动静脉内瘘上机规范化操作质量改进中查检表的构建及应用的多中心研究

Construction and application of a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis:a multi-center study

目的探讨在动静脉内瘘规范化上机操作的质量改进中,查检表的构建及其应用价值。方法采用多中心前瞻性研究。根据动静脉内瘘上机操作流程结合文献制定查检表初稿,经过“专家咨询—修订—预调查—再修订”的方法构建查检表。各参研中心使用查检表进行初次自评,针对检出的问题,通过PDCA[即plan(计划)、do(执行)、check(检查)、action(处理)]循环法进行护理质量改进后再次进行自评。改进前、后查检表评分间的比较采用配对t检验,P<0.05为差异有统计学意义。结果①查检表概况:查检表包括10个维度(共22个条目):身份识别及核对、医嘱核对、病情评估、职业防护、手卫生时机、血管通路穿刺与药物注射、安全核查、垃圾分类及擦拭消毒、人文关怀、耗材使用,满分20分。②规范化操作护理质量持续改进后各维度查检表得分较前均提高,改进前、后总分为(14.87±3.29)和(17.66±1.97)(t=-3.276,P=0.010);其中身份识别(赋分:0.5)[(0.17±0.19)比(0.46±0.08);t=-4.529,P=0.001]、手卫生时机(赋分:4.0)[(2.83±0.87)比(3.51±0.35);t=-3.127,P=0.012]改进后得分较前提高。结论查检表可以促进规范化操作的护理质量改进,可以作为护理质量管理工具加以应用。

Objective To explore the effect of applying a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis.Methods This was a perspective and multicenter study.A quality control checklist was constructed based on the guidelines for arterio-venous access operation and the related information in the literature.The primary checklist was revised by the procedures of“consultation from experts–revision–preliminary investigation–second revision”.Self-evaluation was then conducted after use of the checklist by the several blood purification centers.The drawbacks of the checklist found by the blood purification centers were corrected through several circles of PDCA process,i.e.plan,do,check and action,to improve the nursing quality.Self-evaluation was conducted again.Paired T test was used to compare the scores from the checklist before and after the improvement.P<0.05 was considered to be statistically significant.Results①The checklist comprised of 10 dimensions and 22 items,including identity identification,doctor's order checking,condition assessment,occupational protection,hand hygiene timing,access puncture and drug injection,safety verification,garbage classification and wiping disinfection,humanistic care,and consumables use,with the full score of 20 points.②After continuous improvement of the nursing quality of standardized operation,the scores of every dimension in the checklist increased;the total scores were 14.87±3.286 and 17.66±1.973 before and after quality control respectively(t=-3.276,P=0.010),in which the scores of identity identification(score:0.5)(0.17±0.189 vs.0.46±0.084;t=-4.529,P=0.001)and hand hygiene timing(score:4.0)(2.83±0.871 vs.3.51±0.354;t=-3.127,P=0.012)increased significantly after quality control.Conclusion The checklist can promote the improvement of nursing quality in standardized arteriovenous access operation,and can be used as a tool for the management of nursing quality.