意度。 结果 观察组的约束率、约束不良事件发生率、非计划拔管率分别为42.9%、3.9%、2.9‰，均低于对照组的65.6%、9.2%、6.3‰，平均约束时间观察组（75.35±7.71）h明显少于对照组（159.19±14.71） h，差异有统计学意义（P<0.05或P<0.01）;观察组患者或家属对约束的理解度、患者或家属对治疗护理的满意度分别为97.6%、95.2%，均高于对照组的61.7%、72.2%，差异有统计学意义（P<0.01）。 结论 实施以患者为中心的医护质控小组团队管理模式可明显降低ICU患者身体约束率，减少平均约束时间，提高患者或家属满意度。

[关键词] 医护质控小组;重症监护病房;身体约束;团队管理

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2020）16-0166-06

A study of the effect of team management mode of medical quality control team on reducing physical restraint of ICU patients

KONG Haiyan   YANG Huifang   FANG Zhenhong   CAI Xiaodan   ZHANG Qixia   PAN Jingye▲

ICU， The First Affiliated Hospital of Wenzhou Medical University， Wenzhou   325000， China

[Abstract] Objective To explore the application effect of team management mode of medical quality control team on reducing physical restraint of ICU patients. Methods Convenience sampling method was used to select patients admitted to ICU of our hospital from April to June 2017 as control group， and nurses' personal experience judgment nursing mode was used for physical restraint. Patients admitted to ICU of our hospital from July to September 2017 were selected as observation group to implement the team management mode of medical quality control team. Between the two groups， the restraint rate， average restraint time， unplanned extubation rate， incidence of restraint adverse events（AEs）， understanding of restraint by patients or their families， and satisfaction of patients or their families with treatment and nursing were compared. Results The restraintt rate， incidence of restraintAEs and unplanned extubation rate of the observation group were 42.9%， 3.9% and 2.9 %， respectively， which were lower than those of the control group（65.6%， 9.2%， 6.3%）， and the average restraint time of the observation group（75.35±7.71） was obviously less than that of the control group（159.19±14.71）， with statistically significant difference（P<0.05 or P<0.01）. In the observation group， the understanding of restraint by patients or their families and their satisfaction with treatment and nursing was 97.6% and 95.2% respectively， which were higher than those of the control group（61.7% and 72.2%）， with statistically significant difference（P<0.01）. Conclusion The implementation of patient-centered team management mode of medical quality control team can significantly lower the physical restraint rate of ICU patients， reduce the average restraint time， and improve the satisfaction of patients or their families.

[Key words] Medical quality control team; ICU; Physical restraint; Team management

身体约束是指使用依附于或者临近患者身体的限制患者自由移动或正常接触躯体的任何行为、方法[1]。身体约束作为重症监护病房（Intensive care unit，ICU）常见的一种保护性措施[2]，其主要目的是保证患者安全[3]，防止烦躁或谵妄患者发生非计划拔管[4]，但也不可避免地会给患者带来不同程度的生理伤害[5]和心理伤害[6]，严重者甚至导致死亡[7]。据报道ICU患者身体约束使用率极高（56%～76%）[8-9]，朱胜春等[10]的调查显示ICU患者平均约束时间占ICU住院时间的比率高达60.80%。2016年国家护理质量控制中心发布的《护理敏感质量指标使用手册》[11]首次将住院患者身体约束率纳入评价指标体系，对临床工作提出了新的挑战。……