持续质量改进在ICU危重患者护理质量管理中的应用效果

目的 探讨持续质量改进(continuous quality improvement,CQI)在ICU危重患者护理质量管理中的应用效果.方法 采用柏拉图分析法对2015年1-12月收住解放军第98医院ICU的313例患者的临床资料进行动态分析.针对非计划性拔管(unplanned excubation,UEX)发生率、导管相关性血流感染(catheter related blood stream infection,CRBSI)发生率[包括经锁骨下静脉置入中心静脉导管(central venous catheter,CVC)感染率、经外周静脉置入中心静脉导管(peripherlly inserted centra lcatheter,PICC)感染率]、呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率等进行护理质量控制与改进,以2014年1-12月收治的314例患者为对照组.比较两组患者上述指标、患者住院及经济运行状况等的差异,并分析患者满意度和3项敏感指标的相关性.结果 UEX发生率与护士专业技能的满意度、护士服务态度的满意度及护理服务质量综合满意度呈负相关(均P＜0.05);CRBSI中的CVC感染发生率与护理质量的满意度、护士专业技能的满意度呈负相关(均P＜0.05);CRBSI中的PICC感染发生率与就医环境的满意度、护理质量的满意度、护士专业技能的满意度、护理服务质量综合满意度呈负相关(均P＜0.05);VAP发生率与患者就医环境的满意度、护士专业技术技能的满意度及护理服务质量综合满意度呈负相关(均P＜0.05).结论 针对UEX、CRBSI、VAP等3项护理质量敏感指标的质量控制与改进能进一步提高护理质量.

Application Effects of Continuous Quality Improvement in Nursing Quality Management for ICU Severe Patients

Objective To discuss the application effects of continuous quality improvement(CQI) in nursing quality management for ICU severe patients.Clinical data of 313 patients admitted in ICU from January to Deeember 2015 were dynamically analyzed by using Plato analysis method.The nursing quality control and improvement was conducted based on three sensitive indicators,the inddence rate of unplanned excubation(UEX),incidence rate of catheter related blood stream infection(CRBSI),incidence rate of central venous catheter (CVC),peripherlly inserted centra lcatheter (PICC) and inddence rate of ventilator associated pneumonia(VAP).The 314 cases which admitted in hospital from January to December 2014 were selected as control group.The differences of above indicators,hospitalization and their financial situation were compared,and the patients' satisfaction and correlafionship between three sensitive indicators were analyzed.Results The incidence of UEX was negatively correlated with satisfaction rate of nurses' professional skills,satisfaction level of nurses' attitude towards customers and comprehensive satisfaction level of nursing quality(all P＜0.05).The incidence rate of CVC infection was negatively correlated with satisfaction level of nursing quality and satisfaction level of nurses' professional skills(all P＜0.05).The incidence rate of PICC infection rate was negatively correlated with satisfaction level of hospital enviroment,nursing quality,nurses' professional skills and comprehensive satisfaction of nursing service quafity(all P＜0.05).The incidence rate of VAP was negatively correlated with satisfaction level of hospital environment,nurses' professional skills and comprehensive nursing service quality(all P＜0.05).Conclusions Three nursing sensitive index UEX,CRBSI and VAP have important meaning for continuous improvement of ICU nursing quality.