AIDET沟通联合六西格玛管理在改善床边快速血糖疼痛感中的应用

周玉琴　　徐亚青　　郑建娣　　陈芳芳　　王芳

[关键词] AIDET沟通;六西格玛管理;床边快速血糖;疼痛

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）20-0170-05

Application of AIDET communication combined with 6 Sigma management in decreasing the pain in rapid detection of blood glucose at bedside

ZHOU Yuqin   XU Yaqing   ZHENG Jiandi   CHEN Fangfang   WANG Fang

Department of Endocrinology， Zhejiang Integrated Traditional and Western Medicine Hospital， Hangzhou   310003， China

[Abstract] Objective To observe the application effect of AIDET communication combined with 6 Sigma management in decreasing the pain in rapid detection of blood glucose at bedside. Methods A total of 94 diabetic patients admitted to the department of endocrinology of our hospital from January to June 2019 were selected. AIDET communication mode combined with 6 Sigma management method were used as an improvement tool. Before improvement， patients were included in the control group（n=48）， while after improvement， patients were included in the observation group（n=46）. The instant pain score， pain score after 24 hours， pain score of left hand and right hand， pain score of each finger between the two groups， and change of subjective data before and after improvement were compared. Results The NRS scores of patients in the observation group were lower than those in the control group instantly after rapid detection of blood glucose at bedside and after 24 hours， and the differences were statistically significant（P<0.05）. Compared with that of at beside， there were significant differences in the NRS scores between the left hand and right hand in both the two groups after 24 hours（P<0.05）， and the NRS score in the observation group after 24 hours was lower than that in the control group， with significant differences（P<0.05）. There were significant differences in the the proportion of knowledge， no idea of subjective information between the two groups （P<0.05）. Conclusion Using AIDET communication combined with 6 Sigma management mode to decrease the pain in rapid detection of blood glucose at bedside can effectively reduce the pain of patients， which embodies the concept of humanistic care in high-quality nursing.

[Key words] AIDET communication; 6 Sigma management; Rapid detection of blood glucose at bedside; Pain

血糖監测是糖尿病管理的五架马车之一，其监测结果有助于评估糖尿病患者糖代谢紊乱的程度，便于医生制订合理的降糖方案，同时在治疗过程中及时反映降糖治疗的效果，为医生及时调整治疗方案提供依据[1]。医院内血糖监测主要通过快速、简便、准确的床边快速血糖检测（Point of care testing，POCT）[2]实现，其中手指部血流丰富，毛细血管全血采取与静脉血浆采血血糖值结果误差不大，其结果能较准确且快速反映血浆葡萄糖水平[3]，被认为是最理想的末梢采血部位。患者入院时一般会采取胰岛素强化降糖治疗，《国家基层糖尿病防治管理指南（2018）》[4]指出，如果糖化血红蛋白未达标，建议使用胰岛素治疗的患者每天监测4～7次，而不使用胰岛素治疗的患者每周测3 d血糖，5～7次/d，建议涵盖空腹、三餐前后、睡前，如遇特殊情况，可增加血糖监测次数。患者监测血糖次数频繁，指尖处末梢神经分布密集，疼痛的敏感性较强，频繁的指尖穿刺采血给患者带来生理痛苦和心理负担，导致患者对血糖监测产生恐惧感，从而影响血糖监测的依从性[5]。目前临床上使用的血糖检测方案有毛细血管血糖监测、持续葡萄糖监测、瞬感动态血糖监测、糖化血红蛋白、糖化白蛋白等[6-7]，但是从费用、准确性等方面考虑，临床上仍首选POCT，因此寻找有效的方案帮助住院糖尿病患者减轻床边快速血糖疼痛感，尤为迫切。本研究运用AIDET（Acknowledge问候→Introduce自我介绍→Duration过程→Explanation解释→Thank you感谢）沟通模式联合六西格玛管理方法对原血糖监测流程进行优化，制订了改良版的手指轮换法，并在临床应用，取得了较好的效果，现报道如下。