病人体验在护理质量改进中的应用进展

就病人体验的内涵、在医疗领域的发展以及在护理质量改进中的应用进行综述,并提出其在国内护理质量改进研究中需要注意的事项,以期为构建病人体验的护理质量标准和护理质量改进策略提供建议。     

基因检测在精准医疗中的应用与管理

随着现代医学的发展,基因的序列信息逐渐成为临床疾病分子诊断精确的判定依据,基因检测技术也在精准医疗领域逐步推广.通过精准医学、检验医学、病理学等领域专家共同探讨基因检测在精准医疗中的应用与管理,本文明确了基因检测在精准医疗领域中的应用方法,也对基因检测每一步骤的质量控制及改进优化提出了建议,为从事精准医疗检测的实验室提...     

持续质量改进在手术室处理医疗垃圾中的应用

目的:探讨持续质量改进在手术室各类人员规范处理医疗垃圾依从性中的应用及临床效果.方法:在持续质量改进相关理论的指导下,成立CQI小组,采用FOCUS-PDCA相结合的方法,通过培训、监督、改善外在环境等措施,从而改进各类人员对医疗垃圾的规范处理.观察实施前后医疗垃圾混放情况和混放人员分布情况.结果:实施后医疗垃圾混放情况和混放人员分布明显优于实施前(P＜0.05).结论:持续质量改进在手术室医疗垃圾规范分类的应用,显著提高了各类人员规范处理医疗垃圾的依从性,降低了锐器和感染性垃圾对医疗人员的伤害,减少了不规范处理医疗垃圾对社会和环境的危害,值得推广应用.     

持续质量改进在医疗废物管理中的应用效果分析

目的探讨持续质量改进(continuous quality improvement,CQI)在医疗废物管理实践中的应用效果。方法 2008年8月-2009年2月应用CQI理论指导下对本院废物实施管理,比较实施前与实施半年后医务人员对医疗废物管理知识掌握情况及医疗废物管理检查中出现不合格的情况。结果 CQI半年后医务人员对医疗废物管理知识掌握合格率明显高于改进前(P0.05);医疗废物管理检查不合格情况明显比改进前降低(P0.01)。结论医院实施CQI可以明显提高医疗废物管理质量。     

通过持续质量改进提高医务人员手卫生依从性

目的应用持续质量改进方法提高医务人员手卫生依从性,以降低院内感染的发生,保障患者的医疗安全。方法便利抽样对2011年1月至2012年12月全院12个重点科室医务人员进行手卫生依从性情况调查分析,对存在问题及不足进行分析,找出原因,采取有效措施,进行持续质量改进。结果通过2年的手卫生持续质量改进,12个重点科室医务人员手卫生依从性得到显著的提高(由2011年49.4%上升到2012年66.8%)。结论应用持续质量改进的管理方法能切实提高医务人员对手卫生重要性的认识,使管理工作重点突出,提升医疗内涵质量。     

ICU质量控制指标在护理持续质量改进中的应用

目的 探讨重症医学专业医疗质量控制护理相关指标在持续质量改进中的应用效果.方法 2016年3-10月选取我院重症医学科作为研究对象,将2016年3—6月监测数据作为指标应用前的资料(指标应用前),2016年7—10月监测数据作为指标应用后的资料(指标应用后).指标应用前仅收集监测数据作为基线资料;应用重症医学专业医疗质量控制护理相关指标后进行护理质量评价,收集监测数据,每月进行动态分析,针对分析结果进行护理质量的持续化改进.观察比较重症医学专业医疗质量控制护理相关指标应用前后的差异.结果 指标应用后ICU深静脉血栓预防率较应用有明显的提高(P<0.05);ICU非计划气管插管拔管率、ICU呼吸机相关性肺炎发病率、ICU血管内导管相关血流感染发病率及ICU导尿管相关泌尿系感染发病率低于对照组(P<0.05).结论 基于重症医学专业医疗质量控制护理相关指标为基础的护理持续质量改进能有效提高重症医学专业的护理质量水平,提高了深静脉血栓预防率,降低非计划气管插管拔管率、呼吸机相关性肺炎发病率、血管内导管相关血流感染发病率、导尿管相关泌尿系感染发病率,提高护理水平.     

