| Objective Describe the current situation of surgical ha ndover in elderly patients with hip fracture,analyze the weak links of medical staff handover,introduce foreign ISBA R standard communication tools to provide scientific and standardized transfer handover framework for elderly patients with hip fracture surgery;Aim to standardize handover system,perfect handover content,reduce and eliminate adverse events,ensure patient safety and promote clinical safety management.Methods(1)using Delphi expert method to carry out two rounds of expert letters to 20 nursing experts in 8 provinces and municipalities directly under the Central Government.After each round of expert letters,the positive coefficient of experts,the degree of expert authority,the degree of coordination of expert opinions were calculated,and the indexes were screened according to the mean,percentage and coefficient of variation of each index.After two round s of correspondence,the expert opinion tends to be consistent,forming the surgical handover frame ISBAR elderly patients with hip fracture.(2)By means of cluster sampling,32 nurses were selected in the orthopedics department and operating room of a Chinese medicine hospital in Hubei province.Control group :32 nurses who participated in the study from July to Septem ber 2019 applied the traditional hospital shift method to hand over 42 patients.experimental group :32 nurses aftert raining from november 2019 to january 2020 applied the ISBAR surgical handover template to hand over 36 patients included and collected relevant data.After statistical analysis,the patients were Comparison of baseline data,P>0.05,compared nurses before and after the implementation of shift quality,shift satisfaction,critical thinking and transfer defects occurred events.Results(1)The positive coefficient of experts was 90.9%,100% and 0.855 respectively,the coefficient of variation of each dimension and index was 0.050~0.32 in the first round,0.045~0.240 in the second round,and 0.214,0.189,0.165 in the first round and 0.246,0.227 0.178.The significance test of Kendall's co-ordination coefficient in two rounds of expert letters statistical significance(P<0.05).Through the statistical method,combined with two rounds of expert opinions,the index screening criteria were used to screen it to form the final handover framework: including 5 primary indicators,46 secondary indicators.(2)The total score of nurse shift evaluation scale ±69.95±3.17,79.81±2.04)was divided into three dimensions:information quality(33.68±1.05,37.36±1.43),interaction and support(20.79±1.53,23.07±2.03),efficiency(15.67±0.74,18.25)±1.39).The score of nurse handover evaluation s cale in three dimensions was higher than that before implementation,except for the index difference of "discussion workload ",the other index P value <0.05,the difference was statistically sign ificant.(3)The total score of nurse satisfaction before and after implementation was(74.45±2.17,80.81±2.04),providing patient information(25.78±2.65,28.36±1.73),enhancing nurse supervision responsibility,cooperation(16.81±1.38,18.49±2.07),and promoting patient participation(7.78).56±1.29,8.17±0.34),effective and efficient shift(6.96±1.43,8.26±1.04)and patient safety(8.51,0.73,9.42 and 0.34),compared to the pre-implementation,the post-implementation were better than the pre-implementation,except for the item "prevention of patient care and delay of discharge ",the difference was not statistically significant,and the p value of other items <0.05.(4)Before and after implementation,nurses' total score of critical thinking(287.48±35.76,308.57±43.51)and search for truth(40.63)±5.97,43.57±6.13),open mind(41.08±7.83,40.78±6.75),analytical(39.79±6.21,43.52),systematization(38.41±5.68,38.57±4.79),confidence(44.75±3.67,47.69),thirst for knowledge(43.08±6.15,49.78±4.21),cognitive maturity(39.21±6.03,44.60±5.41)There was no significant difference in score between the two dimensions except "open mind" and "systematic ability".The P value of other dimensions <0.05 and was statistically significa.(5)Comparing the occurrence of the transfer process be tween the two groups before and after implementation,the number of defect events before and after implementation is 31,and the number of defect events after implementation is9,which is obviously reduced.Conclusion Based on the ISBAR standard communication tool and literature analysis and related theory,this study constructs the surgical handover framework ISBAR elderly hip fracture by Delphi method.The consultation results are reliable and scientific.In the future research,we can extend the research time,increase the sample size or expand the scope of clinical application,so as to carry out more indepth research,further ensure the safety of patients,and build a comprehensive and harmonious nurse-patient relation ship. |
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