| Objective To construct an index system for the quality of care for lower extremity deep vein thrombosis prevention in orthopedic hospitalized patients,and to provide objective and scientific standards and reference bases for the quality management,monitoring and evaluation of nursing quality of lower extremity deep vein thromboprophylaxis.Method 1 Construct nursing quality index evaluation system: Consult industry norms and quality control requirements,list relevant quality control indicators based on the research results of the NATIONAL NURSING QUALITY INDEX DATABASE IN THE UNITED STATES,and build on the framework basis of evidence-based model and learning "structure-process-result",invite 15 orthopedic nursing experts to use delphi method to conduct two rounds of expert correspondence,analyze the results of correspondence,and form a quality index system for the prevention of lower extremity deep vein thrombosis in orthopedic inpatients.2 Establish the weight coefficient of the index system: the analysis method is used to investigate the 16 doctors and nursing experts hired by the participants,and the ratio of the sequential relationship between the first,second and third level indicator layers of the evaluation index system and the importance between adjacent targets or indicators is determined,and the calculation of the weight coefficient is realized to solve the results of many expert judgments,and the specific weights of different indicators are finally obtained.3 Based on the nursing index system and the weight coefficients of each layer of indicators,the fuzzy comprehensive evaluation method was used to evaluate and analyze the quality of inpatient deep vein thrombosis prevention in hospitalized patients in the Department of Trauma orthopedics of the Third Hospital of Hebei Medical University,and the evaluation results were obtained to comprehensively evaluate the quality of nursing care,and the application of the quality of deep vein thrombosis preventive care in practice was discussed according to the evaluation results.Results 1 The Delphi method was used to construct a quality index system for deep vein thrombosis prevention care of lower extremities in orthopedic inpatients,including4 primary indicators,10 secondary indicators and 47 tertiary indicators.The positive coefficient of the two rounds of expert inquiries was 100%,indicating that the enthusiasm of experts for this study was high;The authority coefficients are 0.89 and0.905,respectively,indicating that the authority of the experts is high,and the coordination coefficients of the experts are 0.903 and 0.875,respectively,indicating that the conclusions are more reliable.In summary,the judgment of experts is based on theory and practice,and the credibility is high.2 The analysis method is used to determine the index weight coefficient in the index system,among the first-level indicators,the implementation weight coefficient of VTE preventive measures(0.294)is the largest,patients need to use methods and countermeasures to prevent VTE in the absence of contraindications,low-risk patients can take basic preventive measures;patients with medium and high risk can take basic preventive measures,physical preventive measures and combined drugs for prevention or take physical combination drug prevention methods.Among the secondary indicators,the implementation weight coefficient of basic preventive measures(0.421)is the largest,and the basic preventive measures advocate and guide bedridden patients to carry out leg exercises early,elevate the affected limb,and correct ankle pump exercises to increase lower limb muscle contraction and maintain univenous return circulation of lower limbs;Avoid punctures in the lower extremities and ensure adequate volume,avoid vascular loss and blood concentrate;Actively educate patients on the health of thrombosis-related knowledge,quit smoking and alcohol,control blood sugar and blood lipids,etc.,and carry out scientific and reasonable diet.The nursing index system of DVT prevention in orthopedic inpatients is practical,scientific and operable,and can be used as the main evaluation tool for nursing workers to continuously improve the prevention of DVT in orthopedic inpatients.Among the tertiary indicators,the weight coefficient of correct ankle pump movement(0.255)is the largest,followed by the correct elevation of the lower limb(0.231),and the venous thrombosis and blood stasis,damage to the intravenous membrane,and blood in a hypercoagulable state are closely related to the main factors causing DVT.Ankle pump exercise is an essential and effective preventive measure in patients with deep vein thrombosis risk,by adjusting the ankle pump rhythm(the lower limb ankle dorsal extension and ankle plantar flexion is set to 3s time,10 to 15 times a day,20 to 30 groups each time)to improve the preventive effect of ankle pump exercise,for patients with contraindications to ankle pump exercise,guide them to correctly raise the lower limbs to take "slope position","trapezoidal position","triangle position" Three lower limb elevation methods The lower limbs are greater than the heart is affected by gravity,it can improve the speed of blood return to eliminate swelling,reduce the vortex in the femoral vein blood return,increase the speed of blood return,and significantly reduce the risk of venous thrombosis.3 Using the fuzzy comprehensive evaluation method,taking the Department of Trauma and Orthopedics of the Third Hospital of Hebei Medical University as the research object,the clinicians and nurses were surveyed by questionnaire survey method,and the survey data was analyzed and sorted out,and the comprehensive evaluation results were about 89 points(calculated according to the percentage system),of which the second-level indicator "IV.-1 patient safety" had the lowest evaluation,which was 78 points,and the second-level indicator "I.-1 Hospital VTE Team Building" scored the highest,97 points,based on the evaluation case data analysis results,The results of this study can be quantitatively evaluated on the quality of lower extremity deep vein thrombosis prevention care for orthopedic inpatients,and the specific quantitative evaluation results in the nursing quality system of each index are obtained,which provides a solution for improving the quality of lower extremity deep vein thrombosis prevention care for orthopedic inpatients.Conclusion The index system of deep vein thrombosis prevention of lower limbs of orthopedic inpatients constructed in this study has certain practicality,scientificity and operability,and can be used as the main evaluation tool for nursing workers to continuously improve the prevention of deep vein thrombosis of lower limbs in orthopedic inpatients.Figure 4;Table 24;Reference 127... |
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