六西格玛质量管理方法在择期手术患者术前准备中的应用

术前准备质量是整个围术期质量的基础,直接影响手术治疗的成败。因此,如何降低术前准备的缺陷,提高患者的手术安全与护理人员的满意度,是护理管理者应关注的的问题。六西格玛质量管理方法是一种按照定义、测量、分析、改进、     

综合医院护士规范化培训质量调查分析

目的：调查规范化护士培训质量,了解受训护士对培训工作的感受及需求。方法：采取自制问卷,分20个条目对接受规范化培训的320名护士进行问卷调查。采用5级评分法进行质量评价。结果：医院30个科室培训质量平均得分为82．9分,在调查条目中得分最高的前三位分别是：科室护士长支持、临床护理老师的专业基础理论和专科护理理论方面（得分：4．48、4．44、4．34）。得分最低的后三位分别是：培训科室其他护理老师的教学意识、临床护理老师因材施教和带教老师对学员工作的及时肯定（得分：3．55、3．75、3．88）。结论：医院护士规范化培训管理工作有待进一步完善和加强,护士规范化培训对新进护理人员专业能力培养具有积极的促进作用。加强护理部对临床科室护士培训的规范化管理,强化科室护理人员教育意识和教学能力是保证科室规范化护士培训质量的关键。     

Quality Improvement: Implementing Nurse Standard Work in Emergency Department Fast-Track Area to Reduce Patient Length of Stay

IntroductionThe average length of stay of a fast-track area of a large urban hospital was excessively long, which affected the patient experience and the rate at which patients left without being seen. One approach to reducing average length of stay is to create nurse standard work. Nurse standard work was a defined set of process and procedures that reduce variability within a nurse’s workflow.MethodsNurse standard work was created by a team of nurses assisted by management engineering using lean methodology and A3 problem solving. Data were gathered about average length of stay and left without being seen for patients in the emergency department fast-track area of an urban emergency department from October 2018 to June 2020. This period includes 5 months before the intervention start, 4 months during nurse standard work implementation, 9 months using nurse standard work before the unit was repurposed during COVID-19, and 3 months during COVID-19.ResultsNurse standard work helped reduce average length of stay in the emergency department fast-track area from 205 minutes before project initiation to 150.4 minutes in the 7 months after implementing nurse standard work. The time spent walking for supplies was reduced from 422 and 272 seconds before nurse standard work to 25 and 30 seconds for the nurse technician and nurse, respectively, after nurse standard work. Left without being seen was decreased from 4.7% in October of 2018 to 0.7% by March of 2020.DiscussionNurse standard work reduced the amount of time that nurses spent performing support tasks and reduced delays in providing patient care, which then allowed more time for nurses to interact directly with patients. Nurse standard work provides a clear task sequence that eliminates delays in treating patients, but it also allows for fast identification of delays that do occur and simplifies problem solving to eliminate reoccurrence of delays. Therefore, nurse standard work is an essential component of efforts to reduce patient average length of stay in health care processes and reduce left without being seen to the national standard of less than 2%.     

康复医院护士生活质量和应对方式相关性研究

目的 探讨康复医院护士的生活质量、应对方式及两者之间的关系.方法采用方便抽样的方法,应用世界卫生组织生活质量量表(WHOQOL-100)和简易应对方式问卷对203名康复医院护士进行调查.结果与结论护士的心理领域、独立性领域、社会关系领域和精神支柱个人信仰领域的自我评价明显高于常模(P＜0.01);生理领域、环境领域的评价明显低于常模(P＜0.01).护士较多采用积极应对方式.护士的生理状况影响其对应对方式的选择.     