持续质量改进在供应室关键环节管理中的应用供应室 吴雯静

【】目的 探讨持续质量改进在供应室关键环节管理中的具体用法。方法 在供应室质量管理中,将持续质量改进应用到每一个工作环节,对存在的质量问题和隐患进行讨论、分析、找出原因和制定措施,并且实施质量改进。结果 提高工作质量和效率,规范质量控制体系。结论 持续质量改进应用在供应室关键环节管理体系,有效地提高了医疗安全、医疗工作质量和服务质量,使工作流程标准化,质量控制规范化,保障了无菌物品的质量,有效预防院内感染。     

持续质量改进在手术器械集中供应管理中的实践

目的:探讨持续质量改进在手术器械集中供应中的应用效果。方法:成立质量控制小组,运用过程管理理论,针对手术器械的特点,制定和完善各项规章制度及工作流程,进行实时监控,规避风险。结果:持续质量改进后,手术器械包合格率高于改进前(P0.01)。结论:运用持续质量改进可有效保证手术器械包的质量,降低风险隐患,保证医疗安全。     

持续质量改进在护理质量管理中的应用

随着医学模式的转变,健康观念的更新,医疗保险新体系的建立和医疗市场的不断完善,使医院护理管理者面临新机遇和挑战并存的考验.提高护理质量及护理服务已成为医院立足市场的重要法宝.如何建立护理质量可追踪的机制,将"质量持续改进"引入到护理管理中成为护理管理者们探讨的重点.     

持续质量改进在介入手术室医院感染管理中的应用

目的:探讨持续质量改进在介入手术室医院感染管理中的应用效果。方法:为建立健全科室医院感染管理制度,针对医院感染存在的风险因素进行持续质量改进,并比较改进前后手术间空气质量、医疗废物管理、手卫生依从率和正确率等指标。结果:持续质量改进后手卫生依从率、正确率明显提高(P0.05),手术间空气消毒效果优于改进前(P0.05),医疗废物管理问题发生率明显降低(P0.05)。结论:持续质量改进可优化介入手术室医院感染管理效果。     

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.     

Ketamine Sedation and Hypoxia: A Quality Improvement Project to Reduce Respiratory Events Receiving Intervention

BackgroundKetamine is a well-studied and safe medication used for procedural sedation in the pediatric emergency department (ED). However, in our ED and urgent care (UC), we had higher rates of respiratory events receiving intervention (REs) than has been reported nationally.ObjectiveA quality improvement (QI) project was initiated to address this problem with the following aim: during a 24-month period, we aimed to decrease REs during i.v. ketamine sedation from > 10% to < 6% in our network of EDs and UCs.MethodsInclusion criteria included patients in our EDs and UCs who received i.v. ketamine for procedural sedation. We organized a multidisciplinary team to identify key drivers for the primary outcome (i.e., REs) and establish interventions. We based process measures on key interventions and utilized 2 Plan-Do-Study-Act (PDSA) cycles, which we evaluated with Shewhart P (provost) charts. Balancing measures included length of sedation, success of sedation, and length of stay.ResultsREs decreased from 11.4% to 4.9%; this rate was maintained for 12 months, starting 1 month after PDSA cycle 2 implementation. There was no difference in REs for length of stay, length of sedation, or success of sedation.ConclusionsUsing QI methodology, we reduced and maintained rates of RE to < 6%. Due to the nature of the project, it is difficult to link one intervention to the reduction in REs; however, a significant shift occurred just after PDSA cycle 2 interventions. This project can give a guideline for interventions to improve the safety of pediatric ketamine sedations.     

Characteristics associated with intent to stay among Quality Improvement nurses

Kim E.K. & Hwang J.I. (2011) Characteristics associated with intent to stay among Quality Improvement nurses. International Nursing Review 58 , 89–95 Aim: The study aims to investigate characteristics associated with intent to stay among Quality Improvement (QI) nurses in Korean hospitals. Background: QI nurses have recently emerged as a new specialty area in the nursing profession in Korea. They have played a major role in coordinating and facilitating hospital‐wide QI activities. However, their frequent turnover degrades the continuity of overall QI programmes and incurs additional costs in human resource management. Methods: A cross‐sectional questionnaire survey was administered to 123 QI nurses in 123 general hospitals. The collected data included their hospital and department characteristics, work demand, job satisfaction, organizational commitment and demographics. The response rate was 94.3% (n = 116). Multiple logistic regression analysis was performed to determine the factors associated with intent to stay. Findings: Only 32.8% intended to stay in their current job. Significant factors associated with intent to stay were affective commitment and work demands. QI nurses with a higher level of affective commitment were more likely to stay [odds ratios (OR) = 2.50], whereas those with higher quantitative work demands in QI education and support were less likely to stay (OR = 0.40). Conclusion: The findings indicated that intent to stay was closely associated with work environment characteristics. Efforts to enhance their affective commitment and support their workload management are needed to increase the retention of qualified and experienced QI nurses.     

