八小时外护士长巡查督导模式精细化改革运行研究

Research on the Elaborating Reform of Head Nurse Inspection and Supervision outside the Eight-hour Administration

目的为保证无缝隙的质量管理,通过对护士长8 h外质量安全督查模式进行改革,探索改革的成效。方法从2014年1月起,对护士长巡查督导的名称、形式、内容、标准进行改革,形式上实施工作装和便装组相结合,时间上8 h外的无缝隙管理,内容上做到全面覆盖重点管理,评价上做到精细化、目标化和重点化,反馈上现场与汇总相结合,书面与口头相结合的方式,形成全面、全程、全方位的无缝隙管理。结果模式改革后,巡查护士长由2014年1月的102人次增至2014年6月的124人次,巡查科室由2014年1月的276个次增加至2014年6月的332个次。实施后,病室环境管理、护士工作状态得到了提升,不良事件(压疮、跌倒/坠床)发生率下降,重点患者身份识别合格率上升,患者/家属对责任护士、用药、检查知晓率上升,责任护士对诊断知晓率提高,以上指标改革前后差异有统计学意义(P<0.05)。结论精细化改革后的护士长质量安全巡查督导能提高查房的效率,保证8 h外的质量与安全。

Objective To explore the efficacy of reforming head nurse inspection and supervision outside the eight-hour administration, in order to ensure seamless quality management. Methods From January 2014, reform was carried out on the name, form, content, and standard of head nurse inspection and supervision, including the combination of casual and work wear, seamless management outside the eight-hour administration, complete management with key emphasis, fine evaluation with objectives and emphasis, the combination of feedback and summarizing, and the combination of written and oral report. Results After the implementation of 6-month reformation, the head nurses involved in inspection increased from 102 in January 2014 to 124 in June 2014, the departments involved in inspection increased from 276 to 332. After the implementation, the ward environment management and nurses＇ working state were improved. Adverse events （pressure ulcer, fall/drop from bed） were decreased. The qualified rate of patient identification arose. Patients and their relatives had a higher rate of medication and disease knowledge, and nurses had a higher rate of knowledge on the responsibility for diagnosis and major nursing points. The differences before and after the reform were significant （P 〈 0.05）. Conclusion The elaborating reform can promote the efficiency of head nurse inspection and supervision, and ensure the nursing quality and safety outside the eight-hour administration.