基于持续质量改进医疗管理模式对医院门诊患者感染的影响
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摘要
目的探讨基于持续质量改进医疗管理模式对医院门诊感染的影响。方法医院于2015年7月开始实施基于持续质量改进的医疗管理模式,选取2015年3-10月于医院就职的护士为研究对象,其中30名护士进行管理质量考核,另选取实施前(2015年3-6月)、实施后(2015年7-10月)患者各120例作为调查对象,观察实施前、实施后的管理质量、护理满意度、感染发生率、医患纠纷发生率,同时统计卫生指标合格情况。结果实施后护士应急能力、沟通能力、感染知识、操作技能、书写规范性、抗菌药物管理、责任意识评分分别为(3.28±1.01)、(3.64±1.15)、(3.75±1.20)、(3.58±1.13)、(3.49±1.11)、(3.59±1.12)、(3.67±1.15)分高于实施前(P<0.05);实施后患者对就诊环境、沟通技巧、服务态度、健康宣传、隔离消毒评分分别为(7.35±2.14)、(7.98±1.35)、(7.65±2.01)、(7.86±2.13)、(7.76±2.17)分高于实施前(P<0.05);实施后医源性感染与医患纠纷发生率分别为5.83%和1.67%低于实施前15.00%、8.33%(P<0.05);实施后手卫生、消毒液标准、使用器械、空气质量合格率分别为97.50%、96.83%、92.55%、93.98%高于实施前(P<0.05)。结论基于持续质量改进医疗管理模式能有效降低医院门诊感染发生率,提高管理质量和护理满意度,具有一定的临床价值。
OBJECTIVE To explore the influence of medical management model based on continuous quality improvement on hospital outpatient infection.METHODS The hospital began to implement the medical management model based on continuous quality improvement in Jul.2015.Thirty nurses who worked in the hospital from Mar.2016 to Oct.2015 were selected as the research objects,and 120 patients treated in the hospital from Mar.2015 to Jun.2015 and another 120 patients from Jul.2015 to Oct.2015 were selected as the objects of investigation to observe the management quality,nursing satisfaction,incidence of infection,incidence of doctor-patient disputes,and qualified rate of health indicators before and after the implementation.RESULTS After implementation,nurses' emergency response ability,communication ability,infection knowledge,operation skills,writing normalization,antimicrobial management and responsibility sense scores were(3.28±1.01),(3.64±1.15),(3.75±1.20),(3.58±1.13),(3.49±1.11),(3.59±1.12),and(3.67±1.15),significantly higher than those before implementation(P<0.05).After implementation,hospital environment,communication skills,service attitude,health propaganda and isolation disinfection scores were(7.35±2.14),(7.98±1.35),(7.65±2.01),(7.86±2.13),and(7.76±2.17),significantly higher than those before the implementation(P<0.05).After implementation,the incidence of iatrogenic infection and doctor-patient disputes was 5.83% and 1.67% respectively,which was significantly lower than the values(15.00%and 8.33%)before implementation(P<0.05).After implementation,hand hygiene,disinfectant standard,apparatus and air quality qualification rates were 97.50%,96.83%,92.55% and93.98%,significantly higher than those before implementation(P<0.05).CONCLUSION Medical management model based on continuous quality improvement can effectively reduce the incidence of nosocomial infection in outpatient department,and improve management quality and nursing satisfaction,and therefore has certain clinical value.
OBJECTIVE To explore the influence of medical management model based on continuous quality improvement on hospital outpatient infection.METHODS The hospital began to implement the medical management model based on continuous quality improvement in Jul.2015.Thirty nurses who worked in the hospital from Mar.2016 to Oct.2015 were selected as the research objects,and 120 patients treated in the hospital from Mar.2015 to Jun.2015 and another 120 patients from Jul.2015 to Oct.2015 were selected as the objects of investigation to observe the management quality,nursing satisfaction,incidence of infection,incidence of doctor-patient disputes,and qualified rate of health indicators before and after the implementation.RESULTS After implementation,nurses' emergency response ability,communication ability,infection knowledge,operation skills,writing normalization,antimicrobial management and responsibility sense scores were(3.28±1.01),(3.64±1.15),(3.75±1.20),(3.58±1.13),(3.49±1.11),(3.59±1.12),and(3.67±1.15),significantly higher than those before implementation(P<0.05).After implementation,hospital environment,communication skills,service attitude,health propaganda and isolation disinfection scores were(7.35±2.14),(7.98±1.35),(7.65±2.01),(7.86±2.13),and(7.76±2.17),significantly higher than those before the implementation(P<0.05).After implementation,the incidence of iatrogenic infection and doctor-patient disputes was 5.83% and 1.67% respectively,which was significantly lower than the values(15.00%and 8.33%)before implementation(P<0.05).After implementation,hand hygiene,disinfectant standard,apparatus and air quality qualification rates were 97.50%,96.83%,92.55% and93.98%,significantly higher than those before implementation(P<0.05).CONCLUSION Medical management model based on continuous quality improvement can effectively reduce the incidence of nosocomial infection in outpatient department,and improve management quality and nursing satisfaction,and therefore has certain clinical value.
引文
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[2]呼和.持续质量改进在医院感染管理中的应用评价[J].内蒙古医学杂志,2016,48(4):478-479.
[3]熊星.持续质量改进在医院医疗废物处置管理中的应用效果分析[J].中国地方病防治杂志,2014,29(S1):339.
[4] McFadden KL,Stock GN,Gowen CR 3rd.Leadership,safety climate,and continuous quality improvement:impact on process quality and patient safety[J].J Nurs Adm,2014,40(10):S27-37.
[5]孙玉玲,靳秀花.持续质量改进在新生儿重症监护室医院感染管理中的应用[J].青海医药杂志,2015,45(11):45-46.
[6] Gould DJ,Gallagher R,Allen D.Leadership and management for infection prevention and control:what do we have and what do we need?[J].J Hosp Infect,2016,94(2):165-168.
[7] Kalil AC,Metersky ML,Klompas M,et al.Management of adults with hospital-acquired and ventilator-associated pneumonia:2016clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J].Clin Infect Dis,2016,63(5):e61-e111.
[8] Wagner AD,Mugo C,Bluemer-Miroite S,et al.Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge[J].AIDS,2017,31(3):S243-S252.
[9] Atkinson RA,Jones A,Ousey K,et al.Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis[J].J Hosp Infect,2017,95(2):148-153.
[10]陶华,李高亮.消毒供应中心持续质量改进在医院感染管理中的应用[J].中华医院感染学杂志,2013,23(9):2161-2163.
[11] Loveday HP,Wilson JA,Pratt RJ,et al.epic3:national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England[J].J Hosp Infect,2014,86(Suppl 1):S1-S70.
[12]王清梅,胡阳琼,毛长庚,等.持续质量改进在预防和控制医院感染中的应用[J].解放军护理杂志,2014,31(3):54-55.