持续质量改进对护理病历质量的影响

文章围绕护理病历书写中存在的问题和缺陷进行讨论,运用持续质量改进方法,制定预期目标,采用相应的质量改进方案。应用持续质量管理后,护理病历书写质量有了显著提高。     

持续质量改进在护理质量控制中的应用

目的探讨护理质量控制中运用持续质量改进的效果.方法 通过修订护理工作各项考核标准,督促检查和评价环节质量,对护理问题不断总结改进,促使终末质量提高.结果护理质量稳步上升,患者满意度不断提高.结论 持续质量改进能将护理质量管理建立一个良性循环的模式,有效地控制了不良因素的发生,确保了护理质量.     

应用循证护理持续改善护理质量

循证护理是护理学科发展的必然趋势。采用知识-应用循环圈模型指导循证护理临床实践,依托循证转化组构建循证护理组织架构,创新运行模式和培训模式,达成证据总结和证据应用双重目标,推进了循证护理临床应用,改善了患者结局指标,创造了良好经济效益和社会效益。     

持续质量改进护理对NICU新生儿红臀发生情况的影响

目的 探讨持续质量改进护理对NICU新生儿红臀发生情况的影响.方法 选取我院NICU新生儿86例,随机分为两组各43例.对照组给予常规基础护理措施,观察组在对照组基础上给予持续质量改进护理.比较两组的新生儿红臀发生率及家属护理满意度.结果 护理后,观察组的新生儿红臀总发生率低于对照组,家属护理满意度高于对照组(P<0....     

质量控制护理干预在ICU中实施对持续质量改进的影响

目的探讨质量控制护理干预在ICU中实施对持续质量改进的影响。方法选取2017年1月至2017年12月我院ICU收治的110例患者,随机分为观察组和对照组各55例。对照组予以常规护理,观察组在对照组基础上予以质量控制护理干预。比较两组的护理质量考核评分及护理满意度。结果观察组的基础护理、监护记录、护理管理、护理安全等护理质量考核评分均高于对照组(P <0.05)。观察组对就医环境、就诊流程、服务态度及专业技能的满意度分别为92.7%、 94.5%、 94.5%、96.4%,均高于对照组的76.4%、 78.2%、 80.0%、 83.6%(P <0.05)。结论质量控制护理干预可全面提高ICU的护理质量水平,患者对就医环境、就诊流程、服务态度、专业技能等护理工作的满意度较高,值得临床推广应用。     

Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative

Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014–May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants <6 months. Of 110 agencies, eight sites were selected based on volume, geography, and agency leadership. Our adapted Breakthrough Series model included monthly calls with performance feedback and cross-agency learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.     

A Multi-Part Model Approach to Examining Medicaid Payment Methods and Nursing Home Quality

The incentive to provide nursing home quality depends, in part, on whether the state Medicaid reimbursement system is prospective or retrospective in nature. This paper examines the effect of state-level Medicaid reimbursement methods on the provision of quality in the context of bed constraint regulations that may influence market tightness. A three-part estimation strategy is constructed around the idea that a change in the Medicaid reimbursement method may affect both a facility's payer mix and the provision of quality. Across a range of quality measures, this multi-part model did not show nursing home quality to be significantly higher under a retrospective reimbursement system as compared with a prospective-based system of reimbursement. This finding holds regardless of whether the analysis was isolated to those markets with the tightest supply of beds or those homes that care for predominantly Medicaid residents.     

护理质量持续改进对妇产科不良事件及患者满意度的影响分析

目的探讨护理质量持续改进在妇产科中的应用效果。方法我院于2016年1月在妇产科中实施PDCA护理质量持续改进,选择2014年1月至2015年12月妇产科患者3.83万例(实施前), 2016年1月至2017年12月妇产科患者3.9万例(实施后),观察实施前后妇产科不良事件发生率及患者满意度。结果实施后,妇产科的不良事件发生率显著低于实施前(P <0.05);实施后,患者的总满意度显著高于实施前(P <0.05)。结论护理质量持续改进可有效降低妇产科护理过程中不良事件的发生率,提高护理管理质量及患者满意度,值得临床推广应用。     

Doing Better to Do Good: The Impact of Strategic Adaptation on Nursing Home Performance

Objective. To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance.
Data Sources. Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF).
Study Design. The extent of strategic adaptation was measured by an aggregate weighted implementation score. Nursing home performance was measured by occupancy rate and two measures of payer mix. We conducted multivariate regression analyses using a cross-sectional time series generalized estimating equation (GEE) model to examine the effect of nursing home strategic implementation on each of the three performance measures, controlling for market and organizational characteristics that could influence nursing home performance.
Data Collection/Abstraction Methods. OSCAR data was merged with relevant ARF data.
Principal Findings. The results of our analysis provide strong support for the hypothesis.
Conclusions. From a theoretical perspective, our findings confirm that organizations that adjust strategies and structures to better fit environmental demands achieve superior performance. From a managerial perspective, these results support the importance of proactive strategic leadership in the nursing home industry.     

