| Objective1.To construct a chain management program for perioperative medical device-related pressure injuries in patients undergoing cardiac surgery.2.To explore the effect of chain management program for perioperative medicaldevicerelated pressure injuries in patients undergoing cardiac surgery.Methods1.This study is divided into two parts.The first part is based on the related content of chain management,and the preliminary draft of the chain management scheme of perioperative MDRPI for cardiac surgery patients is formed after literature review and expert group discussion.From September to October 2021,Delphi method was adopted to select 24 experts in the fields of cardiac surgery,stomostomy management,wound treatment,nutrition and anesthesiology from 7 third-level first-class hospitals in Beijing,Zhejiang,Henan,Shandong,and Jilin provinces for expert consultation.Items that also meet the screening criteria of mean importance score > 3.5,full score ratio > 20% and coefficient of variation < 0.25 were screened.The next round of expert correspondence questionnaire was formed after group discussion combined with expert opinions until expert opinions reached a consensus.After two rounds of expert consultation,the chain management scheme of perioperative MDRPI for cardiac surgery patients was finally formed.2.The second part applies perioperative MDRPI chain management program to cardiac surgery patients and discusses its application effect.A total of 161 patients undergoing cardiac surgery from July 1,2021 to October 31,2021 were selected as the control group using convenience sampling to implement routine perioperative MDRPI management protocol.From December 1,2021 to March 31,2022,161 patients undergoing cardiac surgery were selected as the intervention group,and the perioperative MDRPI chain management scheme was implemented for patients undergoing cardiac surgery.The incidence of perioperative MDRPI,device-related pain,skin healing time and skin management cost were compared between the two groups to explore the application effect of the scheme.Results1.Delphi expert letter consultation method: two rounds of expert letter consultation were conducted in this study,and the enthusiasm of experts was expressed by effective recovery rate of the questionnaire.The effective recovery rate of the first round was 96%,and that of the second round was 100%.The Cr was 0.814 and 0.844,respectively.The coefficient of variation of the second-level items in the second round of letter poll were 0.13 and 0.10,the coefficient of variation of the third-level items were 0.17 and 0.16,and the Kendall harmony coefficient W of the second round were 0.282 and 0.299,respectively,indicating statistical significance(P < 0.001).2.Application of perioperative MDRPI chain management scheme in patients undergoing cardiac surgery: A total of 322 patients undergoing perioperative cardiac surgery were included in this study,including 161 in the control group and 161 in the intervention group.There was no significant difference in general demographic data and baseline data between the two groups(P > 0.05).In the control group,there were 16 cases of MDRPI(2cases combined with 2 stage 2 MDRPI,1 case combined with 3 stage 1 MDRPI,a total of 20cases),with an incidence of 9.9%,including 11 cases of stage 1,with a constituent ratio of55%,8 cases of stage 2,with a constituent ratio of 40%,and 1 case of deep tissue injury,with a constituent ratio of 5%.In the intervention group,there were 5 cases(3.1%),including 3cases(60%)in stage 1 and 2 cases(40%)in stage 2.There was statistical significance in the incidence of perioperative MDRPI between 2 groups(P < 0.05).There was no significant difference in the composition of perioperative MDRPI staging between 2 groups(P > 0.05).Head and neck was the site of high incidence of perioperative MDRPI in cardiac surgery patients.There were 9 cases of head and neck MDRPI in the control group with an incidence of 5.6%,and 2 cases of head and neck MDRPI in the intervention group with an incidence of1.2%,and the difference was statistically significant(P < 0.05).The medical device-related pain score of the two groups was(2.93±1.18)points in the control group and(2.74±1.01)points in the intervention group,with no statistical significance(P > 0.05).Skin healing time of the two groups was(6.93±4.79)days in the control group and(2.33±3.39)days in the intervention group,and the difference was statistically significant(P < 0.05).The skin management cost of the two groups was(184.00±143.83)yuan in the control group and(63.60±40.09)yuan in the intervention group,the difference was statistically significant(P < 0.05).Conclusion1.Based on the theory of chain management,combined with the characteristics of cardiac surgery patients,through a large number of literature review,and after two rounds of Delphi expert letter consultation,the chain management scheme of MDRPI for cardiac surgery patients was developed.Based on the concept of chain management,has formed a chain and chain link management personnel organization,content involves multidisciplinary team building,staff training,assessment,standardization of the various system specifications and relevant departments protective measures,process management,quality control,reporting,rewards and punishments,etc.,comprehensive,wide coverage,reasonable structure,scientific,provide guidance for clinical practice.2.The application of MDRPI chain management program in perioperative cardiac surgery patients has effectively reduced the incidence of perioperative MDRPI in cardiac surgery patients,accelerated the speed of skin healing in MDRPI patients,reduced the cost of skin management,and achieved good results.At the same time,it provides a new way for the management of perioperative MDRPI in cardiac surgery patients,and also provides reference for the management of MDRPI in other similar multi-department handover patients,which has clinical promotion significance. |
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