Investigation of Unplanned Absenteeism of Nurses Working in a University Hospital: Cross-Sectional Study

AimThis study aimed to determine the tendencies and causes of unplanned absenteeism of nurses and the experiences of clinical nurse managers on this subject.BackgroundAbsenteeism is a common way for an employee to distance themselves from their job. Unplanned absence is defined as the employee's inability to come to work without the employer's consent.MethodsIn the retrospective analysis of the archived data on nurse absenteeism, a qualitative interview technique was used in the data collected from nurse unit managers using the quantitative method, semistructured interview form.ResultsChildren's problems, special reasons, and medical diseases are among the most common reasons for nurses' unplanned absenteeism. As per the nurses in charge, the tendency of unplanned absenteeism in their units is not high; in addition, motivation can reduce the tendency of unplanned absenteeism.ConclusionsIt was emphasized that in absentee management, interteam communication and regulations aimed at increasing the employee's motivation in the work environment are important. Clinical manager nurses can reduce the frequency of unplanned absenteeism by determining the factors that push nurses working in the clinic to unplanned absenteeism for motivational reasons. This study will guide the preparation of programs to improve the causes of unplanned absences in their clinics.     

持续质量改进在放射诊断科护理管理中的应用

目的 探讨持续质量改进在放射诊断科护理管理中的应用方法及效果.方法 2010年底,第三军医大学大坪医院野战外科研究所放射诊断科开始对护理管理进行持续质量改进,具体措施包括健全放射诊断科护理质量层级岗位管理模式;明确岗位定义和任职资格;完善质量控制的制度、指标、标准、操作规范和流程,确定质量控制形式,并将质量控制与绩效考核相结合,形成符合放射诊断科护理发展的质量控制机制等.结果 2012年,放射科实施持续质量改进后,与实施前(2010年)比较,护理质量检查的相关指标均有明显改善(均P＜0.01).结论 持续质量改进应用于放射诊断科护理管理中能够全面提升护理质量,对推动放射科护理工作发展具有重要的指导意义.     

Assessing Part-Time Nursing Faculty Needs: A Needs Assessment for a Quality Improvement Project

Part-time nursing faculty need supports to be successful educators. A needs assessment using qualitative and quantitative data was undertaken as a first step of a quality improvement (QI) project aimed to support part-time faculty and ultimately improve teaching effectiveness. The needs assessment provided essential information about strengths and areas for improvement within our department. A strength in this department was the role of course lead, two areas for improvement include development of a department level orientation and online or written resources. This report can serve as a model for other department on how to use local data to design interventions that reflect the unique needs of their department.     

Nurses Leading Safe Infant Sleep Initiatives in the Hospital Setting

Every day, 10 otherwise healthy infants die from sleep-related deaths in the United States. These deaths, termed sudden unexpected infant death, remain the leading cause of post-neonatal death in the United States despite known modifiable risk factors and prevention recommendations. In birthing hospitals, many parents report being given incorrect and sometimes no information about infant sleep safety, which creates immediate and long-term safety concerns. In this article, we provide an overview of sudden unexpected infant death, including sudden unexpected postnatal collapse, and the latest safe sleep recommendations from the American Academy of Pediatrics. We also offer practical guidelines for nurses—those working at the bedside and those in leadership positions—who may be seeking to improve the quality of infant sleep practices in their organizations.     

Learning What is Important: A Quality Improvement Initiative to Enhance Patient-Centred Care in Home Care

Aim: A quality improvement initiative was undertaken to increase the utilization of a new tool designed to facilitate the provision of patient-centred care in the homecare setting. Methods: The tool, entitled Life Through My Eyes (LTME), is completed voluntarily by the patient or a family member. In order to personalize the patient’s care, it captures information about what is important to the patient and ways to make the patient feel comfortable. Patients and families played an integral role in the Plan, Do, Study, Act cycle used to introduce the tool into practice. Results: Patients and family members (n?=?19) and personnel (n?=?7) offered feedback that directed revisions to the tool’s format, and additional strategies were implemented to increase personnel’s familiarity with the tool. Conclusion: Improvements in the format and in the implementation process for the LTME tool were identified through a QI initiative, and the revised tool has now been distributed broadly.     

