肿瘤患者门诊化疗流程分析与瓶颈探讨

目的:探索肿瘤患者门诊化疗流程中存在的问题及其可能的原因,为门诊化疗的流程重组奠定基础。方法:参照业务流程重组(business process reengineering,BPR)的理论和方法,采用定性与定量研究相结合的方法对现有门诊化疗流程进行分析。结果:绘制了门诊化疗流程图,较深入地了解了该医院门诊化疗流程的现状、存在问题及可能的原因。结论:现有门诊化疗流程存在很大的重组空间。     

Human cell culture process capability: a comparison of manual and automated production

Cell culture is one of the critical bioprocessing steps required to generate sufficient human‐derived cellular material for most cell‐based therapeutic applications in regenerative medicine. Automated cell expansion is fundamental to the development of scaled, robust and cost effective commercial production processes for cell‐based therapeutic products. This paper describes the first application of process capability analysis to establish and compare the short‐term process capability of manual and automated processes for the in vitro expansion of a selected anchorage‐dependent cell line. Estimates of the process capability indices (Cp, Cpk) have been used to assess the ability of both processes to consistently meet the requirements for a selected productivity output and to direct process improvement activities. Point estimates of Cp and Cpk show that the manual process has poor capability (Cp = 0.55, Cpk = 0.26) compared to the automated process (Cp = 1.32, Cpk = 0.25), resulting from excess variability. Comparison of point estimates, which shows that Cpk < Cp, indicates that the automated process mean was off‐centre and that intervention is required to adjust the location of the process mean. A process improvement strategy involving an adjustment to the automated process settings has demonstrated in principle that the process mean can be shifted closer to the centre of the specification to achieve an estimated seven‐fold improvement in process performance. In practice, the 90% confidence bound estimate of Cp (Cp = 0.90) indicates that that once the process is centred within the specification, a further reduction of process variation is required to attain an automated process with the desired minimum capability requirement. Copyright © 2009 John Wiley & Sons, Ltd.     

咽炎口含片的纯化工艺研究

目的:比较醇沉法和壳聚糖絮凝法用于咽炎口含片浸膏纯化的优劣.方法:应用醇沉法进行咽炎口含片浸膏的纯化,以浸膏得率及大黄素含量为指标,对药液的浓度及加入乙醇后浓度[1]进行了优选,壳聚糖絮凝法以浸膏得率和大黄素含量为指标,对壳聚糖的加入量进行了优选,并将两者进行比较.结果:醇沉法与壳聚糖絮凝法比较,大黄素保留率分别为97.61%,81.57%,浸膏得率分别为11.91%,19.21%.结论:醇沉法能最大程度地去除杂质而且最大程度地保留有效成分,壳聚糖絮凝法去除杂质不多,而且有效成分有一定损失.醇沉法用于咽炎口含片的纯化优于壳聚糖絮凝法.     

流程再造在产房中的实施与效果评价

目的探讨流程再造在产房护理中的应用效果。方法调查产房护理工作中存在的问题，根据调查结果将对孕妇入院及检查流程、陪产服务流程、护理文书记录流程、产房急救抢救流程等进行再造，并将再造流程前后的孕妇入院办理时间、孕产妇的满意率、护理文书记录缺陷率、新生儿抢救成功率等进行比较。结果孕妇入院及检查时间由原来的78min减少到40min，孕产妇满意率由原来的91．60％上升到98．30％，护理记录缺陷由原来的年18起下降到4起，新生儿窒息5min抢救成功率由81．63％上升到91．30％。结论产房护理流程的再造，提高了产房的服务质量和工作效率，减少了护理风险的发生。     

流程管理在手术室管理中的应用

目的探讨流程管理在手术室管理中应用的实施效果。方法将手术室的全面质量管理与业务流程管理有机地结合起来，以核心流程、辅助流程和质控流程为指导，对现有的流程执行过程进行监控，并不断改进。结果提高了手术室护理工作效率和质量，患者满意度由95％上升至98％。手术配合熟练有序，手术医生的满意度由86％上升至95％。手术时间缩短，医疗费用降低，护理缺陷明显减少。结论流程管理可以提高手术室护理工作效率和质量。     

