基于FOCUS-PDCA循环管理模式对长时间滞留手术器械清洗质量的影响

Influence of FOCUS-PDCA circulation management model on the cleaning quality of long-stay surgical instruments

目的探讨基于FOCUS-PDCA(F:发现问题,O:组织团队,C:澄清问题,U:原因分析,S:选择改进流程;P:计划,D:实施,C:检查,A:处理)循环管理模式在长时间滞留手术器械清洗中的应用效果。方法将2019年1月至4月本院行基于FOCUS-PDCA循环管理模式前管理的60562件手术器械(放置时间超过12 h)作为对照组,将2019年5月至8月本院行基于FOCUS-PDCA循环管理模式后管理的手术器械(放置时间超过12 h)64803件纳入观察组。对照组采用常规清洁消毒管理模式;观察组采用基于FOCUS-PDCA循环管理,以提高长时间滞留手术器械清洗质量作为质量改进选题,成立质量持续改进小组,从人员、成本、设备设施及管理4个方面分析原因,确立夜间手术器械滞留手术室、供应室人力不足、回收不及时、清洗难度较大、使用后的器械未进行预处理与保湿、岗位职责不明确、清洗工具选择不当等因素为主要影响因素,并采取多种措施验证改进。对比两组手术器械返洗率及21名手术医生对两组手术器械的使用满意度。结果观察组手术器械返洗率低于对照组[1.30%(84/64803)比3.68%(223/60562)],两组比较差异有统计学意义(P<0.001);21名手术医生对观察组手术器械的使用满意度高于对照组[100.00%(21/21)比66.67%(14/21)],两组比较差异有统计学意义(χ2=8.400,P=0.004)。结论基于FOCUS-PDCA循环管理模式在提升长时间滞留手术器械清洗质量中具有较好的应用效果,有利于提高器械清洗合格率,降低器械返洗率,提升医师器械使用满意度。

Objective To explore the application effect of FOCUS-PDCA(plan,do,check,and action)cycle management model in the cleaning of long-stay surgical instruments.Methods From January to April 2019,60562 surgical instruments which were placed for more than 12 hours in our hospital before the implementation of FOCUS-PDCA cycle management model,were selected as a control group.From May to August 2019,64803 surgical instruments which were placed for more than 12 hours in our hospital after the implementation of FOCUS-PDCA cycle management model,were selected as an observation group.The control group received the routine cleaning and disinfection management model,and the observation group received the FOCUS-PDCA cycle management model.The quality improvement topic was improving the cleaning quality of long-stay surgical instruments,and a continuous quality improvement team was set up to analyze the reasons from four aspects:personnel,cost,equipment and facilities,and management.It was established that the main influencing factors were the detention of surgical instruments in the operating room at night,insufficient manpower in the supply room,untimely recovery,difficulty in cleaning,no pretreatment and moisturizing of the used instruments,unclear job responsibilities,improper selection of cleaning tools,and other factors.A variety of measures were taken to verify the improvement.The rewashing rate of surgical instruments and the satisfaction of 21 doctors on surgical instruments were compared between the two groups.Results The rewashing rate of surgical instruments in the observation group was lower than that in the control group[1.30%(84/64803)vs.3.68%(223/60562)],with a statistically significant difference(P<0.001).The satisfaction degree of 21 doctors on surgical instruments in the observation group was higher than that in the control group[100.00%(21/21)vs.66.67%(14/21)],with a statistically significant difference(χ2=8.400,P=0.004).Conclusions The FOCUS-PDCA cycle management model has a good application effect in improving the cleaning quality of long-stay surgical instruments,which is beneficial to improving the qualification rate of instrument cleaning,reducing the rewashing rate of surgical instruments,and improving the satisfaction of doctors in the use of surgical instruments.