专家咨询法建立患者安全管理的心理评估、干预以及心理危急值报告体系

Reporting System of Patients' Safety Management Established By the Delphi Method about Psychological Evaluation, Intervention and the Psychological Critical Value

  • 摘要:
      目的  探讨通过专家咨询法建立患者安全管理的心理评估、干预以及心理危急值报告体系的可行性。
      方法  结合文献检索,采用改良德尔菲法对筛选的14项患者安全管理的心理评估与干预指标进行讨论。向43位专家发放问卷,征求心理评估维度的意见和各维度量化评分、评估方法、评估分级、评估原则等建议。根据专家意见,计算专家权威系数及各指标评分均值和变异系数,初步构建患者安全管理的心理评估、干预及心理危急值报告体系,并对该体系的可行性进行讨论。
      结果  共经6次专家讨论,并向专家发放问卷43份,回收问卷35份(81.4%)。在14项评估指标重要性和紧迫性的评价中,专家积极性系数为0.97,重要性Kendall W协调系数为0.241(P<0.001),紧迫性Kendall W协调系数为0.283(P<0.001)。专家权威系数为0.68~0.74。经专家讨论,认可“自杀风险”“抑郁”“焦虑”“治疗期望过高”“医患关系期待”“兴奋激越”“幻觉”“妄想”“谵妄”“酒瘾”“吸毒”“医生职业耗竭”12项指标纳入患者安全管理的心理评估体系;评估方法应包括患者自评和医护观察。专家认为应对患者安全管理的心理评估结果进行分级干预,最高预警级别按照危急值的标准进行衡量和设置。建立患者安全管理的心理评估指标及相应干预措施体系具有可行性。
      结论  患者安全管理的心理评估指标和分级干预体系已通过专家咨询法建立初步框架,在此基础上可进一步制订细则,并进行试实践。

     

    Abstract:
      Objective  To explore the feasibility of establishing a reporting system of patients' safety management by the Delphi method about psychological evaluation, intervention and the psychological critical value.
      Methods  Based on literature review, we used the modified delphi method to study 14 indexes of safety management of patients in terms of psychological evaluation and intervention. Questionnaires were sent to 43 experts to solicit the opinions about patients' safety management regarding psychological assessment dimensions, suggestions on quantitative score, assessment method, assessment grading, and assessment principles of each dimension. According to the experts' opinion, the average value and the coefficient of variation of each index were calculated to form the preliminary construction of a reporting system of patients' safety management in terms of psychological evaluation, intervention and psychological critical value, and the feasibility of the system was discussed.
      Results  After six rounds of discussion of the experts, 43 questionnaires were sent to experts, and 35 ones (81.4%) were returned. In the evaluation of the importance and urgency of the 14 assessment indicators, the coefficient of experts' participation was 0.97; the Kendall W coefficient of importance was 0.241 (P < 0.001), the coefficient of the urgency was 0.283 (P < 0.001). The authority coefficient of experts ranged from 0.68 to 0.74. After the discussion of the experts, 12 indicators were approved to be included in the psychological evaluation system about patients' safety management: suicide risk, depression, anxiety, excessive treatment expectation, expectation of doctor-patient relationship, agitation, hallucination, delusion, delirium, alcohol addiction, drug abuse and occupational exhaustion. The evaluation method should include patients' self-evaluation and medical observation. According to the consulting meeting of the experts, graded intervention should be performed in the results of psychological assessment of patients' safety management, and the highest warning level should be measured and set according to the standard of the critical value. The expert-group considered that it is feasible to establish psychological evaluation indexes and corresponding intervention measures.
      Conclusions  The system framework of indicators of psychological assessment and hierarchical intervention system for the management of patients' safety has been established by the delphi method. On this basis, detailed methods and tools can be further formulated and trial practice can be carried out.

     

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