目标管理方案降低导尿管相关性尿路感染发生率的临床实践

目的 实施目标管理方案降低导尿管相关性尿路感染发生率,通过制订目标、实施目标、完成目标,推进质量改善。方法 对某三级甲等综合医院2020年4月—9月留置导尿管的住院患者,应用目标管理方案,依次制订质量改善目标、质量改善计划,实施计划并对过程进行质量评价,通过评估结果的反馈改进行动,实现质量改善。设定1个月为1个质量周期,首个周期的质量为基线,之后各周期质量与之比较,同时与前1周期质量比较。结果 12个过程指标与基线质量比较,6个指标在第2个周期得以改善（P<0.05）,此后凡优于第2周期和基线质量的指标,较基线质量比较,差异均具有统计学意义（均P<0.001）。5个过程指标基线完成率已达到较高水平,与后续测量数据持平。结果指标导尿管相关性尿路感染发生率项目末期较基线显著降低（P<0.05）。过程指标10项措施执行完成率≥95%,2项措施执行率≥91%,达成目标。结论 应用目标管理方案进行质量改善,实现目标导向指标具体化管理,对护理质量进行客观测量,科学比较,切实降低了留置导尿管住院患者的导尿管相关性尿路感染发生率,促进护理质量提升。

Clinical practice of objective management project to reduce the incidence of catheter-related urinary tract infection

Objective To improve the project of reducing the incidence of catheter-associated urinary tract infection（CAUTI）through the management by objectives（MBO）,so as to enhance the quality by setting,implementing and completing goals. Methods The data of patients with indwelling catheters hospitalized in a tertiary Grade A General Hospital from April 2020 to September 2020 were analyzed. The project objectives and plans were developed through MBO. Besides,the project was implemented according to the plans,and an assessment of the process was carried out. Actions were taken to improve the project based on the feedback of assessment results. A month is set as a quality cycle. The quality of the first cycle is the baseline,and then the quality of each cycle is compared with the baseline data and the quality of the previous cycle. Results Compared with the baseline quality of 12 process indexes,6 indexes were statistically significant in the second cycle（P<0.05）. The results that were better than the baseline quality and the quality of the second cycle were statistically significant,compared with the baseline quality（P<0.001）. The baseline completion rate of 5 process indexes has reached a greater extent. Similar measurement data were obtained after that,indicating that high-quality nursing care was given. The indexes of the incidence of CAUTI at the end of the project were statistically significantly lower than the baseline（P<0.05）. The completion rate of the process indexes was over 95%,indicating that objectives were met. Conclusion MBO can be used for improvement in projects and goal-oriented management of indexes. It can also verify the effectiveness and further improve the quality by objectively measuring and scientifically comparing the quality of nursing care.