戴明环护理路径落实单在ICU护理质量同质化中的效果研究

Effect of Plan. Do-Check-Act on homogenization of nursing processes in ICU

目的 探讨戴明环护理路径落实单在ICU护理质量同质化中的效果.方法 依据循证设计戴明环护理路径落实单,选择从事ICU临床一线的监护岗位护士36名,要求护士在工作中依据护理路径落实临床工作,监护组长进行监督检查.比较戴明环护理路径落实单实施前后护理质量综合质量控制指标与专项质量控制指标.结果 戴明环护理路径落实单实施后,综合质量控制指标临床护理质量由（89.28±2.36）分上升至（97.45±1.38）分,差异有统计学意义（t=-7.310,P〈0.01）;专项质量控制指标包括呼吸机相关性肺炎发生率、导管相关血流感染发生率、尿管相关尿路感染发生率、意外拔管发生率、压疮发生率、血糖失控发生率、镇静失控发生率以及ICU滞留时间实施前分别为26.2%（53/202）、17.8%（36/202）、18.8%（38/202）、11.9%（24/202）、2.5%（5/202）、18.3%（37/202）、15.3%（31/202）、（168.0±3.3）h;实施后分别为7.1%（14/196）、3.1%（6/196）、4.1%（8/196）、0.5%（1/196）、0、3.6%（7/196）、3.1%（6/196）、（96.0±4.2）h,差异有统计学意义（χ2=4.913~25.907,t=66.195,均P〈0.01）.结论 戴明环护理路径落实单能够提升ICU护理质量,促进护理质量同质化,减少护理不良事件及医源性并发症发生率.

Objective To explore the effect of Plan. Do-Check-Act on homogenization of nursing processes in ICU. Methods A total of 36 nurses were selected to implement Plan. Do-Check-Act in ICU according to evidence-based medicine. Their nursing was inspected by a senior nurse. The differences of the following items before and after Plan. Do-Check-Act were compared： nursing quality comprehensive quality control index and specialized quality control index. Results After the implementation of Plan. Do-Check-Act, comprehensive quality control index of clinical nursing quality score by （89.28 ± 2.36） points up to （97.45±1.38） points, and there was significant difference（t=-7.310, P〈0.01）. The specialized quality control indicators including the incidence of ventilator associated pneumonia, the incidence of catheter-related bloodstream infection, the incidence of catheter-associated urinary tract infections, the incidence of accidental extubation, the incidence of pressure sores, the incidence of glycemic out of control, the incidence of sedation out of control and retention time were 26.2%（53/202）, 17.8%（36/202）, 18.8%（38/202）, 11.9%（24/202）, 2.5%（5/202）, 18.3%（37/202）, 15.3%（31/202）, （168.0 ± 3.3） h before the implementation and 7.1%（14/196）, 3.1%（6/196）, 4.1%（8/196）, 0.5%（1/196）, 0, 3.6%（7/196）, 3.1%（6/196）, （96.0±4.2） h after the implementation. There were significant differences （χ2=4.913-25.907, t=66.195, all P〈0.01）. Conclusions The Plan. Do-Check-Act is an effective way to improve nursing quality of ICU to make it homogeneous, reduce adverse nursing and iatrogenic complications.