基于根因分析法的持续质量改进降低PICC患者非计划性拔管率的研究

A root cause analysis-based study of reducing unplanned extubation rate in patients with PICC by continuous quality improvement

目的:对PICC患者发生非计划性拔管进行根因分析,提出改进策略,降低非计划性拔管率。方法:采用非同期对照实验,将2016年12月至2017年5月的373例PICC患者设为对照组,2017年6月至2017年11月的340例PICC患者设为观察组,观察两组非计划性拔管率、PICC维护的依从性、并发症的发生率和护理满意度。结果:对照组PICC患者中发生非计划性拔管28例,占7.5%。观察组发生非计划拔管12例,占3.5%,非计划性拔管率低于对照组(P<0.05);PICC维护依从性显著高于对照组(P<0.01);并发症发生率低于对照组(P<0.05);护理工作满意度评分除患者接受度及对日常生活的影响外,其余项目均高于对照组(P<0.01)。结论:护理人员将根因分析法应用于PICC持续质量改进中,通过术前全面评估、高质量护理宣教、优化固定方法等,能有效降低PICC非计划性拔管的发生率。

Objective: To analyze the root causes of unplanned extubations in patients with peripherally inserted central catheter(PICC), to propose strategies for improvement, and to reduce the unplanned extubation rate.Methods: In the non-concurrent control experiment, 373 patients with PICC from December 2016 to May 2017 were assigned into control group, and 340 patients with PICC from June to November, 2017 were assigned into observation group. The root causes of unplanned extubations in the control group were analyzed, and strategies for improvement were proposed and applied to the observation group. Both groups were observed for unplanned extubation rate, compliance with PICC maintenance, incidence rate of complications, and degree of satisfaction with nursing.Results: There were 28 unplanned extubations(7.5%) in the patients with PICC in the control group. Based on root cause analysis, the unplanned extubations were related to incomplete preoperative evaluation, unimplemented propaganda and education, and unscientific fixation. There were 12 unplanned extubations(3.5%) in the observation group. Compared with the control group, the observation group had significantly lower unplanned extubation rate and incidence rate of complications(both P < 0.05), but significantly higher compliance with PICC maintenance(P <0.01). There were significant differences between the two groups in all respects relevant to degree of satisfaction with nursing except for degree of patient’s acceptance and impact on daily life(P < 0.01). Conclusion: After nursing staff’s adoption of root cause analysis in continuous quality improvement of PICC, the unplanned extubation rate in patients with PICC can be effectively reduced by comprehensive preoperative evaluation, high-quality nursing propaganda and education, and fixation method optimization.