Study On The Application Of Sbar Handover Mode Based On Early Warning Assessment In Emergency

Objects:1.Understand the current situation early warning evaluation of nurses’ handover in the emergency department.2.Through literature review and group discussion,the entry pool of the emergency patient condition early warning evaluation form was determined,the emergency shift early warning evaluation form was determined by Delphi expert letter consultation method,and the reliability,the validity and predictive efficacy test was conducted on the evaluation form.3.The transition mode of SBAR communication mode based on early warning assessment was constructed and applied to clinical practice,so as to improve the shift quality of emergency nurses and ensure the safety of patients.Methods:The first stage: The convenience sampling method was adopted to investigate 95emergency department nurses from 6 grade Iii a hospitals in Zhenjiang,Nanjing and other 4 cities in Jiangsu province from March to May 2018.The cognition and status of early warning assessment of their shift condition were investigated.The specific contents of the questionnaire were as follows: general information,status of early warning assessment of shift,cognition and use of early warning assessment tools,and evaluation and suggestion of the currently used assessment tools.The second stage: The initial entry pool of patients’ condition early warning evaluation table was formed by referring to domestic and foreign literatures and intra-group discussions.Two rounds of expert letter consultation were conducted on15 experts who had worked for 10 years in nursing education,nursing management,emergency clinical nursing and clinical medicine.Through the expert letter consultation results,the entry pool was modified and improved,and finally the early warning and evaluation form for the condition of the shift was formed.Patients admitted to the emergency department of a third-grade A hospital in Zhenjiang city from July 2019 to August 2019,who met the inclusion and exclusion criteria,were selected by the convenience sampling method as the research objects to evaluate the reliability,validity and predictive efficacy of the early warning evaluation form for the condition of the shift.The third stage:Develop the handover plan of SBAR communication mode based on early warningassessment.Including determining the early warning evaluation indicators and standards,making SBAR handover guidelines based on early warningassessment,and applying them to the handover process of the emergency department of a third-grade A hospital in Zhenjiang from November to December2019 after completing the nurse training,and listing them as the observation group.The transfer of traditional SBAR communication mode in the emergency department of the hospital from November to December 2018 was taken as the control group.The incidence of nursing adverse events,the quality of nursing shift,and the satisfaction of doctors and nurses to the shift were compared between the two groups.Results:1.Among the respondents,38.95% of the nurses conducted early warning assessment during the shift,while only 30.53% of the nurses used early warning assessment tools during the shift.In addition,only 11.58% of the nurses would include the results of early warning assessment into the overall shift of the department,and the assessment tools used by the emergency department nurses in the six first-class hospitals were different,believing that there was a lack of unified and perfect early warning assessment tools.2.Through two rounds of expert letter consultation,an emergency shift alarm assessment scale with 9 items including heart rate,systolic blood pressure,respiratory rate,body temperature,state of consciousness,oxygen saturation,pain score,age and past history was finally formed.The content validity index of this research item is0.93～1.00,the content validity index of the consistent scale level is 0.87,the content validity index of the average scale level is 0.99,the Cronbach coefficient of the total scale of this research is 0.803,the reduced half reliability of the total scale is 0.891,which has good reliability and validity,all within the acceptable range.The area under the ROC curve of the evaluation table was 0.921,with the optimal cut-off point being5.5 points.At this time,the sensitivity and specificity of the diagnosis of the severity of the disease in emergency patients were 88.9% and 80% respectively.3.After the SBAR handover mode based on early warning assessment was applied in the emergency department,the incidence of nursing adverse events of patients in the observation group was lower than that of the control group,the quality of nurse handover was better than that of the control group,and the medical satisfaction was higher than that of the control group,with statistically significant differences(P <0.05).Conclusions:1.Emergency nurses do not pay enough attention to early warning assessment of shift handover,nurses lack of cognition and application of early warning assessment tools,nurses do not have high evaluation of existing early warning assessment tools,and there is a lack of special early warning assessment tools for shift handover.2.The disease early warning evaluation form formed in this study has good reliability validity and predictive efficacy,which can be used to evaluate the severity of emergency patients and provide scientific and effective early warning and evaluation tools for emergency nurses’ succession.3.SBAR handover mode based on early warning management can significantly improve the early warning ability of nurses in the emergency department during the handover,reduce the occurrence of nursing adverse events,improve the quality of nursing handover,and enhance the satisfaction of both sides of the medical.