运用PDCA循环管理降低血液肿瘤患儿医用粘胶相关性皮肤损伤发生率
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摘要
目的探讨运用PDCA循环管理降低血液肿瘤患儿医用粘胶相关皮肤损伤(MARSI)发生率的效果。方法分析科室血液肿瘤患儿MARSI发生现状,查找原因,运用PDCA循环管理持续改进MARSI防控质量。PDCA管理实施前(2017年1月—11月)和实施后(2018年2月—12月)分别选取25例患儿为研究对象。记录MARSI发生情况,评价实施前后护士对MARSI认知和MARSI预防能力。结果实施前25例患儿共计接受化疗201次,MARSI发生15(7.46%)次;实施后25例患儿共计接受化疗209次,MARSI发生2(0.96%)次,差异有统计学意义(P<0.05)。实施PDCA循环管理后,护士MARSI认知程度和MARSI预防能力评分均较实施前提高(P<0.01),护理质量评分提高(P<0.01)。结论实施PDCA管理模式能够有效提高儿科护理质量,提高护士对MARSI认知及预防能力,降低血液肿瘤患儿MARSI的发生风险。
Objective To investigate the effect of plan-do-check-act(PDCA) cycle in reducing the incidence of medical adhesive-related skin injuries(MARSI) in children with hematologic neoplasms. Methods The management tools based on PDCA cycle were adopted to analyze current situation and potential reasons of MARSI in children with hematologic neoplasms. Corresponding measures were carried out to improve the nursing quality continuously. The incidence of MARSI in 50 children recruited before implementation of PDCA cycle(January to November, 2017) and in 50 children recruited after implementation of PDCA cycle(February to December, 2018) was compared. The MARSI-related disease awareness and preventive skills of nurses were evaluated. Results Totally 402 times of chemotherapy were performed before implementation of PDCA, and 15(7.46%) times of MARSI were reported, which was higher than 2(0.96%)times of MARSI among 417 times of chemotherapy after implementation of PDCA(P<0.05). Nurses achieved better outcomes in assessment MARSI-related disease awareness and preventive skills after implementation of PDCA(P<0.01), as well as nursing quality assessment(P<0.01). Conclusion The PDCA cycle is an effective tool to improve quality of pediatric nursing, enhance the MARSI-related disease awareness and preventive skills of pediatric nurses, and reduce the risk of MARSI in children with hematologic neoplasms.
Objective To investigate the effect of plan-do-check-act(PDCA) cycle in reducing the incidence of medical adhesive-related skin injuries(MARSI) in children with hematologic neoplasms. Methods The management tools based on PDCA cycle were adopted to analyze current situation and potential reasons of MARSI in children with hematologic neoplasms. Corresponding measures were carried out to improve the nursing quality continuously. The incidence of MARSI in 50 children recruited before implementation of PDCA cycle(January to November, 2017) and in 50 children recruited after implementation of PDCA cycle(February to December, 2018) was compared. The MARSI-related disease awareness and preventive skills of nurses were evaluated. Results Totally 402 times of chemotherapy were performed before implementation of PDCA, and 15(7.46%) times of MARSI were reported, which was higher than 2(0.96%)times of MARSI among 417 times of chemotherapy after implementation of PDCA(P<0.05). Nurses achieved better outcomes in assessment MARSI-related disease awareness and preventive skills after implementation of PDCA(P<0.01), as well as nursing quality assessment(P<0.01). Conclusion The PDCA cycle is an effective tool to improve quality of pediatric nursing, enhance the MARSI-related disease awareness and preventive skills of pediatric nurses, and reduce the risk of MARSI in children with hematologic neoplasms.
引文
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[11] 栗英,刘延锦,李星,等.开展品管圈活动降低蝶翼无损伤针二次固定率[J].护理学杂志,2014,29(24):47-50.
[12] NOONAN C,QUIGLEY S,CURLEY M A.Skin integrity in hospitalized infants and children:a prevalence survey[J].J Pediatr Nurs,2006,21(6):445-453.
