Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ2=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ2=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ2=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.
ObjectiveTo study the effect of PDCA cycle model on the standardization of the application of common disinfectants, in order to promote the management level of hospital disinfection. MethodsBy questionnaire and observation, the study was to learn the knowledge and its application in medical workers on common disinfectants. Based on the results, we tried to regulate effective preventive measures and carry out continuous improvements. ResultAfter the implementation of PDCA cycle model, the awareness rate of the medical staff on disinfection and the application accuracy of disinfectants were significantly increased (P<0.05). ConclusionThe implementation of PDCA cycle model can improve nosocomial infection management level effectively, ensure medical quality management and patients' safety, which is an effective way of management to reduce the rate of nosocomial infection.
ObjectiveTo study the effects of PDCA cycle in the control of surgical site infection (SSI). MethodsA total of 1 761 surgeries between January 2012 and December 2013 were chosen to be monitored. PDCA cycle was used as a tool of total quality management evaluation to enhance the control of SSI. ResultsAfter 2 to 4 cycles of PDCA, the preventive medication rate of ClassⅠ operation incision was decreased significantly (χ2=309.513，P<0.001) and the postoperative incision infection rate did not change significantly (χ2=1.474，P=0.669). ConclusionUsing PDCA cycle can increase SSI management level and quality significantly and total quality management can be operated effectively.
ObjectiveUtilizing PDCA circulation to enhance the quality of single photon emission computed tomography (SPECT) in whole body bone scan (WBS). MethodsBased on a retrospective analysis of the quality of WBS in the first half of year 2012, advices and measurements to improve the quality were implemented by the technologists. In the following half year of 2012, monthly evaluation of the WBS quality were carried out to further improve the quality by focusing on fine details of the patient positioning, radiopharmaceuticals injection and image processing, etc. ResultsBy utilization of PDCA circulation, WBS quality in the latter half year of 2012 constantly improved. Further more, effective and improved technical procedures were extracted from scattered individual experience, which was expected to improve the WBS quality effectively in the long run. ConclusionApplication of PDCA circulation in SPECT in whole body bone scan improves the image quality, because it not only brings better communication and understanding between patients and physicians/technologists, but also enables better patient preparations and individualized procedures based on standard protocols.
ObjectiveTo explore medical waste management method in a large hospital and strengthen the standardized management of medical waste. MethodsBetween July 2012 and December 2014, according to the PDCA cycle working procedures, existing problems were found in medical waste management through survey, the cause of which was analyzed to formulate and implement a new system of medical waste management, to help carry out employee training and cross examination, and give feedback to clinical departments to make improvements. Then, we analyzed the awareness rate of medical waste-related knowledge among medical staff, accuracy rate of medical waste disposal, average daily medical waste amount before and after the application of PDCA cycle to evaluate the effect of the measures taken. ResultsAwareness rate of medical waste-related knowledge among medical staff (2012:55.59%, 2013:62.89%, 2014:94.43%) increased with statistical significance (χ2=410.871, P<0.001). Accuracy rate of medical waste disposal (2012:69.83%, 2013:87.29%, 2014:94.91%) increased with statistical significance (χ2=197.449, P<0.001). Rank correlation analysis showed that average daily medical waste amount declined as average daily inpatients number increased (rs=?0.590, P<0.001). ConclusionUsing PDCA cycle can improve the awareness rate of medical waste-related knowledge and accuracy among medical staff to achieve continuous quality improvement of medical waste management.
ObjectiveTo explore the application of PDCA (plan, do, check, action) circulation method in basic life support (BLS) technique training among non-medical personnel in hospitals. MethodsIn a third-level grade-A hospital, BLS technique training was carried out for 66 non-medical personnel of various working categories between July and September 2011. During the training process, PDCA circulation method was applied to each step. The existing problems were searched and causes of the problems were found. Improving strategies were made and carried out, and finally, the effect of training was statistically analyzed. ResultsAfter the application of PDCA circulation method, the test scores in the three training stages were significantly different (P ＜ 0.05) . ConclusionPDCA circulation method can help non-medical personnel to master the operation process and the technique points of BLS quickly, and it also can improve the quality of BLS technique training for non-medical personnel in hospitals.
