血液透析护理质量控制指标构建与应用

Construction and Application of Hemodialysis Nursing Quality Control Index

目的构建血液透析护理质量控制指标,为持续改进血液透析护理质量提供依据。方法基于文献回顾、专家评价、德尔菲法等初步确定指标,经由全国护理质量促进联盟血液净化专业组讨论后最终确定血液透析护理质量控制指标。于2021年11月在陕西省119家医院血液透析室进行试点应用。结果共确定了5项血液透析护理质量控制指标。陕西省119家医院血液透析室护患比均达到1:0.5,体外循环凝血发生率、体外循环漏血发生率、内瘘穿刺损伤发生率、血液透析导管相关血流感染发生率分别为0.468%、0.033%、0.663%、0.199‰,二级医院各项指标发生率均高于三级医院。结论血液透析护理质量控制指标适用于血液透析专科护理管理与质量评价。建议各省血液净化、护理质控中心从信息平台、质量评价标准、指标数据填报人员培训、基层帮扶、适宜血液透析护理技术推广等方面持续改进血液透析护理质量。

Objective To construct hemodialysis nursing quality control index and provide basis for continuous improvement of hemodialysis nursing quality.Methods Based on literature review,expert evaluation,Delphi consultation,preliminary indicators were determined,through the discussion by blood purification nursing professional group of the National Nursing Quality Promotion Alliance,the hemodialysis nursing quality control indicators were finally determined.In November 2021,it was piloted in hemodialysis rooms of 119 hospitals in Shaanxi Province.Results Five quality control indexes of hemodialysis nursing were determined.The nurse-patient ratio of hemodialysis rooms in 119 hospitals in Shaanxi Province reached 1:0.5.The incidence of coagulation in cardiopulmonary bypass,blood leakage in cardiopulmonary bypass,internal fistula puncture injury and hemodialysis catheter-related bloodstream infection were 0.468%,0.033%,0.663%and 0.199‰,respectively.The incidences of all indicators in secondary hospitals were higher than those in tertiary hospitals.Conclusion Hemodialysis nursing quality control index was suitable for hemodialysis specialist nursing management and quality evaluation.It was suggested that the blood purification quality control center in each province should continuously improve the quality of hemodialysis nursing from the aspects of information platform,quality evaluation standards,training of personnel filling the index data,grassroots support,and promotion of appropriate hemodialysis nursing technology.