全程管理模式对肿瘤患者PICC置管并发症的影响

Effects of the whole process management pattern on the complication of PICC among cancer patients

目的：探讨全程管理模式对肿瘤患者PICC置管并发症的影响。方法于2012年10月开始建立全程管理模式,对PICC置管患者运用PDCA循环模式的计划、执行、检查和处理4个阶段对环境、安全、质量、患者健康等管理方面进行要素整合,进行全院一体化的全程管理。比较分散管理（2012年1—10月）和实施后全程管理后（2012年11月—2013年12月）全院PICC置管数、一次置管成功率及并发症发生率,比较患者对护理服务的满意度。结果全院PICC置管数从275例上升至475例,一次置管成功率从94.9%上升到98.9%,差异有统计学意义（χ2=11.58,P〈0.01）；全程管理组导管相关并发症发生率下降,机械性静脉炎发生率为1.8%,导管性相关感染发生率为2.1%,均低于分散管理组,差异有统计学意义（χ2值分别为5.99,25.17；P〈0.01）。患者满意度从93.1%提高至97.1%,差异有统计学意义（χ2=6.53,P〈0.05）。结论全程管理模式减少了肿瘤患者PICC置管并发症发生率,促进了患者安全,减轻了临床护理压力,提高了患者满意度,提升了专科护理质量。

Objective To explore the effects of whole process management pattern on the complication of PICC among cancer patients. Methods From October 2012, we started to build up the whole process management pattern to plan, implement, check and cope with integration of 4 stages key element including environment, safety, quality and patient′s health for PICC patients, and it carried out in the whole hospital. We compared the number of PICC cases, success rate of first PICC insertion and incidence of complication between the time of January to October 2012 and the time of November 2012 to December 2013, and compared the patients′satisfaction of nursing quality. Results After the whole process management pattern used, the total number of PICC climbed from 275 cases to 475 cases and the success rate of first PICC insertion increased from 94. 9% to 98. 9% with statistical difference （χ2 =11. 58,P〈0. 01）. The incidences of complication declined, of which the rate of mechanical phlebitis was 1. 8%, infection related catheter 2. 1%, and all complications were lower than before the whole process management pattern used （χ2 =5. 99,25. 17, respectively; P 〈0. 01）. The patients′satisfaction increased from 93. 1% to 97. 1% with statistical difference （χ2 =6. 53,P〈0. 05）. Conclusions The whole process management pattern declines the complications of PICC among cancer patients, and promotes patients safety, releases clinical pressure and enhanced patients′satisfaction and quality of specific nursing.