质量与结果框架管理模式在静脉治疗护理管理中的应用效果

Effects of quality and outcomes framework management model on nursing management for intravenoustherapy

目的探讨英国质量与结果管理框架（QOF）管理模式在静脉治疗护理管理中的实施及效果。方法采用便利抽样法，选取2015年9月（QOF管理模式应用前）和2017年3月（QOF管理模式应用后）株洲地区12家医院105个科室。2016年1月借鉴QOF管理模式制定静脉治疗护理管理方案并实施，将2015年9月与2017年3月的静脉治疗护理质量横断面调查结果对比，比较QOF管理模式应用前后科室护士静脉输液穿刺工具的使用情况、静脉输液头皮针应用不当情况、留置静脉导管护理不当情况和留置静脉导管患者并发症情况。结果应用QOF管理模式实施静脉治疗护理管理后，科室护士使用头皮针、留置针、中心静脉导管分别为902、916、120例，与应用前比较差异有统计学意义（x2=30．84，P〈0．001）。QOF管理模式应用后，科室护士静脉输液头皮针应用不当情况为305例、留置静脉导管护理不当为145例，留置静脉导管患者并发症为90例，低于应用前的563、327、204例，差异有统计学意义（x2值分别为199．99、139．13、82．52；P〈0．01）。结论质量与结果框架管理模式可有效提高护理人员的专科护理能力，提高静脉治疗护理质量，是实现质量持续改进的有效管理模式。

Objective To explore the effects of the quality and outcomes framework （QOF） of the UK primary care in nursing management for intravenous therapy. Methods A total of 105 departments from 12 hospitals in Zhuzhou City in September 2015 （before QOF） and March 2017 （after QOF） were selected by convenient sampling. The nursing and management protocol for intravenous therapy was established and implemented with reference to the QOF management model in January 2016. The cross-sectional study results regarding the nursing quality for intravenous therapy in September 2015 and March 2017 were compared, The tool of intravenous puncture, improper use of scalp acupuncture, inappropriate nursing for indwelling catheters and the complications induced by indwelling catheters were compared before and after QOF. Results Totally 902 scalp acupunctures, 916 indwelling needles and 120 central venous catheters were found after the QOF management model was carried out for intravenous therapy, the difference was statistically significant before QOF （ X2=30.84, P 〈 0.001）. Totally 305 improper use of scalp acupunctures, 145 inappropriate nursing for indwelling venous catheters and 90 cases of complications induced by indwelling catheters were found, lower than those before QOF, for which the cases were 563, 327 and 204, respectively （ X2=199-99, 139.13, 82.52; P 〈 0.01）. Conclusions The QOF management model can effectively enhance the specialized nursing ability of nursing staff and improve the nursing quality for intravenous therapy, which is an effective management modelfor continuous quality improvement.