流程管理应用在人工关节植入物及外来器械管理的效果评价

Evaluation on Results of Process Management in Joint Prosthesis Implants and External Instruments

目的探讨流程管理在人工关节植入物及外来器械管理中的方法及效果,确保植入物及外来器械质量安全。方法运用流程管理理论和方法,对流程进行规范、优化和再造。通过充分调查分析,多部门联合管理,制定出规范、科学的外来器械管理流程。医务部、感染管理科制定规范的准入制度,医学工程科进行规范的验收签字,消毒供应中心进行植入物抽检,并对外来器械进行详细的检查登记后,按规范流程进行清洗、检查、包装、灭菌后送至手术室备用,手术室护士按照各种登记信息检查清点各种器械及植入物,根据手术中使用植入物的编码进行三方签字后,医工科进行扫码确认并实施计费。结果通过流程规范管理,人工关节置换的患者647名,无1例因植入物型号不合格或因器械清洗消毒灭菌不合格造成的手术延误,患者手术切口感染率由上一年度6.02%下降至2.78%;人工关节植入物感染率由1.54%下降至0.77%;人工关节植入物漏费率由2.23%下降为0.00%,手术延误率由1.72%下降至0.00%,4项指标均有统计学意义(P<0.05)。结论通过建立规范的流程管理,可以有效地提高人工关节植入物及外来器械的管理水平,有效地降低手术切口及植入物的感染率,保证患者的安全,减少患者漏费的发生。

Objective To investigate the methods and results of process management in joint prosthesis implants and external instruments, in order to ensure the quality safety in operation.Methods In view of the theory and methods of process management, the process management of joint prosthesis implants and external instruments were standardized, optimized and regenerated by cooperation of related department through enough investigation and analysis. That is to say, standardized admittance criterion was made by medical department and infection management department; standardized checking and signing were made by medical engineering department, and implants sampling and detailed external instruments recording were implemented by disinfection and supply center. After that, cleaning, examining, packaging and sterilization were performed for all the implants and external instruments based on standardized process. And all the implants and external instruments were checked carefully by operating nurses according to their own recording information, and their information code should be conifrmed and charged by medical engineering department.Results Among all the 647 patients with joint prosthesis replacement, none of them occurred surgery delaying caused by incompetent type of implants and unqualiifed instruments sterilization. The infection rate of operative incision decreased from 6.02% last year to 2.78%; the infection rate of joint prosthesis implants decreased from 1.54% to 0.77%; the loss rate of unpaying in joint prosthesis implants decreased from 2.23% to zero; and the incidence of delayed surgery decreased from 1.72% to 0.0% （allP〈0.05）.Conclusion The management level of joint prosthesis implants and external instruments could be improved greatly by standardized process management, thus to decrease infection rate of operative incision and implants effectively, and ensure the safety of patients and lower the loss rate of unpaying.