椎体棘突四条线法在判定腰椎棘突偏歪中的应用

目的:为明确椎体棘突四条线法对腰椎棘突偏歪的诊断价值,探讨腰痛患者腰椎棘突偏歪的变化规律。方法:采用“椎体棘突四条线法”在89例腰痛患者的腰椎正位X线片上,观察测量腰椎棘突的变化规律。结果:在89例腰痛患者中,腰椎棘突偏歪的占80例,无改变者仅9例;偏歪的棘突以L2最多,L5最少;侧线的位置改变可见“成弧”和“成角”两种变化;腰椎棘突顶线偏歪值差异有显著性意义(P=0.002),以L1最明显,L2最小。腰椎棘突尖线偏歪值差异无显著性意义(P>0.05)。结论:椎体棘突四条线法是触诊有无棘突偏歪的有效手段之一;腰椎棘突偏歪以L2最多,但偏歪程度以L1最为明显。     

门诊流程优化的研究与分析

目的分析门诊流程存在的问题,为门诊流程优化的必要性提供依据。方法调查现有门诊流程的现状,抽取500例门诊患者在收费处缴费的相关数据,并对一周内每天的挂号量及收费处打印的发票数按时间段进行分析统计。结果门诊患者就诊需要多次排队等候,高峰期排队等待时间长,门诊挂号的高峰期为每天的7:00～10:00,收费处打印发票的高峰期在每天的8:00～11:00。结论医院制定相应的策略进行门诊流程优化十分必要,基于一卡通平台通过信息化手段进行门诊流程优化是一种有效方式。     

新清洗流程在全自动喷淋清洗机清洗器械中的应用

目的供应室在无水处理装置的条件下，探讨为全自动喷淋清洗机建立一个有效的清洗流程。方法在清洗机的同定清洗流程上增加清洗机以及器械的除水垢程序，和原始的清洗程序做清洗效果的对比，观察喷淋管道的堵塞情况。结果新清洗流程清洗器械洁净度达到97．23％，清洗效果优于原清洗流程；清洗机喷淋孔的堵塞问题也得到解决。结论在医院供应室没有配备水质软化装置，使用全自动喷淋清洗机清洗器械时，可增加除水垢流程，保证清洗质量。     

Multiple Mini Interviews as Part of Holistic Admissions Review for Nursing Schools

Studies in the nursing admission process have demonstrated the benefits of holistic admissions review. Literature regarding the use of multiple mini-interviews (MMI's) as it relates to the holistic admissions process has been minimally addressed in nursing literature, although widely described in medical education journals. This article will describe the change in the interview process from unstructured group interviews to a structured MMI process for California Baptist University (CBU) College of Nursing, Riverside, CA, and how changes were beneficial for the institution's holistic admissions review process. Many activities were included in this holistic interview process to capture the unique attributes and strengths of each applicant. It was discovered that the change from the unstructured group interview process to the holistic MMI approach helped to identify strong candidates who align with the mission and values of California Baptist University College of Nursing.     

Comparison of paper-based and electronic data collection process in clinical trials: Costs simulation study

An alternative to clinical trial paper-based data collection (PDC) is internet based electronic data collection (EDC), where the investigators over the internet enter data directly in the electronic database by themselves. In our study we considered clinical trial as a business process. Our objective was to model PDC and EDC process and to estimate the difference of the costs of PDC and EDC process for a sample clinical trial based on these models.We used Extended Event-driven Process Chains (eEPC) modeling technique to model PDC and EDC process. In order to evaluate the costs of the processes we assigned costs functions to each process function which appears in the model. The parameters which appear in these functions include efforts, staff prices and data quality parameters. We estimated the values of all these parameters and performed costs calculations for a sample clinical trial.Through an analysis and modeling efforts we identified sub-processes which contain main differences affecting duration and costs of the PDC and EDC process: data gathering at the research center; monitoring; and data management. The most significant model difference between PDC and EDC process appeared in data management sub-process. For the sample clinical trial considered in our simulation study and our parameters estimations the EDC process decreased data collection costs for 55%. For different scenarios of parameters variations we show that the EDC process may bring from 49% to 62% of savings when compared to PDC process.     

新清洗流程在全自动喷淋清洗机清洗器械中的应用

目的 供应室在无水处理装置的条件下,探讨为全自动喷淋清洗机建立一个有效的清洗流程. 方法在清洗机的固定清洗流程上增加清洗机以及器械的除水垢程序,和原始的清洗程序做清洗效果的对比,观察喷淋管道的堵塞情况.结果 新清洗流程清洗器械洁净度达到97.23%,清洗效果优于原清洗流程;清洗机喷淋孔的堵塞问题也得到解决.结论 在医院供应室没有配备水质软化装置,使用全自动喷淋清洗机清洗器械时,可增加除水垢流程,保证清洗质量.     

