Analysis Of Risk Factors And Prediction Model For Nursing Interruption Events During The Surgical Counts

Objective:1.Investigate the current situation and risk factors of nursing interruptions during the inventory of surgical counts,analyze the causes of adverse events based on domestic and foreign research,and provide theoretical basis for nursing managers to propose targeted intervention measures.2.Construct an effective prediction model for nursing interruption events during the surgical counts,screen or identify surgeries with high-risk nursing interruption events,propose targeted preventive measures,guide nursing work,and improve the quality of nursing services.Methods:1.Using the convenient sampling method,select the surgery performed in a Class III general hospital in Shanxi Province from June 2022 to October 2022 as the observation object.Develop a"Questionnaire on Nursing Interruption Incidents during the Checkout of Surgical counts"to collect basic information about the operating room environment,surgical patients,and surgery,as well as general information about operating room nurses.Using a random number table method,the study subjects were divided into a development group and a validation group in a ratio of 2:1.The development group was divided into nursing interruption events group and non nursing interruption events group based on the occurrence of nursing interruption events during the surgical counts.Theχ~2test was used for comparison between the two groups.The independent risk factors for nursing interruption events during the surgical counts were determined using Logistic regression,the variables with P<0.05 in the single factor analysis as independent variables and whether nursing interruption events occurred during the surgical counts as dependent variables.2.According to the regression coefficients obtained in the Logistic regression analysis,each risk factor is assigned a value,and a risk scoring model for nursing interruption events in surgical counts is established.Use the validation group data to internally validate the model,using Hosmer-Lemeshowχ~2.Test the prediction effect of the area evaluation model under the ROC curve.Results:1.578 surgeries were eventually included,of which 364(63.0%)had nursing interruptions during the inventory of surgical items.In the development group,there were385 operations,of which 244(63.4%)had nursing interruptions during the inventory of surgical counts;A total of 193 operations were performed in the validation group,of which 120(62.2%)had nursing interruptions during the inventory of surgical counts.The difference analysis of all variables of surgery between the development group and the validation group showed that there was no statistical difference between the two groups in the basic situation of the operating room environment,the basic situation of surgical patients and surgery,and the general information of operating room nurses(P>0.05).2.Surgical counts in the developments group the results of univariate analysis of counted episodes of nursing interruption in the links showed that there were statistically significant differences among the different working hours,working shifts,number of surgeons,number of anesthesiologists,frequent/emergency surgeries,whether or not the combination of multiple surgeries was performed,operating times,seniority of circulating nurses,qualifications of scrub nurses,and whether circulating nurses and surgeons first collaborated with each other(P<0.05).Logistic regression analysis was performed considering the 10 variables with P<0.05 in univariate analysis as independent variables,The results showed,The number of surgeons>3(OR=4.025,95%CI:2.306～7.023,P<0.001),operating time>4h(OR=2.890,95%CI:1.564～5.339,P=0.001),whether a multisurgical approach was combined(OR=10.820,95%CI:2.095～55.886,P=0.004),frequent/emergency surgery(OR=4.890,95%CI:2.451～9.757,P<0.001),and seniority of circulating nurses≤10 years(OR=6.573,95%CI:3.777～11.438,P<0.001)and qualifications of scrub nurse to be undergraduate and below(OR=2.308,95%CI:1.131～4.707,P=0.021)were independent risk factors for incident nursing interruptions during inventory sessions of surgical counts.3.the contributing factors and corresponding points of the risk scoring model for nursing interruptions events during the surgical counts were:number of surgeons>3(2points),operating time>4h(1 point),combined multiple surgical procedures(3 points),emergency surgery(2 points),seniority of circulating nurses≤10 years(2 points)and qualifications of scrub nurse to be undergraduate and below(1 point).The total score of the model ranged from 0 to 11 points,and a score≥4 points was classified as high risk.In the development group,the results showed that Hosmer-Lemeshowχ~2=7.342,P=0.196.The area under the ROC curve was 0.857(95%CI:0.821～0.893,P<0.001),corresponding to a sensitivity of 77.87%and a specificity of 75.89%.In the validation group,the results showed that Hosmer-Lemeshowχ~2=5.845,P=0.211,and the area under the ROC curve was 0.891(95%CI:0.847～0.934,P<0.001),with a sensitivity of 75.00%and a specificity of 93.15%.Conclusion:The study found that the number of surgeons>3,operating time>4h,multiple surgical joint operation,emergency surgery,seniority of circulating nurses≤10 years and qualifications of scrub nurse to be undergraduate and below were independent risk factors for nursing interruption events in the surgical counts.This study constructed a risk score model with good predictive effect to assess the risk of a nursing interruption events taking place in the surgical counts before surgery,providing an effective and easy surgical counts session for clinical healthcare workers to conduct a nursing interruption event risk assessment tool,and provid a practical basis for managing and regulating the surgical counts.