Objective To formulate standardized procedure of incontinence-associated dermatitis (IAD) in ICU and evaluate the outcomes.Methods The standardized procedure of IAD,including training program,risk assessment workflow,grading intervention process and physician-nurse communication style,was formulated based on the best evidences combined with the experience of clinical team and patients needs.Then,IAD standardized procedure was applied to the quality improvement project of ICU,and the incidence and severity degrees of IAD were evaluated.Results The total incidence of IAD was on the decline before,during and after improvement,22.43％(96/428),16.06％(71/442),13.90％(51/367),the difference was statistically significant (x2=11.06,P＜ 0.01).The incidence of severe IAD was 2.57％ (11/428),0.45％ (2/442),0.27％(1/367) before,during and after improvement,the difference was statistically significant (x2=11.67,P＜0.01).The incidence of fungal infection was 5.14％ (22/428),2.04％ (9/442),1.63％ (6/367) before,during and after improvement,the difference was statistically significant (x2=10.53,P ＜ 0.01).Conclusions Application of evidence-based practice with specification of IAD,can improve nursing quality and promote patient safety.

Objective:To explore the effect of nursery-led multidisciplinary evidence-based intervention in the management of anticoagulation in inpatients with oral warfarin.Methods:In this study, Quasi-experimental research was adopted. 478 patients were selected as the baseline review group on August 1st, 2019 and December 31th, 2019, and 494 patients were selected as the after-effect evaluation group on February 1st, 2020 and May 31th, 2020 in cardiovascular surgery and cardiovascular medicine. Established a multidisciplinary team, according to theoretical framework basing on the evidence of continuous quality improvement model, combining with evidence and clinical practice to develop evidence-based solutions, the comparison of international normalized ratio (INR) before and after the intervention in the percentage of time in therapeutic range (TTR) and anticoagulant related the incidence of complications.Results:Before and after the multidisciplinary evidence-based intervention, the mean TTR of the patients were (51.67±31.04)% and (64.34±26.37)%, with statistically significant differences ( tvalue was 6.958, P<0.01); the incidence of bleeding and embolization was not statistically significant ( χ 2values were 0.294 and 0.268, P>0.05). Conclusion:Nursing-led multidisciplinary evidence-based interventions can improve the intensity and stability of oral warfarin anticoagulant therapy in inpatients.

Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

Objective This paper summarizes the safety management of 13 ARDS patients resulting from influenza A (H7N9) virus infection with daily awakening during analgesia and sedation treatment.Methods Safety management was given to 13 ARDS patients with influenza A (H7N9) virus infection during analgesia and sedation treatment.Results No serious complications or adverse events occurred during interruption period of analgesia and sedation.Conclusions To give safety management of daily awakening to patients with influenza A (H7N9) virus infection during analgesia and sedation treatment can increase treatment effect and facilitate early recovery of patients.

Objective To analyze the common causes leading to lung infection following renal transplantation and provide targeted preventive measures to reduce the incidence of lung infection.Methods The clinical data of 561 recipients who underwent renal transplantation from January 2006 to February 2011 were retrospectively analyzed.The recipients were divided into two groups:group Ⅰ,from January 2006 to December 2009 (n =416) ; group Ⅱ,from January 2010 to February 2011 (n =145).The causes possibly leading to lung infection which took place 3 days before the appearance of the clinical symptoms were offered by the patients who suffered lung infection of group Ⅰ.And then the causes were summarized and analyzed to formulate the specific and comprehensive measures to prevent the infection.Finally the measures were applied to recipients in group Ⅱ from January 2010.After applying the measures for 14 months,the incidence of lung infection in group Ⅱ was counted and compared with that in group Ⅰ to see the preventive effect.Results There were 58 cases of lung infection in group Ⅰ (58/416,13.9％) and 12 cases in group Ⅱ (12/145,8.3％). There was significant difference in the incidence of lung infection between two groups (x2 =4.0361,P＜0.05).All of the recipients with lung infection were hospitalized in six months after the transplantation.The causes leading to lung infection of 58 cases in group Ⅰ were as follows:6 cases due to being excessively tired,3 cases due to guest visiting,12 cases due to abrupt change of weather,9 cases due to exposure to public place,8 cases due to returning to hospital,6 cases due to close contact with children,5 cases due to close contact with animals,and the other 9 cases without specific causes found.Conclusion The incidence of lung infection following renal transplantation can be notably reduced by the application of targeted and concrete health propaganda education and preventive measures based on analysis on the specific causes of infection.

