品管圈在提高骨科交接班质量的应用与效果评价

Application and effects evaluation of quality control circle in enhancing shifting of duty quality in department of orthopedics

目的通过品管圈及计划-实施-检查-处理（PDCA）循环的管理手法,应用个性化的现状-背景-评估-建议（SBAR）沟通模式,提高骨科交接班质量及医护、护护沟通效率。方法通过2015年4~9月我院交接班质量不良因素的查检,设立标杆值,计算交接班质量合格率等,设计骨科个性化SBAR交班报告卡,完善和制定集中及床旁交接流程、交接班质量考核标准,推进＂医护一体化＂工作模式,落实护理程序临床应用,并将改善前后查检表中交接班质量不良因素进行统计分析。结果实施质量改进交接班后,集中交接班合格率、护士床旁交接班合格率分别由42.86%、40.21%上升到80.95%、79.89%;护士体验综合评分比例由改善前的60.53%上升到改善后的81.60%;交接班各类不良因素得到较大改善,改善前后比较,差异有统计学意义（P〈0.05）。结论提高的骨科交接班管理活动,可健全护理交接班流程,建立良好的医护、护护沟通,提升护士的专业价值感,提高护理质量。

Objective To enhance shifting of duty quality in department of orthopedics and doctors-nurses and nursesnurses communication efficiency by using quality control circle and plan-do-check-action（PDCA） circulation management technique,communication model of situation-background-assessment-recommendation（SBAR）.Methods Benchmark value was established and qualified rate of shifting of duty quality was evaluated by checking the bad factors of shifting of duty in our hospital from April to Setember 2015;report card of personalized SBAR of shifting of duty in orthopedics department was established,concentration and bedside handover process and shifting of duty quality assessment standard were perfected and formulated, ＂medical care integration＂ working mode was promoted,clinical application of nursing procedure was implemented,the bad factors of shifting of duty quality in checking table before and after improvement were analyzed.Results After conducting quality improvement of shifting of duty,qualified rate of centralized shifting of duty and nurses′ bedside shifting of duty was respectively increased to 80.95% and 79.89% from which was respectively 42.86% and 40.21%;proportion of nurse experience comprehensive score was increased to 81.60% after improvement from 60.53% before improvement;various bad factors in shifting of duty had been greatly improved,the difference before and after improvement was statistically significant（P〈0.05）.Conclusion Improved shifting of duty management in orthopedics department improves the nursing shifting of duty process,establishes doctors-nurses and nurses-nurses communication,promotes the professional value sense of nurses and enhances the nursing quality.