Curricular Revision to Increase Use of Quality Improvement Principles in Doctor of Nursing Practice Projects

BackgroundA gap was identified related to students’ use of quality improvement (QI) methodologies in their final project, so a curricular change was made to incorporate a health care QI methods course in the curriculum.MethodsWe compared the use of SMART (specific, measurable, achievable, relevant, and time-bound) aims and QI evaluation methodologies in doctor of nursing practice (DNP) project proposals in 2 cohorts before and after the curriculum change.ResultsA total of 88 DNP proposals were evaluated.ConclusionIncluding a QI course increased the use of SMART aims but did not influence the use of QI methodologies. Future interventions will target faculty development related to QI.     

Systematic Review to Develop the Clinical Practice Guideline for the Use of Capnography During Procedural Sedation in Radiology and Imaging Settings: A Report of the Association for Radiologic & Imaging Nursing Capnography Task Force

Advances in radiology and imaging technologies and the emergent scope of practice have led to the capacity to provide services to a growing population of high-acuity patients with comorbid conditions. These procedures are often performed with the radiology nurse administering procedural sedation. Monitoring patients is challenging due to certain patient conditions and the unique environment, that is, the radiology procedure suite. The addition of capnography monitoring, along with standard monitoring, is a valuable modality that provides a continuous objective assessment of the patient's ventilatory status even when direct visualization of the patient is compromised. The purpose of this article is to provide clinical practice recommendations for the use of capnography by procedural sedation nurses outside the operating room setting.     

品管圈活动促进ICU护患沟通的效果

目的探讨品管圈活动(quality control circle,QCC)在促进ICU护患沟通中的作用。方法由9名ICU护士组成QCC,设定主题为促进护患沟通,按QCC活动步骤拟定活动计划,包括现状把握、目标设定、要因解析、圈员共同拟定对策并按计划实施与检讨,比较活动前后护士及患者的满意度。结果实行QCC后,ICU护士对护患沟通满意度的自我评价由50.0%升至85.7%(目标设定为71.4%);患者的护患沟通满意度由67.0%升至83.3%(目标设定为90.0%)。活动后,圈员在团队合作能力、沟通能力、凝聚力、接受新鲜事物能力、护患关系融洽程度及创新思维能力等方面都有显著提高。结论开展品管圈活动能有效促进ICU护患沟通,提高患者的满意度,提升临床护士的综合素质。     

A Quality Improvement Initiative on Reducing Blood Culture Contamination in the Emergency Department

IntroductionContaminated blood cultures may have detrimental effects on patients, the organization, and antimicrobial stewardship. Patients in the emergency department may need blood cultures collected before antimicrobial therapy. Contaminated blood culture samples may contribute to prolonged hospital stay and also are associated with delayed or unnecessary antimicrobial therapy. This initiative aims to improve the emergency department’s blood culture contamination rate that will eventually benefit the patients who will receive timely and proper antimicrobial therapy, and benefit the organization fiscally.MethodsThis quality improvement initiative used the Define–Measure–Analyze–Improve–Control (DMAIC) process. The organization targets blood culture contamination rate of ≤2.5%. Control charts were used to study how blood culture contamination rate changed over time. In 2018, a workgroup was formed to work on this initiative. Improved site disinfection using 2% Chlorhexidine gluconate cloth before the standard procedure of blood culture sample collection was initiated. Chi squared test of significance was used to compare blood culture contamination rates 6 months before and during feedback intervention as well as contamination rate from source of blood draw.ResultsBlood culture contamination rates 6 months before and during feedback intervention showed significant decrease (3.52% before intervention and 2.95% after intervention; P < .05). Contamination rates differed significantly based on the source of blood culture draw (7.64% via line, 3.05% via percutaneous venipuncture, and 4.53% via other; P < .01).DiscussionBlood culture contamination rate continued to decrease with the use of a predisinfection process with 2% Chlorhexidine gluconate cloth before blood sample collection process. Practice improvement also was evident with effective feedback mechanism.