全面质量管理在医院医疗质量与安全管理中的运用探析

Application of Total Quality Management in Hospital Medical Quality and Safety Management

目的:观察探析全面质量管理在医院医疗质量与安全管理中的运用。方法:2016年4月,在笔者所在医院质控科管理下实施全面质量管理,在2016年4月-2018年4月管理下的医疗事件为管理后,并选取2014年4月-2016年3月接受常规医院医疗质量管理下发生的医疗事件为管理前,并于管理前后各抽查200例接受诊疗的患者。对管理前后的医疗质量、护理质量、安全质量进行对比。结果:管理后门诊首诊负责制落实率99.00%,高于管理前的73.50%,病房每日查房频率高于管理前,医疗文书书写及时率100%,高于管理前的78.00%,医疗文书书写达标率100%,高于管理前的86.00%,差异有统计学意义(P<0.05)。管理后护理文书书写合格率100%,高于管理前的91.00%,护理文书书写及时率99.50%,高于管理前的77.50%,消毒隔离合格率100%,高于管理前的84.00%,护理纠纷与投诉率2.00%,低于管理前的9.00%,差异有统计学意义(P<0.05)。管理后的不良事件发生率2.50%,低于管理前的7.00%,非预期重返手术室发生率0.50%,低于管理前的3.50%,医疗器械消毒合格率100%,高于管理前的97.50%,院内感染率0.50%,低于管理前的7.00%,医疗纠纷与投诉率1.00%,低于管理前的4.50%(P<0.05)。结论:在医院医疗质量与安全管理中,运用全面质量管理的方法,可明显提高管理后的门诊首诊负责制落实率与医疗文书书写及时率、达标率,病房每日查房频率更高,护理文书书写合格与及时率更高,护理纠纷与投诉率更低。安全管理中,消毒隔离合格率、医疗器械消毒合格率更高,不良事件发生、非预期重返手术室、院内感染率及医疗纠纷与投诉率更低,效果理想。

Objective:To explore the application of total quality and safety management in hospital.Method:In April 2016,under the management of the quality control department of our hospital,the total quality management method was implemented.The medical events under the management from April 2016 to April 2018 were selected as the post management,and the medical events under the routine hospital medical quality management method from April 2014 to March 2016 were selected as the pre management,and 200 patients were randomly selected before and after the management.Before and after the management,the medical quality,the nursing quality,and the safety quality were compared.Result:After the management,the implementation rate of the first outpatient responsibility system was 99.00%,higher than 73.50%before the management,the daily ward rounds frequency was higher than before the management,the timely writing rate of medical documents was 100%,higher than 78.00%before the management,and the standard writing rate of medical documents was 100%,higher than 86.00%before the management,with significant difference(P<0.05).After management,the qualified rate of writing nursing documents was 100%,higher than 91.00%before management,the timely rate of writing nursing documents was 99.50%,higher than 77.50%before management,the qualified rate of disinfection and isolation was 100%,higher than 84.00%before management,and the rate of nursing disputes and complaints was 2.00%,lower than 9.00%before management,with significant differences(P<0.05).The incidence of adverse events after management was 2.50%,lower than 7.00%before management,the incidence of unexpected return to the operating room was 0.50%,lower than 3.50%before management,the qualified rate of disinfection of medical devices was 100%,higher than 97.50%before management,the nosocomial infection rate was 0.50%,lower than 7.00%before management,and the rate of medical disputes and complaints was 1.00%,lower than 4.50%before management(P<0.05).Conclusion:In the hospital medical quality and safety management,the application of total quality management method can significantly improve the implementation rate of outpatient first visit responsibility system,the timely writing rate of medical documents and the rate of reaching the standard,the daily ward rounds frequency is higher,the qualified and timely writing rate of nursing documents is higher,the incidence of nursing disputes and nursing litigation are lower.In safety management,the qualified rate of disinfection and isolation,the qualified rate of medical equipment disinfection are higher,the incidence of adverse events,the incidence of unexpected return to the operating room,the nosocomial infection rate and the rate of medical disputes and complaints are lower,and the effect is ideal.