FOCUS-PDCA程序在心力衰竭患者容量管理中的应用

Application of FOCUS-PDCA program in volume management in patients with heart failure

目的探索FOCUS-PDCA两阶段持续质量改进程序在心内科心力衰竭患者容量管理中的应用效果。方法选择2023年1-12月该院心内科收治的45例心力衰竭患者为研究对象,分为对照组和试验组。对照组采用原流程;试验组采用基于FOCUS-PDCA程序改进后的新流程,即以容量状态平衡控制为目标,以医生、护士、患者、物品、管理为视角,提出6项主要举措,建立质量不断改进的工作机制。收集患者治疗10 d减容量,入院时、治疗10 d患者N末端B型钠尿肽前体(NT-proBNP)水平,出院30 d再入院率、容量管理重点护理措施规范执行率、住院期间再发急性心力衰竭等资料进行比较。结果试验组治疗10 d减容量明显高于对照组(P<0.05)。入院时和治疗10 d后,两组间NT-proBNP水平比较,差异均无统计学意义(P>0.05)。出院后,试验组出院30 d再入院率为0.0%,明显低于对照组的17.4%(P<0.05)。住院期间,试验组重点护理措施规范执行率为95.5%,高于对照组的69.6%(P<0.05)。住院期间,试验组中0例(0.0%)患者再发急性心力衰竭,对照组中4例(17.4%)患者再发急性心力衰竭,两组比较,差异有统计学意义(P<0.05)。结论FOCUS-PDCA程序有效提升了临床对心力衰竭患者容量平衡状态的管理能力,形成质量持续改进的工作机制,具有较好的推广和应用价值。

Objective To explore the application effect of FOCUS-PDCA two-stage continuous quality improvement program in the volume management in the patients with heart failure in the cardiology department.Methods Forty-five patients with heart failure admitted and treated in the cardiology department of this hospital from January 2023 to December 2023 were selected as the study subjects and divided into the control group and experimental group.The control group adopted the original process;the experimental group adopted a new process based on FOCUS-PDCA program improvement,which taked the capacity state balance control as the goal and doctor,nurse,patient,item,management as the perspective,six main measures were proposed to establish a working mechanism for continuous quality improvement.The volume reduction during 10 d treatment was collected,the N-terminal B-type natriuretic peptide precursor(NT-proBNP)levels at admission and after 10 d treatment,readmission rate after 30 d of discharge,standardized implementation rate of key nursing measures for volume management,and recurrence of acute heart failure during hospitalization were collected and compared.Results The capacity reduction after 10 d treatment in the experimental group was significantly higher than that in the control group(P<0.05).At admission and after 10 d treatment,there was no statistically significant difference in the NT-proBNP level between the two groups of patients(P>0.05).After discharge,the readmission rate after 30 d of discharge in the experimental group was 0.0%,which was significantly lower than 17.4%in the control group(P<0.05).The standardized implementation rate of key nursing measures during hospitalization in the experimental group was 95.5%,which was higher than 69.6%in the control group(P<0.05).During hospitalization,there were 0 case(0.0%)of recurrent acute heart failure in the experimental group and 4 cases(17.4%)of recurrent acute heart failure in the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusion T he FOCUS-PDCA program effectively enhances the management ability of volume balance status in heart failure patients,forms the quality continuous improvement working mechanism,and has good promotion and application value.