Objective To evaluate the effects of exercise therapy for patients with difficult weaning using mechanical ventilation.Methods A total of 63 patients with difficult weaning using mechanical ventilation were randomly divided into the experimental group(33 cases) and the control group(30 cases).The patients in the control group received routine respiratory care,however,the patients in the experimental group received gradual and individualized exercise therapy according to patients' condition and physical strength.The items such as the tidal volume,respiratory rate,PaO2/FiO2 were compared between two groups.Results Compared with the control group,the tidal volume,respiratory rate,PaO2/FiO2 and the score of APACHE Ⅱ were better in the experimental group on the 21th and 28th day after mechanical ventilation,the heart rate was better in the experimental group on the 28th day after mechanical ventilation.In addition,the duration of mechanical ventilation and ICU hospitalization was shorter in the experimental group.But the rate of complications showed no significant difference.Conclusions Exercise therapy has a positive effect on patients with difficult weaning using mechanical ventilation.

Objective To explore the intervention mechanism of Yiqi Huoxue Fang on deep venous thrombosis ( DVT) of rabbit model,by observing its effects on serum t-PA and PAI-1,D-D,NO,CRP,PT,blood rheology and vascular pathology. Methods Fifty New Zealand rabbits were randomly selected.Ten rabbits were served as blank control group.DVT animal models were established in the remaining 40 rabbits, which were randomly divided into model control group, Yiqi Fang group, Huoxue Fang group and Yiqi Huoxue Fang group (n=10 each group).The changes of serum t-PA,PAI-1,D-D,NO,CRP,PT and pathological changes of blood vessel were observed after 7-days treatment. Results As compared with the blank control group, the serum t-PA,PAI-1,D-D,CRP and PT were significantly increased in the model control group,Yiqi Fang group,Huoxue Fang group and Yiqi Huoxue Fang group (all P<0.01); NO was decreased (P<0.01 or P<0.05 in model control group,Yiqi Fang group and Huoxue Fang group;P>0.05 in Yiqi Huoxue Fang group vs.the blank control group).As compared with model control group,the serum t-PA,NO,D-D increased,PAI-1 and CRP value reduced in Yiqi Huoxue Fang group and Huoxue fang group (P<0.01 or P<0.05).As compared with Yiqi Huoxue Fang group,serum t-PA in both Yiqi Fang group and Huoxue Fang group was significantly lower (P<0.01 and P<0.05) ,other indexes were significantly higher than that in Yiqi Huoxue Fang group (serum PAI-1,P<0.01 in Yiqi Fang group;NO and D-D,P<0.01 or P<0.05 in Yiqi Fang group;CRP value,P<0.01).Vascular pathology showed that blood vessels,especially vascular endothelia,of Yiqi Huoxue Fang group were most slightly injured,with slightest infiltration of inflammatory cells. Conclusion Yiqi Huoxue Fang can prevent DVT through regulating t-PA and PAI-1,keeping the fibrinolytic system function at a relatively high level,protecting vascular intima and relieving the inflammation in venous thrombosis.

Objective To examine the benefits of ECMO for potential organ donors with hemodynamic instability after brain death.Methods Three brain-dead potential donors who presented with hemodynamic instability despite maximal medical management,finished a declaration of brain death,that were supported by extracorporeal circulation membrane oxygenation (ECMO).Results Donor organs,including six kidneys,and two livers,were harvested from the three donors under ECMO support,leading to 8 successful transplantations.The organs functioned well and the recipients made full recoveries.Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement,providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.

This paper reviewed the present nursing manager succession planning at home and abroad, covering the succession standard of nursing managers, the content and form of pre-job training, and the evaluation tool of management ability. These efforts aim to provide references for the construction of nursing management talents teams in China.