持续质量改进联合护理质量指标在减少动静脉内瘘穿刺损伤中的应用研究

Application of continuous quality improvement combined with nursing quality indicators in reducing arteriovenous fistula puncture injury

目的 探讨持续质量改进及护理质量指标控制在降低动静脉内瘘穿刺损伤发生的护理实践中的作用。方法 以降低动静脉内瘘穿刺损伤作为质量控制目标,以2022年8、11月于北京大学人民医院血液透析室应用动静脉内瘘作为血管通路的患者为研究对象,8月质量改进前治疗的123例患者为对照组,11月质量改进后的125例患者为观察组,通过联合采用动静脉内瘘穿刺损伤发生率、各内瘘穿刺方法占比、血管超声使用率、患者穿刺满意度作为护理质量指标,每月汇总分析指标结果及发生原因,针对性进行护理质量管理与改进措施。结果 对照组患者共穿刺1 810例次,发生穿刺损伤10例次,动静脉内瘘穿刺损伤发生率为0.55%(10/1 810);观察组患者穿刺1 733例次,发生损伤3例次,动静脉内瘘穿刺损伤发生率为0.17%(3/1 733)。疑难血管通路穿刺损伤发生率下降(P=0.039),绳梯穿刺法占比上升至63%,血管超声使用率由4%(5/123)增加至100%(P<0.001),患者对穿刺满意度增加(P<0.001)。结论 联合应用血液透析专科护理质量指标,实施持续质量改进管理,可降低动静脉内瘘穿刺损伤发生率。

Objective To explore the role of continuous quality improvement and nursing quality indicators in nursing practice to reduce the incidence of arteriovenous fistula puncture injury.Method Taking reducing the incidence of arteriovenous fistula puncture injury as the goal of quality control,patients who used arteriovenous fistula as a vascular access in the hemodialysis room of Peking University People's Hospital in August and November 2022 were selected as the research subjects.Patients treated before quality improvement in August were selected as the control group,and patients treated after quality improvement in November were selected as the observation group.The incidence of arteriovenous fistula puncture injury,the proportion of various fistula puncture methods,the usage rate of vascular ultrasound,and patient satisfaction with puncture were used as nursing quality indicators.The results and causes of the indicators were summarized and analyzed monthly,and targeted nursing quality management and improvement measures were implemented.Results A total of 1,810 punctures were performed in 123 patients in the control group,with 10 cases of puncture injuries,and the incidence of arteriovenous fistula puncture injuries was 0.55%(10/1,810);There were a total of 125 patients in the observation group,with 1,733 punctures and 3 injuries,and the incidence of arteriovenous fistula puncture injuries was 0.17%(3/1,733).The incidence of difficult vascular access puncture injury decreased(P=0.039),and the proportion of rope ladder puncture increased to 63%.The use of vascular ultrasound increased from 5/123(4%)to 125/125(100%,P<0.001),and patient satisfaction with puncture significantly increased(P<0.001).Conclusion The combined application of specialized nursing quality indicators for hemodialysis and the implementation of continuous quality improvement management can significantly reduce the incidence of arteriovenous fistula puncture injuries.