基于约束理论的精细化管理在医院消毒供应中心外来医疗器械管理中的价值研究

Study on value of fine management based on theory of constraints in the management of loaner medical instruments in central sterile supply department

目的:探讨基于约束理论(TOC)的精细化管理在医院消毒供应中心(CSSD)外来医疗器械管理中的应用价值。方法:选取医院CSSD处理的2553包外来医疗器械,采用便利抽样法将其分为对照组(1027包)和观察组(1526包),对照组行常规清洗消毒灭菌管理;观察组实行基于TOC的精细化管理。采用自制满意度调查表,对两组器械包使用人员进行满意度调查,比较两组器械包各管理环节质量、管理指标及CSSD护理人员考核成绩。结果:观察组器械清洗不合格、器械不全或损坏、包装不规范、湿包、灭菌监测不合格和器械提前放行发生率低于对照组,术后送洗率高于对照组,差异有统计学意义(x^(2)=50.723,x^(2)=41.868,x^(2)=48.908,x^(2)=31.276,x^(2)=31.121,x^(2)=31.972,x^(2)=440.832;P<0.05);观察组漏包、漏报和漏登记发生率低于对照组,差异有统计学意义(x^(2)=34.958,x^(2)=58.364,x^(2)=75.162;P<0.05);观察组物品质量、器械配送、物品交接、信息追溯和服务态度满意度得分高于对照组,差异有统计学意义(t=21.817,t=13.841,t=13.037,t=10.431,t=18.153;P<0.05);CSSD护理人员对观察组的理论知识、处理流程、清洗消毒和灭菌包装考核得分高于对照组,差异有统计学意义(t=21.817,t=13.841,t=13.037,t=10.431;P<0.05)。结论:基于TOC的精细化管理用于医院CSSD外来医疗器械管理,可改善清洗消毒灭菌各环节质量,提高使用科室满意度。

Objective:To explore the application value of fine management based on theory of constraints(TOC)in the management of loaner medical instruments in central sterile supply department(CSSD).Methods:2,553packages of loaner medical instruments processed in CSSD of the hospital were selected and divided into control group(1,027 packages)and observation group(1,526 packages)by convenient sampling.The control group was managed by routine cleaning,disinfection and sterilization.The observation group implemented TOC-based fine management.Self-designed satisfaction questionnaire was used to investigate the degree of satisfaction of departments using the two groups of instruments packages.The quality of each link of instruments packages,management indicators and CSSD nursing staff assessment results of the two groups were compared.Results:The incidence rates of unqualified cleaning,incomplete or damaged instruments,improper packaging,wet packing,unqualified sterilization monitoring,and early release of instruments in observation group were lower than those in control group,the postoperative washing rate was higher than that in control group,the difference was statistically significant(x^(2)=50.723,x^(2)=41.868,x^(2)=48.908,x^(2)=31.276,x^(2)=31.121,x^(2)=31.972,x^(2)=440.832;P<0.05).The incidence rates of missing package,missing reporting and missing registrations were lower in observation group than those in control group,the difference was statistically significant(x^(2)=34.958,x^(2)=58.364,x^(2)=75.162;P<0.05).The satisfaction scores in terms of item quality,instrument distribution,item handover,information traceability and service attitude in observation group were higher than those in control group,the difference was statistically significant(t=21.817,t=13.841,t=13.037,t=10.431,t=18.153;P<0.05).The assessment scores of nursing staff in terms of theoretical knowledge,processing flow,cleaning and disinfection and sterilization packaging in observation group were higher than those of control group,the difference was statistically significant(t=21.817,t=13.841,t=13.037,t=10.431;P<0.05).Conclusion:Fine management based on TOC can improve the quality of each link of cleaning,disinfection and sterilization of loaner medical instruments in CSSD of the hospital,and enhance the satisfaction of using department.