流程管理在肝癌患者行PD-1单抗治疗中的应用探讨朱燕1 俞静娴1 周海英1 王燕1 孙丽骏1

目的 探讨流程管理对优化肝癌患者PD-1治疗护理流程的效果。方法 成立流程管理小组,将2019年1-6月流程管理改善前收治的66例PD-1治疗患者与2019年7-12月改善后的62例PD-1治疗患者进行比较,比较流程管理改善前后患者的住院时间及患者的满意度情况。 结果 流程改善后,观察组住院时间显著优于对照组(P<0.001),患者的满意度大于95%。结论 运用流程管理,可有效减少患者住院时间,改善患者的就医感受,减轻医护人员的压力。     

血液分析方法的过程能力与性能及其室内质量控制方法的研究

目的通过研究临床血液常用指标的过程能力与性能,为血液指标检测方法过程能力与性能的改进以及不同项目质控方案的设计提供重要依据,同时能有效降低血液质控经济成本。方法运用两个水平的未定值全血质控品检测8个常用血液指标,依据美国CLIA'88的PT质量要求确定各血液指标的TEa,计算常用血液项目的过程能力与性能指标,同时作过程能力分析图,6σ水平方法决定图,功效函数图及OPSpecs图。结果通过血液指标过程能力与性能的研究获得了常用血液指标的过程能力与性能指数,建立了合适的血液指标检测方法的质控方法;通过查找并解决一些过程能力与性能不恰当的方法的原因,进行持续质量改进,提高各血液项目检测方法的过程能力,达到既保证质量又降低质控成本的目的。结论临床血液常用指标过程能力与性能的研究是其过程能力与性能改进及质量控制方案设计的基础,其方法适用于所有临床实验室定量指标的过程研究,值得推广应用。     

Using continuous process improvement methodology to standardize nursing handoff communication

The purpose of this article was to describe the use of continuous performance improvement (CPI) methodology to standardize nurse shift-to-shift handoff communication. The goals of the process were to standardize the content and process of shift handoff, improve patient safety, increase patient and family involvement in the handoff process, and decrease end-of-shift overtime. This article will describe process changes made over a 4-year period as result of application of the plan-do-check-act procedure, which is an integral part of the CPI methodology, and discuss further work needed to continue to refine this critical nursing care process.     

Managing recruitment and retention problems: an application of the marketing process

This article helps the nurse administrator apply the marketing process to manage recruitment and retention problems. The marketing process is presented through analogy to the comparable phases of the nursing process. A case study of a difficult recruitment problem in an intensive care unit is used to highlight steps in the process. Marketing techniques and specific situation analysis are emphasized.     

Student stakeholders impact redesign for management practicum

Healthcare educators are continually challenged to respond to societal needs as they engage in the dynamic and ongoing process of curriculum redesign.The expectations of a group of stakeholders in the process, our students, were obtained through a survey process over time and led to change in the management and leadership practicum.The authors describe the survey process and its outcomes.     

Failure mode and effect analysis: a technique to prevent chemotherapy errors

Complex, multidrug chemotherapy protocols commonly are administered to patients with cancer. At every step of the chemotherapy administration process, from the point that chemotherapy is ordered to the point that it is infused and beyond, potential for error exists. FMEA, a proactive process that promotes systematic thinking about the safety of patient care, is a risk analysis technique that can be used to evaluate the process of chemotherapy administration. Error prevention is an ongoing quality improvement process that requires institutional commitment and support, and nurses play a vital role in the process.     

新护士培训流程再造在风险管理中的应用效果

目的探讨新护士培训流程再造在风险管理中的应用效果。方法评估分析原有新护士培训流程,找出存在的瓶颈问题,对不合理的流程进行重组再造。比较流程再造前后缺陷发生率、新护士独立上岗时间、患者或家属满意度。结果流程再造后缺陷与纠纷的发生率降低,由再造前的7.84%下降到再造后的1.83%;新护士上岗时间平均缩短(4±0.22)周,患者或家属的满意度提高了10.19%(均P<0.05)。结论培训流程再造使新护士培训更加规范、有效,实现了护理质量持续改进。