ObjectiveTo explore the impact of continuous quality improvement on the quality of life and complications in end-stage hemodialysis patients. MethodWe reviewed the clinical data of 128 end-stage renal disease patients undergoing hemodialysis from January 2013 to January 2014. The patients were divided into observation group and control group randomly with 64 patients in each. Patients in the control group received routine nursing only during hemodialysis, while those in the observation group received extra continuous quality improvement nursing on the basis of routine one. Quality of life of the two groups of patients was evaluated by World Health Organization Quality of Life Scale-brief before and after intervention. Adverse reactions during hemodialysis were also observed in these two groups. ResultsThe incidences of hypotension, malnutrition, thrombosis, infection and arrhythmia in the observation group were significantly lower than those in the control group (P<0.05). Psychological dimension, social dimension, physiological adaptability and total scales of quality of life in the observation group were significantly better than those in the control group (P<0.05). ConclusionsContinuous quality improvement of nursing reduces the rates of complications and improves patients' quality of life.
This paper introduces the background, significance, definition and types of clinical audit and describes five stages of clinical audit, including preparing for clinical audit, selecting criteria, measuring performance and sustaining improvement. This paper also introduces the international and national status quo of implementing clinical audit in nursing practice and describes the reporting guideline for articles of clinical audit. Finally, this article suggests that providing methodological training and creating a supportive environment are crucial strategies to promote the implementation of clinical audit and bridge the gaps between evidence and practice.
ObjectiveTo analyze and reduce the defects in nursing records for blood transfusion by continuous quality improvement (CQI) method, in order to prevent blood transfusion related medical disputes. MethodsIn October 2014, CQI team was established to analyze the reason for transfusion record defects and make standardized process and quality monitoring forms for nursing record of blood transfusion. Six months after the implementation of CQI, 40 records were randomly selected before the CQI implementation (April to September 2014) and after the implementation (April to September 2015) for comparison and analysis. ResultAfter 6 months of implementation of CQI, nursing record defects of blood transfusion decreased significantly from 228 to 55 items. ConclusionUsing CQI method can effectively reduce nursing record defects of blood transfusion. CQI can also improve the quality of nursing records and prevent medical disputes caused by blood transfusion.
ObjectiveTo explore the supervision and inspection mechanism of hospital-acquired infection management at hospital-level in order to promote continuous quality improvement of hospital-acquired infection control. MethodsInstead of inspecting hospital departments only by hospital infection control professionals, the clinical hospital infection control nurses were also involved in the two cross-inspections carried out respectively in September and December, 2013, which shared the same contents, methods, and the inspectors. According to standard procedures, on-site view and inquiry methods were adopted to check the implementation of the system and measures and the infection control knowledge among medical staff. Inspection results were written down to feed back to each department with a unified form. The problems found during the two inspections were classified to be analyzed and solved. The results of the two inspections were compared to understand whether the effect of continuous quality improvement can be achieved through cross-inspections and subsequent work. ResultsThe excellent rate of department and overall accuracy rate of the second inspection increased with statistical significance compared to that of the first inspection (χ2=619.902, P=0.000; χ2=40.347, P=0.000). Meanwhile, the correct rate of each module and infection control knowledge among all kinds of medical staff also increased compared with the first inspection with statistically significant differences (P<0.05). ConclusionLong-term mechanism of cross-inspection involving hospital infection control nurses should be established to facilitate the continuous quality improvement of hospital-acquired infection management.
Objective To explore strategies to reduce the same-day cancellation rate of gynecological day surgery. Methods The same-day cancellation status of gynecological surgery in the Department of Day Surgery, West China Second University Hospital, Sichuan University from January to December 2021 (before improvement) was investigated. The causes of cancellation were analyzed from three aspects: patient-related factors, medical factors, and examination factors. Subsequently, management countermeasures were formulated for the controllable factors and continuous quality improvement was implemented. After improvement, the same-day cancellation rate of gynecological day surgery from September 2022 to January 2023 was collected and compared with that before improvement. Results Continuous quality improvement was implemented targeting three factors in day surgery, namely the short interval between patient’s visit time and pre-scheduled time, the irrational sequence of preoperative examinations for patients, and the non-standardized treatment of patients with abnormal vaginal discharge by physicians. The same-day cancellation rates of gynecological day surgery before and after the continuous quality improvement were 3.70% (156/4211) and 2.13% (30/1411), respectively, and the difference was statistically significant (χ2=8.231, P=0.004). ConclusionOptimizing the preoperative examination and admission process, effective preoperative education and physician-patient communication, establishing unified standards for the approval of vaginal discharge tests and standardized treatment protocols, and clarifying the responsibilities of the preoperative comprehensive assessment outpatient clinic along with the supervision system are effective measures to reduce the same-day cancellation rate of gynecological day surgery.
ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
目的:调查手术室实施持续质量改进(continuous quality improvement,CQI)对手术室护理工作质量、工作效率和医生、患者满意度的影响。方法:成立科室质量控制小组,全科护理人员均为责任人。根据手术室质量管理中存在的问题确立改进目标,实施CQI。质控小组定期监测及发放问卷调查并比较实施CQI前后手术室工作质量、工作效率及医生和患者的满意度。结果:实施CQI后,手术室的术前用药准备、术前平面清洁、术后整理、药品按序摆放、物品定位放置、仪器完好、器械清洗合格各项指标均较实施CQI前改善;手术等待时间缩短,手术总台次增加;医生和患者的满意度提高。结论:通过实施CQI,规范了护士的行为,提高了手术室的工作质量和工作效率,增加了医生和患者的满意度。