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Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.
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Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.
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Objective Based on the three-dimensional quality structure model,to construct the nursing quality evaluation index system for acute leukemia,in order to provide references for clinical evaluation of quality of nursing care for acute leukemia.Methods Based on the theory of Donabedian's structure-process-outcome quality structure model,through literature search,semi-structured interview,expert meeting,expert consultation and analytic hierarchy process,the quality evaluation index system and index weight for acute leukemia were determined.Results After two rounds of expert consultation,questionnaire response rates were 94.74％,100％;expert authority coefficients were 0.848,0.854;Kendall coordination coefficients were 0.273,0.420,and P values were all less than 0.01.The final index system consisted of 3 first-level indicators,8 second-level indicators,and 24 third-level indicators (3 structure indicators,7 process indicators,14 outcome indicators).Each of third-level indicators contained index names,calculation methods,and data collection methods.Conclusion The process of construction of nursing quality evaluation index system for acute leukemia is scientific,the contents are reasonable,which can reflect nursing characteristics of acute leukemia.
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Objective To investigate the accuracy and safety of using normal saline as a medium to guide the catheter lumen to assist the localization of the catheter tip. Methods This study included the patients with hematological malignancies in our fully implantable venous port. We enrolled 105 patients from January 2014 to December 2015 as control group, and 220 patients from January 2016 to June 2017 as the experimental group. The control group used the traditional fully implantable venous port after the chest X slice to determine the location of the catheter tip. The experimental group used the intracavitary electrocardiogram location technology to assist the complete implantable venous port catheter tip positioning catheter, then chest X film. Results No catheterization occurred in all the patients. The rate of catheter placement was 100％. In the experimental group, 179 patients (81.36％) had the best placement of catheter tip (i.e., superior vena cava right atrium junction, CAJ), and 35 patients (52.38％) in the control group had the best placement of catheter tip. The proportion of the catheter tip located in the best position (the superior vena cava auricular commissure and CAJ) in the experimental group was higher than that in the control group (χ2=29.615, P < 0.05). Conclusions By the injection of saline guided endocardial mapping real-time monitoring of totally implantable venous transfusion port catheter tip position, can guide the surgeon to grasp the real-time operational direction of totally implantable venous transfusion port catheter tip, accurately positioning the catheter tip position, improve the surgical success rate, worthy of clinical use.