Evidence Summary And Application On Prevention And Treatment Of Nasointestinal Tube Blockage

Objective l.To systematically and comprehensively retrieve,evaluate and integrate the relevant evidence on the prevention and treatment of nasoenteric tube blockage,form the best evidence summary for the prevention and treatment of nasointestinal tube blockage,and provide evidence-based basis for clinical nursing.2.The best evidence is used for clinical transformation,aiming to standardize the evidence-based clinical practice behavior of clinical nurses,improve the knowledge level of nurses,reduce the incidence of nasoenteric tube blockage,and improve the quality of nursing.Methods 1.By systematically and comprehensively retrieving evidence related to the prevention and treatment of naso-intestinal tube blockage,evidence summary,systematic review,expert consensus,and group standards,and conducting strict quality evaluation and literature analysis of relevant evidence,screening and integration of nasal Evidence for prevention and management of bowel obstruction.2.Through the expert meeting method,the applicability of the evidence obtained in this study was evaluated,and finally the evidence suitable for clinical situation was selected for clinical transformation and application.3.Taking the i-PARIHS framework as a theoretical guide,formulate corresponding review indicators based on the best evidence,and conduct a baseline review to fully understand the gap between the best evidence and clinical practice.Based on the three dimensions of change(changes brought about by evidence),recipients and organizational environment,analyze the factors of obstacles,and formulate targeted countermeasures to promote the transformation of evidence into clinical practice.This study carried out evidencebased clinical reform in a pilot ward of a Grade-Ⅲ hospital in Zhejiang Province from May 11 to September 10,2022,and evaluated the effect of applying the best evidence at the system level,practitioner level and patient level.Results 1.Finally,15 literatures were included,including 1 guideline,7 evidence summaries,1 systematic review,4 expert consensus and 2 group standards.By extracting and summarizing the evidence in the included literature,a total of 22 pieces of best evidence were formed in six aspects,including catheter selection,catheter evaluation,nutrient solution storage and use,drug administration,tube flushing,tube blocking identification and treatment.Through the expert group meeting,the applicability of the best evidence for the prevention and treatment of nasoenteric tube blockage was evaluated,among which two pieces of evidence were excluded due to insufficient feasibility.Therefore,20 pieces of best evidence suitable for practice were selected for clinical transformation and application..2.After the clinical transformation and application of the best evidence,it has achieved certain results at the system level,practitioner level and patient level:(1)At the system level:①Formulated the nasoenteric tube administration process and the post-blocking treatment process,in order to guide the nursing staff to take correct measures to deal with the administration through the nasoenteric tube according to the standardized process and block the tube;②The catheter evaluation sheet was revised and improved to standardize and homogenize the catheter evaluation sheet;③Apply for a nutrition pump and Enteral perfusion devices and other related consumables ensure the smooth application of the best evidence in clinical practice;④The knowledge manual for the prevention and treatment of nasoenteric tube blockage has been formulated,and the relevant content of training and assessment materials has been improved.(2)At the practitioner level:①After the application of the best evidence in the pilot ward,the knowledge level of prevention and treatment of nasointestinal tube plugging was significantly improved,and the score of knowledge of prevention and treatment of nasointestinal tube plugging was increased from(59.12±16.21)to(90.51±11.30),and the difference was statistically significant(P<0.01).②After the application of the best evidence,the review index 16 was developed from zero,and the implementation rate reached 96.00%.The implementation rates of review indicators 2,3,14,15,18,25,26 and 28 were all above 80%,and the differences were statistically significant(P<0.05).The implementation rates of review indicators 13,17,23,24,27 and 29 all reached more than 70%,with statistical significance(P<0.01).Among them,the examined indicators 6,7,10 and 19 were not reviewed in clinical practice,so they were not counted.The implementation rate of only examined indicator 1 was still low(36.84%).After the application of evidence,the implementation rate of evidence-based review indicators of nursing staff increased significantly.(3)At the patient level:After the application of evidence,the incidence of nasointestinal tube blocking decreased from 11.43%to 0.00%,and the incidence of tube blocking decreased compared with that before,and the difference was statistically significant(P<0.05).Conclusion 1.Based on clinical practice,this study summarized the best evidence of prevention and treatment of nasointestinal tube blockage from six aspects:catheter selection,catheter evaluation,nutrient solution storage and use,drug administration,flushing,blockage identification and treatment.2.By conducting based on nasal bowel wall tube of prevention and treatment of the best evidence for clinical application research,improved the nursing staff of nasal bowel wall tube of prevention and treatment knowledge rate,adherence to evidence-based nursing behavior improved significantly,and formulate the bowel wall tube manual of prevention and treatment knowledge,improve the training and examination of material related content,effectively improved the quality of care,It can reduce the incidence of nasointestinal tube blockage and provide reference for the later development of evidence-based practice.