产房护理质量保证的实施与评价

Implementation and evaluation of quality assurance in the delivery room

目的 :定义产房助产护理质量 ,发展测量助产护理质量的工具 ,通过质量保证模式的实施与评价 ,提高助产护理质量。运用JCAHO的质量保证模式作为框架 ,明确产房助产护理质量由助产士长和每位助产士共同承担。针对产房的服务对象、护理范围 ,根据高危险性、高量的、高成本的和问题倾向性的活动等四个原则 ,产房的助产护理质量可定义为 8个方面 :产后出血的预防、新生儿窒息的预防、产妇及家属的满意度、产后随访、会阴切口感染的预防、新生儿锁骨骨折的预防、助产士的态度、知识、技能及工作满意度 ,针对这八个方面 ,制定了测量的指标、标准 ,建立阈值 ,并选择适当的收集资料的方法。将助产护理的现状与阈值比较 ,其结果显示 :我院产房在开展此项目的两年中 ,助产护理质量处于稳定和持续提高的状态。

The objectives of this project were to identify the important aspects of midwifery care in the delivery room, identify the indicators for the important aspects of midwifery care. Through implementation of quality assurance process, the quality of midwifery care was improved continuously. JCAHO's ten-step monitoring and evaluation process were used as the framework of this project. Quality assurance responsibility was assigned to not only the head midwife but also each staff midwives. According to the scope of midwifery care, and based on the four principles which were high risk, high volume, problem-prone and high cost activities, eight important aspects of midwifery care were identified which were prevention of postpartum hemorrhage, prevention of neonatal asphyxia, consumers' satisfaction, postpartum following up, prevention of infection of episiotomy, prevention of neonatal clavicular fracture, attitude knowledge and skill of midwife, and staff midwife's job satisfaction. For each eight aspects, indicators were identified, threshold for evaluation were established and data collecting methods were determined. Comparing performance with thresholds showed that for each eight aspect,the threshold were not reached, and it indicated that quality of midwifery care was stable and continuously improved in our hospital.