Organizational Characteristics and Cancer Care for Nursing Home Residents

Objective. We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease. Data Sources/Study Design/Data Collection. Using data from the Michigan Tumor Registry (1997–2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis. Principal Findings. Approximately 25 percent of the residents were diagnosed at or near death. Only 61 percent of residents diagnosed with late or unstaged cancer received pain medication during the diagnosis month or the following month. Residents in nursing homes with lower staffing and in counties with fewer hospital beds were more likely to be diagnosed at death. After the Balanced Budget Act (BBA), residents were more likely to be diagnosed at death. Conclusions. Nursing home characteristics and community resources are significantly related to the cancer care residents receive. The BBA was associated with an increased likelihood of later diagnosis of cancer.     

持续质量改进在体检科护理质量管理中的应用效果探讨

目的探究持续质量改进在体检科护理质量管理中的应用效果。方法该次将该院在2018年7-12月的体检者200名作为研究的对象,视为对照阶段,采取常规护理管理方法;将该院2019年1-6月的体检者200名作为观察阶段对象,在护理管理工作中采取持续质量改进管理模式,进一步对比两个阶段患者对于体检科工作质量的评分。结果在体检工作质量、服务态度、体检满意度这3个模块,观察阶段评分对照阶段比较均明显更高,差异有统计学意义(P<0.05)。结论持续质量改进应用于体检科护理质量管理中,可有效提升体检服务品质,值得推广应用。     

信息化管理在临床护理质量管理与持续改进中的应用体会

目的研究在临床护理质量管理和持续改进当中信息化管理的应用效果。方法选择2018年6月-2019年6月期间在该院接受治疗的130例患者,随机平分为对照组和观察组,每组65例。对照组患者接受常规的非信息化管理的护理,观察组患者接受信息化管理的护理。结果观察组患者对疾病知识知晓情况的评分为(97.27±1.08)分,高于对照组的(90.07±1.12)分,护理质量评分为(96.94±1.48)分,高于对照组的(89.97±1.05)分,护理满意度为98.46%,高于对照组的81.53%,差异有统计学意义(P<0.05)。结论信息化管理应用于临床护理质量管理与持续改进当中,能够有效改进护理工作,提升护理质量和患者对护理的满意程度,值得推广。     

Nursing Home Staff Perceptions of Barriers and Facilitators to Implementing a Quality Improvement Intervention

ObjectivesQuality improvement (QI) may be a promising approach for staff to improve the quality of care in nursing homes. However, little is known about the challenges and facilitators to implementing QI interventions in nursing homes. This study examines staff perspectives on the implementation process.DesignWe conducted semistructured interviews with staff involved in implementing an evidence-based QI intervention (“LOCK”) to improve interactions between residents and staff through targeted staff behavior change. The LOCK intervention consists of 4 practices: (1) Learn from the bright spots, (2) Observe, (3) Collaborate in huddles, and (4) Keep it bite sized.Setting and participantsWe interviewed staff members in 6 Veterans Health Administration nursing homes [ie, Community Living Centers (CLCs)] via opportunistic and snowball sampling.MeasuresThe semistructured interviews were grounded in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change and covered staff experience, challenges, facilitators, and lessons learned during the implementation process. The interviews were analyzed using thematic content analysis.ResultsOverall, staff accepted the intervention and appreciated the focus on the positives. Challenges fell largely within the categories of capability and opportunity and included difficulty finding time to complete intervention activities, inability to interpret data reports, need for ongoing training, and misunderstanding of study goals. Facilitators were largely within the motivation category, including incentives for participation, reinforcement of desired behavior, feasibility of intervention activities, and use of data to quantify improvements.Conclusions/ImplicationsAs QI programs become more common in nursing homes, it is critical that interventions are tailored for this unique setting. We identified barriers and facilitators of our intervention's implementation and learned that no challenge was insurmountable or derailed the implementation of LOCK. This ability of frontline staff to overcome implementation challenges may be attributed to LOCK's inherently motivational features. Future nursing home QI interventions should consider including built-in motivational components.     

Smart Case Review: A Model For Successful Remote Medical Direction and Enhanced Nursing Home Quality Improvement

This article describes how medical directors can use a strategic approach [Smart Case Review (SCR)] to perform effective and efficient clinical case reviews and key medical director oversight functions simultaneously. SCR can be done either on-site or remotely, by using existing information in the medical record for a focused clinical discussion of patient symptoms and issues while simultaneously evaluating related clinical practices and facility processes and performance. Common problem-solving and cause identification methods apply to both patient- and process-related reviews. This approach supports effective and efficient medical direction and facility quality improvement. Unlike most current approaches to quality assurance and performance improvement, SCR begins by reviewing cases and then aggregates the findings, instead of vice versa. Although the electronic medical record (EMR) facilitates the process, it can be done without an EMR. Any medical director can potentially use this approach, and it is relevant to any long-term and postacute care facility. This method could potentially transform the approach to medical direction, evaluating quality and improving care, and the nursing home survey process.