| Objective:This research is based on the theory of "Enterprise Risk Management-Integrated Framework(COSO-ERM)".Delphi method was used to construct the nursing safety management index of day surgery patients and determine the weight of all indicators.The constructed nursing safety management index of day surgery patients is applied clinically to achieve systematic and scientific predictive nursing,in order to provide reference for the nursing safety management of day surgery.Methods:1.The construction of index and determination of index weight:(1)Nursing safety management index related to day surgery patients were extracted through systematic search of domestic and foreign literatures.(2)From June to July 2021,a questionnaire on risk perception of day surgery was designed by referring to relevant literature and clinical investigation,and the current situation of 213 nurses in the departments of day surgery in three tertiary comprehensive hospitals in Qingdao was investigated by convenient sampling method,so as to analyze the existing and potential nursing safety problems of day surgery.(3)Based on the COSO-ERM,and combined with the results of literature review and current investigation,the nursing safety management index of day surgery patients based on integrated framework was preliminarily developed.(4)By using Delphi method,18 experts from Shandong province and outside the province were consulted for 2 rounds of correspondence to revise and improve the indicators,determine the nursing safety management index of day surgery patients based on the COSO-ERM,and use the analytic hierarchy process to determine the weight of each indicator.2.The application of indicators:Use indicators to develop evaluation standards for nursing safety management of day surgery.Five departments of day surgery were selected by convenient sampling method.150 patients included from March to May 2022(before the application)were selected as the control group,and routine nursing safety management was adopted;150 patients included from June to August 2022(after the application)were selected as the observation group,and safety management was carried out using the evaluation standard of nursing safety management of day surgery,and questionnaires of satisfaction and health awareness were distributed to patients.Cancellation rate,delayed discharge rate,unplanned reoperation rate,unplanned 30 day readmission rate,admission assessment completion rate,complication rate,satisfaction rate and health awareness rate were collected.From March to May 2022 and from August 2022,questionnaires were distributed to nurses from 5 departments in the form of questionnaire star,and scores of nurses’ risk perception of day surgery were collected in the two stages.Results:1.The results of index construction and weight:(1)Through literature review,16 literatures were finally included in this study according to inclusion and exclusion criteria.(2)Current investigation results showed that the overall score of the 213 nurses’ risk cognition of day surgery was(48.63±4.30)points,indicating that the nurses’ cognition was at the moderate level.The dimension with the highest average score was medical staff factors(13.71±1.18),and the dimension with the lowest average score was patient factors(9.88±1.27).Nurses received more training on basic nursing knowledge(81.69%),and less training on medical and surgical nursing knowledge(53.05%).There were imperfections in the procedure of day surgery(regulation,evaluation,communication,etc.).(3)Guided by the COSO-ERM and combined with the results of literature review and current investigation,the nursing safety management index of day surgery patients were preliminarily constructed,including 3 first-level indexes,12 second-level indexes and 38third-level indexes.(4)Two rounds of expert letter consultation were carried out in this study.The effective recovery rate of the two rounds of questionnaire was 100%,and the authority coefficients were 0.892 and 0.920,indicating a high degree of expert initiative and authority.Kendall’s coefficient was 0.224 and 0.230,respectively(P<0.001),indicating a good coordination of expert opinions.Finally,an integrated framework-based nursing safety management index of day surgery patients was formed,including 3 first-level indexes,12 second-level indexes and41 third-level indexes.The analytic hierarchy process was used to calculate the weight coefficient of each index.The weight coefficient of the first-level index was 0.164,0.297,and 0.539,respectively.Consistency ratio of all indicators were lower than 0.1.2.The results of index application:(1)A total of 300 patients with day surgery were included in this study,including 63 males and 87 females in the observation group and 59 males and 91 females in the control group.There was no significant difference in general data between the two groups(P>0.05).The satisfaction rate and health awareness rate of patients in the observation group were96.49% and 97.09%,respectively,higher than 90.04% and 90.11% in the control group(P<0.001).The appointment cancellation rate,unscheduled reoperation rate and unscheduled30 d readmission rate of both groups were 0%.The delayed discharge rate of patients in the observation group was 7.33%,which was lower than that in the control group(16%)(P<0.05).The completion rate of admission assessment was 100% in both groups.The incidence of common complications was 6% in the observation group compared with12.67% in the control group(P<0.05).(2)216 nurses were included in this study.The risk perception score of nurses in the observation group(62.95±8.95)was higher than that in the control group(48.93±5.22)(P<0.001).Conclusion:In this study,the integration framework is taken as the theoretical basis,and the index of nursing safety management of day surgery patients constructed by current situation investigation,Delphi method and analytic hierarchy process are scientific and reliable.Through clinical application,it provides comprehensive evaluation criteria for the management of day surgery for medical staff,standardizes the behavior of medical staff,guarantees the safety of patients in day surgery,and provides reference for the safety management of day surgery,so as to optimize the nursing management of day surgery. |
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