品管圈在降低NICU患儿胃管意外脱管率中的应用

Application of quality control circle in management of accidental extubation in NICU infants

目的品管圈活动是持续质量改进的一种方式。目前它已不断融入医院细节管理过程,并在护理工作中取得了较好的效果。本文探讨了品管圈活动对蚌埠医学院第一附属医院NICU患儿胃管意外脱落的改进作用。方法以医院留置胃管的NICU患儿为研究对象,根据入院先后顺序随机分为对照组和品管圈组。全体圈员确定以降低NICU患儿胃管意外脱管率为品管圈活动主题,通过拟定活动计划、目标设定、现状分析、制定留置胃管各环节精细化操作流程并在护理过程中进行具体实施。活动结束后通过χ2检验比较2组NICU患儿的胃管意外脱管率及其差异,同时对进步率及目标达成率进行统计分析。结果经过此次品管圈活动,对NICU患儿胃管留置形成了标准化操作流程。在护理工作中严格按照该流程进行操作,使NICU患儿胃管意外脱管率由开展品管圈前的32%降低到开展品管圈后的11.2%,2组患儿之间具差异有统计学意义（OR=2.844,95%CI：1.584～5.109,P〈0.01）。开展品管圈活动后该项工作的进步率达65%、目标达成率为102%。而且,通过品管圈活动培养了护理人员在工作中运用科学的方法主动寻找问题、解决问题的能力。结论品管圈是一种科学有效的管理工具,将品管圈用于NICU患儿留置胃管流程的改进,不仅能够显著降低NICU患儿胃管意外脱管率,而且能提高护理工作的效率和护士工作的积极性、主动性与创新性。

Objective To evaluate the effect of quality control circle （QCC） system in the management of accidental extu- bation in NICU infants. Methods The NICU infants with gastric tube were selected and divided into the control and quality control circle groups randomly according the admission time. The selected theme of QCC was decreasing the rate of accidental extubation by the members of our quality control circle. The activity was realized through planning activity programs, setting goals, analyzing current situation and formatting the fine process of detaining gastric tube. The rates of acci- dental extubation, progress and goal attainment were analyzed after the activity with statistical methods. Results The standard nursing operating protocol for gastric tube retaining of NICU infants was established in our department by the activity and was strictly applied in practical nursing serves. Through which the rate of accidental extubation in NICU infants decreased from 32% to 11.2% ,the difference was significant between the two groups（ OR =2. 844,95% CI： 1. 584 - 5. 109 ,P 〈 0.01 ）. The rate of progress and goal reaching was 65% and 102% respectively after quality control circle activity. Furthermore, the ability of nurses to actively find and solve questions with scientific methods in working was fostered through quality control circle activity. Conclusion Quality control circle is a scientific and effective management tool. QCC in the process of detaining gastric tube in NICU infants can reduce the rate of accidental extubation,improve the efficiency of nursing work, and the positivity, activity and creativity of nurses.