应用护理敏感质量指标提升血液透析质量

Application of Nursing Sensitive Quality Indicators in Continuous Improvement of Hemodialysis Quality

目的探讨护理敏感质量指标在血液透析护理质量持续改进中的应用效果。方法通过德尔菲法确定血液透析敏感指标共计11项,并于2017年4月—9月应用在血液透析质量评估中,运用SPSS 20.0统计软件对收集的指标数据进行分析。结果 11项血液透析护理敏感质量指标中,护患比符合国家标准,透析中急性并发症发生率、透析超滤达标率、透析充分性达标率、门诊透析患者急诊透析率和内瘘并发症发生率等5项指标第三季度与第二季度相比,差异有统计学意义(P<0.05),体外循环凝血发生率、体外循环失血发生率、假性动脉瘤发生率、透析患者跌倒发生率和血液透析导管相关血流感染例次发生率等5项指标第三季度与第二季度相比,差异无统计学意义(P>0.05),但指标均明显下降,并且在第三季度体外循环失血发生率、假性动脉瘤发生率和透析患者跌倒发生率均为0。结论 11项血液透析护理敏感质量指标符合科学性、实用性与敏感性原则,适合目前血液透析护理临床实践。

Objective To explore the application of nursing sensitive quality indicators in continuous improvement of hemodialysis nursing quality. Methods There were eleven hemodialysis sensitivity indicators determined by the Delphi method which was applied in the quality assessment of hemodialysis nursing from April to September 2017. The collected data on the indicators were analyzed by the SPSS 20.0 statistical software. Results Among the eleven indicators, the proportion of nurses to patients met the national requirement. There had statistical significance on the five indicators （the incidence of emergency complications in dialysis, the ultrafiltration rate, the dialysis adequacy rate, the proportion of emergency dialysis among outpatient dialysis patients, and the incidence of internal fistula complication） between the third quarter and the second quarter （ P 〈 0.05）. No statistical significance was found on the other five indicators （the incidence of coagulation in extracorporeal circuit, the incidence of bleeding during the cardiopulmonary bypass, the incidence of pseudoaneurysm, the incidence of falls and the incidence of catheter related bloodstream infections in hemodialysis patients） between the third quarter and the second quarter （ P 〉 0.05）. However, there were still a reduction in these five indicators, and the incidence of bleeding during cardiopulmonary bypass, pseudoaneurysm and the incidence of dialysis patients the incidence of falls was zero in the third quarter. Conclusion The eleven hemodialysis nursing sensitive indicators were in line with scientific, practical and sensitive principles, and suitable for the current hemodialysis nursing clinical practice.