儿童早期预警评分在儿童神经外科应用的持续质量改进

Continuous Quality Improvement of Pediatric Early Warning Score(PEWS)in Pediatric Neurosurgery

目的提高儿童神经外科护士使用儿童早期预警评分的评估准确率,并进行持续质量改进。方法2018年2-12月,以PDCA循环模式为路径,对复旦大学附属儿科医院儿童神经外科的23名护士应用儿童早期预警评分评估的情况进行现状分析,找出评估不准确的主要障碍因素,并制订、落实相应的改进措施,进行持续质量改进。对比分析持续质量改进前、后及维持期神经外科护士应用儿童早期预警评分的评估准确率。结果持续质量改进实施后,护士应用儿童早期预警评分评估的准确率得以提高,由改进前的89.15%至改进后的98.69%,并逐渐上升至改进维持阶段的99.53%,改进后、改进后维持阶段的评估准确率与改进前相比,差异均有统计学意义(P<0.05)。结论应用PDCA循环模式在儿童神经外科进行儿童早期预警评分的持续质量改进,可提高神经外科护士应用儿童早期预警评分的评估准确率,从而有助于临床护士早期发现患儿病情变化和筛查出潜在危重患儿。

objective To improve the accuracy of PEWS evaluation by the nurses in Pediatric Neurosurgery Department for continuous quality improvement.Methods From February to December 2018,the PDCA(Plan-Do-Check-Act)cycle was applied to analyze the current situation of PEWS evaluation by 23 nurses in the Pediatric Neurosurgery Department,Children's Hospital of Fudan University,to find out the major barriers of inaccurate evaluation,thus formulating and executing relevant measures for continuous quality improvement.The accuracy of PEWS evaluation by neurosurgical nurses was compared and analyzed before and after the continuous quality improvement,and during the maintenance period.Results After the continuous quality improvement,the accuracy of PEWS evaluation by nurses was improved from 89.15%before the improvement to 98.69%after the improvement,and gradually increased to 99.53%in the maintenance period.There were significant differences in the evaluation accuracy after the improvement and in the maintenance period when compared with that before the improvement(P<0.05).Conclusion The continuous quality improvement of PEWS by using PDCA cycle can improve the accuracy of PEWS evaluation by the nurses in the Pediatric Neurosurgery Department,which is helpful for clinical nurses to early detect the changes of pediatric condition and screen out potentially critically ill children.