基于PDCA循环法规范结核病房痰液处置管理

Management of sputum disposal in tuberculosis ward based on PDCA circulation method

目的通过对痰液处置管理的持续质量改进，提高对传染源的控制。方法基于PDCA循环法，对结核科的痰液处置管理进行质量改进。改进前横断面调查结核病房在院的32例患者，作为对照组。PDCA第1轮主要对《痰杯发放和使用工作流程》进行了质量改进，由工人主导的工作流程改为以护士主导的工作流程，改进后横断面调查在院的36例患者，作为试验1组。针对第1轮PDCA改进中出现的专用痰杯使用率低的问题，进行了对痰杯的改进，并在此基础上设计了“专用痰液处置杯”获得了国家专利授权，第2轮改进后横断面调查在院的35例患者，作为试验2组。结果经过2轮PDCA改善，试验2组与对照组比较，床边痰杯配置不到位率从53．1％（17／32）下降至0（0／35），差异有统计学意义（χ2=24．916，P〈0．01）；配置痰杯后未使用率从53．1％（17／32）下降至8．6％（3／35），差异有统计学意义（χ2=15．846，P〈0．01）。结论PDCA循环法能提高规范痰液处置管理的质量。病房痰杯配给率是病房规范痰液消毒基础，护士介入并主导痰杯发放工作，能提高病房痰杯配给率，改进盛痰器皿（痰杯）能提高患者规范吐痰的依从性。

Objective To improvethe control of infection source by improving the continuous quality of sputum disposal management. Methods PDCA method based on the management of tuberculosis sputum disposal of the hospital quality improvement. The cross-sectional survey of tuberculosis ward in 32 cases of hospital patients, as control group.PDCA first round of ＂sputum cup distribution and use of work flow＂ for quality improvement, the reason leading the work flow of workers to nurse led work flow, the improved cross- sectional survey in 36 cases of hospital patients as experimental group l.Aiming at the problem of low utilization rate of special sputum cup in the improvement of the first round of PDCA, the improvement of the sputum cup was carried out,On this basis, the ＂special sputum disposal Cup＂ was designed to obtain the national patent authorization. After the second round of improvement, the cross-sectional investigation in 35 patients in the hospital, as the experimental group 2. Results After two rounds of PDCA improvement, experimental group 2 groups compared with control, bedside sputum cup configuration was not in place rate decreased from 53.1% （17/32） to 0,the difference was statistically significant （χ2=24.916, P〈0.05）; configuration after the sputum cup unused rate from 53.1% （17/32） down to 8.6% （3/35）, the difference was statistically significant （χ2=15.846, P〈 0.05）.Conclusion PDCA method can improve the quality of management standard sputum disposal. Ward sputum cup ration is standardized sputum disinfection ward-based nurse intervention and leading sputum cup release, ward can improve the sputum cup ration, improved sputum containers （sputum cup） can improve patient compliance standard of spitting.