The Effect of a Quality Improvement Program on Paramedic On-scene Times for Patients with Penetrating Trauma

OBJECTIVE: To decrease paramedic on-scene times (OSTs) for major trauma patients through a focused quality improvement (QI) program. METHODS: A prospective study was conducted from 1993 through 1997 to determine the impact of a QI program on paramedic OSTs. All penetrating trauma patients transported by paramedics to Los Angeles County/USC Medical Center, a Level-1 trauma center, were included, and all cases with OSTs > 20 minutes were reviewed in detail for extenuating circumstances. Cases including multiple victims or unsecured scenes were considered "acceptable deviations." All others were considered "fallouts," which prompted extensive review with the paramedics and their field supervisors. RESULTS: Prior to the inception of the QI project there was a 4.1% fallout rate of penetrating trauma patients with OSTs > 20 minutes. This fallout rate fell to 1.5% in 1997 (p < 0.01). Mortality rates among these fallouts decreased from 5.1% to 0.8% during the study period (p < 0.01). CONCLUSIONS: An intensive QI program can have a significant, positive impact on paramedic OSTs among patients with penetrating trauma.     

Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016

Objective

To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.

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.     

Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants

Objective

To examine and synthesize the outcomes of quality improvement (QI) initiatives related to cue-based feeding of preterm infants to facilitate implementation of findings to improve nursing practice.

Quality improvement strategies for hypertension management: a systematic review

BACKGROUND: Care remains suboptimal for many patients with hypertension. PURPOSE: The purpose of this study was to assess the effectiveness of quality improvement (QI) strategies in lowering blood pressure. DATA SOURCES: MEDLINE, Cochrane databases, and article bibliographies were searched for this study. STUDY SELECTION: Trials, controlled before-after studies, and interrupted time series evaluating QI interventions targeting hypertension control and reporting blood pressure outcomes were studied. DATA EXTRACTION: Two reviewers abstracted data and classified QI strategies into categories: provider education, provider reminders, facilitated relay of clinical information, patient education, self-management, patient reminders, audit and feedback, team change, or financial incentives were extracted. DATA SYNTHESIS: Forty-four articles reporting 57 comparisons underwent quantitative analysis. Patients in the intervention groups experienced median reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) that were 4.5 mm Hg (interquartile range [IQR]: 1.5 to 11.0) and 2.1 mm Hg (IQR: -0.2 to 5.0) greater than observed for control patients. Median increases in the percentage of individuals achieving target goals for SBP and DBP were 16.2% (IQR: 10.3 to 32.2) and 6.0% (IQR: 1.5 to 17.5). Interventions that included team change as a QI strategy were associated with the largest reductions in blood pressure outcomes. All team change studies included assignment of some responsibilities to a health professional other than the patient's physician. LIMITATIONS: Not all QI strategies have been assessed equally, which limits the power to compare differences in effects between strategies. CONCLUSION: QI strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient's physician was associated with substantial improvement. Future research should examine the contributions of individual QI strategies and their relative costs.     

A Quality Improvement Project Focused on Women's Perceptions of Skin-to-Skin Contact After Cesarean Birth

A quality improvement (QI) project was designed to identify women's perceptions of the benefits of skin-to-skin contact with newborns immediately following cesarean birth. Women reported positive experiences associated with skin-to-skin contact with their newborns. A major theme that emerged was that women who had cesarean birth felt that this QI project resulted in a birthing experience comparable to that of mothers who had vaginal deliveries. Participants also experienced decreased anxiety regarding the health and welfare of their newborns, as compared to a previous cesarean birth experience in which they did not have skin-to-skin contact.     

Identifying priorities for quality improvement at an emergency Department in Ghana

Background

Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization’s (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program.

Methods

Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities.

Results

Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality.

Conclusions

ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.