[13] 贾丽娜,陆燕萍,袁春香,等.新生儿医用粘胶相关性皮肤损伤的研究现状[J].中西医结合护理(中英文),2018,4(1):169-172.
[14] 张宇,王欣然,张晓雪.ICU患者医用粘胶相关性皮肤损伤防控新进展[J].护理管理杂志,2017,17(12):914-917.
[15] 白姗,杨巧芳,董方方.医用粘胶相关性皮肤损伤现况调查[J].护理学杂志,2017,32(18):14-17.
[16] 莫雄飞,吉东娅,黄志萍,等.PDCA循环质量管理工具对输液港中使用无损伤穿刺针效果的评价[J].护理实践与研究,2017,14(16):102-104.
[17] 章亚颖,赵锐炜.应用PDCA护理模式对晚期肝癌患者经外周静脉穿刺中心静脉置管护理的效果评价[J].中国医药导报,2014,11(7):123-125.
[2] 李海洋,黄金,高竹林.完全植入式静脉输液港应用及护理进展[J].中华护理杂志,2012,47(10):953-956.
[3] LEBEAUX D,FERNANDEZHIDALGO N,CHAUHAN A,et al.Management of infections related to totally implantable venous-access ports:challenges and perspectives[J].Lancet Infect Dis,2014,14(2):146-159.
[4] 高颖.无损伤针在植入式静脉输液港中的应用及管理[J].全科护理,2013,11(22):2074-2075.
[5] 沈煜,路红玲,葛琰.蝶翼无损伤针在植入式静脉输液港应用中的常见问题及对策[J].护理学杂志,2011,26(5):54-56.
[6] 余卓文,顾莺,徐晓凤.医用粘胶相关性皮肤损伤患儿1例护理[J].上海护理,2018,18(5):71-72.
[7] WARING M,BIELFELDT S,MATZOLD K,et al.A new methodology for evaluating the damage to the skin barrier caused by repeated application and removal of adhesive dressings[J].Skin Res Technol,2013,19(1):e366-e374.
[8] 林倩倩,赵广慧.品管圈降低肿瘤患者MARSI发病率效果分析[J].中国烧伤创疡杂志,2018,30(3):210-215.
[9] GORSKI L A.The 2016 Infusion Therapy Standards of Practice[J].Home Healthc Now,2017,35(1):10-18.
[10] GROVE G L,ZERWECK C R,EKHOLM B P,et al.Randomized Comparison of a Silicone Tape and a Paper Tape for Gentleness in Healthy Children[J].J Wound Ostomy Continence Nurs,2013,41(1):40-48.
[11] 栗英,刘延锦,李星,等.开展品管圈活动降低蝶翼无损伤针二次固定率[J].护理学杂志,2014,29(24):47-50.
[12] NOONAN C,QUIGLEY S,CURLEY M A.Skin integrity in hospitalized infants and children:a prevalence survey[J].J Pediatr Nurs,2006,21(6):445-453.
[13] 贾丽娜,陆燕萍,袁春香,等.新生儿医用粘胶相关性皮肤损伤的研究现状[J].中西医结合护理(中英文),2018,4(1):169-172.
[14] 张宇,王欣然,张晓雪.ICU患者医用粘胶相关性皮肤损伤防控新进展[J].护理管理杂志,2017,17(12):914-917.
[15] 白姗,杨巧芳,董方方.医用粘胶相关性皮肤损伤现况调查[J].护理学杂志,2017,32(18):14-17.
[16] 莫雄飞,吉东娅,黄志萍,等.PDCA循环质量管理工具对输液港中使用无损伤穿刺针效果的评价[J].护理实践与研究,2017,14(16):102-104.
[17] 章亚颖,赵锐炜.应用PDCA护理模式对晚期肝癌患者经外周静脉穿刺中心静脉置管护理的效果评价[J].中国医药导报,2014,11(7):123-125.