근거기반 정맥혈전색전증 예방 간호실무지침 개정
Updates of Evidence-Based Nursing Practice Guideline for Prevention of Venous Thromboembolism
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목적: 본 연구는 기존에 발표된 정맥혈전색전증(VTE) 예방을 위한 간호실무지침을 개정하는 것을 목적으로 한다. 방법: NICE(National Institute for Health and Care Excellence)와 SIGN(Scottish Intercollegiate Guidelines Network)에서 개발한 매뉴얼과 Handbook for Clinical Practice Guideline Developer Version 10의 가이드라인에 따라 개정하였다. VTE 예방간호실무지침은 16개의 영역, 46개의 하위 영역, 216개의 권장안으로 구성되었다. 각 영역의 권장안은 일반 문제 4개, 위험 및 출혈 요인 평가 8개, 정맥혈전색전증 예방 중재 18개, 기계적 중재 36개, 내과적 중재 36개, 암환자 25개, 임신 13개, 수술환자 8개, 흉부 및 심장외과 7개, 정형외과 16개, 두개골 및 척추 수술 10개, 혈관에 대한 수술 5개, 기타 수술 13개, 교육 및 정보 3개, 문서 및 보고서 2개이었다. 이들 권고안의 근거수준은 미국감염학회(IDSA) 등급체계에 따라 1단계 32.1%, 2단계 51.8%, 3단계 16.1%였다. 총 112개의 새로운 권장 사항이 개발되었으며 49개의 이전 권장 사항이 삭제되었다. 결론: 개정된 정맥혈전색전증 예방을 위한 간호실무지침은 국내 정맥혈전색전증 예방을 위한 근거중심 간호실무지침으로서의 역할을 할 것으로 기대된다. VTE 예방의 효과를 개선하기 위해 이 지침을 전국의 임상 간호 환경에 확산할 것을 제언한다.
Abstract
Purpose: This study aimed to update the previously published nursing practice guideline for prevention of venous thromboembolism (VTE). Methods: The guideline was updated according to the manuals developed by National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), and a Handbook for Clinical Practice Guideline Developer Version 10. Results: The updated nursing practice guideline for prevention of VTE was consisted of 16 domains, 46 subdomains, and 216 recommendations. The recommendations in each domain were: 4 general issues, 8 assessment of risk and bleeding factors, 5 interventions for prevention of VTE, 18 mechanical interventions, 36 pharmacological interventions, 36 VTEprevention starategies for medical patients, 25 for cancer patients, 13 for pregnancy, 8 for surgical patients, 7 for thoractic and cardiac surgery, 16 for orthopedic surgery, 10 for cranial and spinal surgery, 5 for vascular surgery, 13 for other surgery, 3 educations and information, and 2 documentation and report. For these recommendations, the level of evidence was 32.1% for level I, 51.8% for level II, and 16.1% for level III according to the infectious diseases society of America (IDSA) rating system. A total of 112 new recommendations were developed and 49 previous recommendations were deleted. Conclusion: The updated nursing practice guideline for prevention of VTE is expected to serve as an evidence-based practice guideline for prevention of VTE in South Korea. It is recommended that this guideline will disseminate to clinical nursing settings nationwide to improve the effectiveness of prevention of VTE practice.
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