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首页> 外文学位 >Factors associated with pharmaceutical venous thromboembolism prophylaxis in hospitalized surgical patients.
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Factors associated with pharmaceutical venous thromboembolism prophylaxis in hospitalized surgical patients.

机译：住院外科手术患者中与药物性静脉血栓栓塞预防相关的因素。

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摘要

Despite evidence that venous thromboembolism (VTE) is one of the most preventable causes of death, pharmaceutical prophylaxis is underused. It is unclear why such evidence-based risk assessment and treatment is often omitted or delayed. One unexamined factor is nursing's role in the administration of prophylaxis, and the nursing work environment. This study applied a theoretical framework of situational awareness, recognized by high reliability organizations (HROs) as a critical component in daily operations, to an important problem: VTE prophylaxis. This retrospective cohort study, utilizing data from the Michigan Surgical Quality Collaborative (MSQC), the electronic medical record, and the staffing system, aimed to examine environmental factors associated with 1) the administration of pharmaceutical VTE prophylaxis, 2) VTE occurrences, and 3) other postoperative occurrences. The sample included patients from a single institution in the MSQC database who were hospitalized for at least 24 hours and remained on the same unit (N=1,370). Correlations and logistic regressions were used to analyze the data. Nearly one-third of patients experienced an error. Significant predictors included VTE risk score, the difference between actual and budgeted RN hours per patient day (RN HPPD), census, workload, education, and unit type, all in expected directions. As the gap in RN HPPD decreased, patients were 12.4% more likely to receive prophylaxis. Patients were less likely to receive prophylaxis as nursing workload increased. The more baccalaureate-prepared nurses on the unit, the more likely patients received prophylaxis; a 1% increase corresponded to a 4% decrease in patients not receiving necessary prophylaxis. Patients admitted to surgical units were four times more likely to receive the prophylaxis. Patients who received prophylaxis were less likely to have a VTE occurrence. This is the first study to examine the environmental factors of situational awareness and patient outcomes. Situational awareness is recognized as a contributing factor in HROs to manage and reduce risk. Future work is needed to extend this research and contribute to an understanding of how the nursing work environment impacts patient outcomes in a high reliability organization. The findings from this study have potential to extend our understanding of the complex work in nursing.
机译：尽管有证据表明静脉血栓栓塞症（VTE）是最可预防的死亡原因之一，但药物的预防作用仍未得到充分利用。目前尚不清楚为什么经常省略或延迟这种基于证据的风险评估和治疗。一个未经检查的因素是护理在预防管理和护理工作环境中的作用。这项研究将情景意识的理论框架应用于一个重要问题：预防VTE，该框架已被高可靠性组织（HRO）认可为日常运营中的关键组成部分。这项回顾性队列研究利用了密歇根州外科质量合作组织（MSQC），电子病历和人员配备系统的数据，旨在研究与1）预防药物性VTE，2）VTE发生和3相关的环境因素。 ）其他术后情况。样本包括来自MSQC数据库中一所机构的患者，他们至少住院了24小时，并留在同一病房（N = 1,370）。相关性和逻辑回归用于分析数据。近三分之一的患者出现错误。重要的预测因素包括VTE风险评分，实际和预算的每位患者每天RN小时数（RN HPPD）之间的差异，普查，工作量，教育程度和单位类型，均符合预期的方向。随着RN HPPD差距的减小，患者接受预防的可能性增加了12.4％。随着护理工作量的增加，患者接受预防的可能性较小。单位中准备好文凭的护士越多，患者接受预防的可能性就越大； 1％的增加对应于未接受必要预防的患者减少4％。接受手术治疗的患者接受预防的可能性高四倍。接受预防的患者发生VTE的可能性较小。这是第一个研究情境意识和患者预后的环境因素的研究。情境意识被认为是HRO管理和降低风险的重要因素。需要进一步的工作来扩展这项研究，并有助于理解护理工作环境如何影响高可靠性组织中的患者结果。这项研究的发现有可能扩展我们对护理复杂工作的理解。

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  • 作者

    Fore, Amanda M.;

  • 作者单位

    University of Michigan.;

  • 授予单位 University of Michigan.;
  • 学科 Nursing.;Surgery.;Pharmaceutical sciences.;Health care management.
  • 学位 Ph.D.
  • 年度 2016
  • 页码 123 p.
  • 总页数 123
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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