品管圈对胸外科患者导管留置期间意外拔管感染的影响分析

Effect of quality control circle on accidental extubation and infections in patients with indwelling catheter in department of thoracic surgery

目的分析胸外科患者给予品管圈活动管理对导管留置期间意外拔管发生率与感染不良事件发生率的影响。方法分别选取医院2012年1月-2015年12月品管圈活动开展前后两年的胸外科住院患者263例,将2012年1月-2013年12月入院患者设为对照组126例,2014年1月-2015年12月入院患者设为试验组137例,对照组患者实施普通管道护理,试验组患者实施品管圈管道护理。对比两组患者管道防护依从性、意外拔管发生率、导管不良事件发生率及医护人员工作满意度。结果试验组患者管道防护依从性为91.24%高于对照组56.35%(P<0.05);试验组患者各类导管意外拔管总发生率为1.42%低于对照组11.83%(P<0.05);试验组患者引流导管受压、引流袋/球未拧紧、引流导管堵塞、引流导管未双固定、衔接处松脱、引流量漏记录/错误、静脉炎及感染等各类导管不良事件发生率分别为0.18%、0.18%、0.00%、0.71%、0.00%、0.53%、0.36%、0.00%低于对照组(P<0.05);试验组护理人员工作满意度和临床医师工作满意度量表评分(MMSS)分别为(4.17±0.62)分、(4.36±0.54)高于对照组(P<0.001)。结论胸外科患者实施留置导管的品管圈管理,可有效降低导管留置期间意外拔管事件发生率和感染等导管不良事件发生率,提高患者依从性和医护人员工作满意度,确保患者安全。

OBJECTIVE To analyze the effect of quality control circle management on the incidences of unexpected extubation and adverse events.METHODS A total of 263 cases of inpatients from Jan. 2012 to Dec. 2015 in depart- ment of thoracic surgery in the two years before and after the activities of quality control circle were selected, 126 cases of patients from Jan. 2012 to Dec. 2013 were set as control group, and 137 cases of patients from Jan. 2014 to Dec. 2015 were set as observation group. Patients in control group were received general nursing, and in obser- vation group were with the implementation of quality control circle pipeline nursing. The pipeline compliance, acci- dental extubation rate, incidence of catheter adverse events and job satisfaction of the medical staff were compared between the two groups.RESULTS The compliance of the patients in observation group （91.24%） was significantly higher than that in control group （56.35%） （P〈0.05）. The total incidence of catheter extubation in observation group （1.42 %） was significantly lower than that in control group （11.83 % ） （P 〈0.05）. The drainage catheter and drainage bag/compression ball no tightened, drainage catheter obstruction, drainage catheter without double fixa- tion, joint loosening and leakage drainage record/error, phlebitis and catheter infection and other adverse event rates of patients in observation group were 0.18%, 0.18%, 0.00%, 0.71%, 0.00%, 0.53%, 0.36%, and 0.00%, lower than those in the control group（P〈0.05）. The job satisfaction of nursing staff （4.17±0.62） and clinicians job satisfaction scale score （MMSS） （4.36 ± 0.54） of observation group were significantly higher than those of control group（P〈0.001）.CONCLUSION Indwelling catheter QCC management of department of thoracic surgerypatients, can effectively reduce the accidental extubation events and catheter infection rate of adverse events, im prove patient compliance and medical staff job satisfaction, and ensure the safety of the patients.