ObjectiveTo investigate the effect of PDCA circulation management on pain, psychology and prognosis of patients with thoracic aortic aneurysm in the perioperative period.Methods The clinical data of seventy-six patients with thoracic aortic aneurysm who received perioperative nursing based on PDCA circulation management from April 2016 to March 2017 were retrospective analyzed and these patients were selected as the study group, including 44 males, 32 females, aged 23–65 (47.27±5.87) years. At the same time, 72 patients with thoracic aortic aneurysm who received routine perioperative nursing from April 2015 to March 2016 were selected as the control group, including 41 males, 31 females, aged 24–67 (48.30±5.26) years. The nursing effects of the two groups were compared and analyzed.ResultsThe operation time (t=11.342, P<0.05) and hospitalization time (t=5.986, P<0.05) of the study group were significantly shorter than those of the control group. The visual analogue scale (VAS) scores of the two groups had no significant difference before nursing (t=0.914, P=0.361), but the VAS scores in the study group after nursing were obviously lower than those in the control group (t=5.475, P<0.05). The self-rating depression scale (SDS, t=1.026, P=0.307) and self-rating anxiety scale (SAS) scores (t=7.866, P<0.05) of the two groups had no significant difference before nursing, while the SDS (t=7.657, P<0.05) and SAS (t=7.866, P<0.05) scores in the study group after nursing were obviously lower than those in the control group. The incidence of adverse reactions in the study group was significantly lower than that in the control group (χ2=4.292, P=0.038).ConclusionPDCA circulation management used in patients with thoracic aortic aneurysm in the perioperative period can effectively relieve patients' pain, depression and anxiety, reduce the incidence of adverse reactions, and the prognosis is good.
Objective To analyze the main problem of continuous hand hygiene improvement by PDCA cycle, find out the causes and carry out corresponding measures, in order to improve hand hygiene management continuously. Methods Between January and June 2014, PDCA cycle was used to strengthen comprehensive training, enhance awareness of hand hygiene, reinforce supervision, and evaluate the effect of continuous hand hygiene improvement. The knowledge of hand hygiene, increase of hand hygiene facilities, use of hand hygiene products and hand hygiene implementation before (from July to December 2013) and after PDCA application (from January to June 2014) were compared and analyzed. Results After the implementation of PDCA cycle, the pass rate of hand hygiene knowledge increased from 61.0% to 88.3%; the total amount of hand hygiene use increased from 1 817 046 mL to 3 347 386 mL; the hand hygiene compliance rate increased from 43.03% to 71.31%; and the correct rate of hand hygiene implementation increased from 62.68% to 87.68%. All the above differences were statistically significant (P<0.05). After the implementation of PDCA cycle, the compliance rate of different hand hygiene indications became significantly different (P<0.05). The growth rate of hand hygiene implementation before aseptic manipulation and after contact with body fluids were relatively higher (34.56% and 34.01%, respectively). Conclusion Through the application of PDCA cycle, hand hygiene compliance rate and correct rate have gradually increased.
Objective To explore the application effect of PDCA cycle management on reducing the unplanned overnight recovery rate in patients undergoing transabdominal preperitoneal inguinal hernia repair (TAPP) under the same-day surgery model. Methods The unplanned overnight recovery rate in patients who underwent TAPP at West China Tianfu Hospital of Sichuan University between January and October 2023 (pre-improvement phase) was analyzed. A quality control group was established, and PDCA cycle management was employed to define control objectives and implement strategies to reduce the unplanned overnight recovery rate. The unplanned overnight recovery rate in patients who underwent TAPP between November 2023 and April 2024 (post-improvement phase) was compared with that in the pre-improvement phase. Results After the implementation of PDCA cycle management, the unplanned overnight recovery rate in patients undergoing TAPP under the same-day surgery reduced from 23.87% (37/155) in the pre-improvement phase to 9.05% (19/210) in the post-improvement phase, with a statistically significant difference (P<0.05). Conclusion The application of PDCA cycle in the process management of TAPP under the same-day surgery model significantly reduces the unplanned overnight recovery rate in patients.
Objective To analyze the causes of drug dispensing errors and reduce the error rate through scientific precautions, and improve the quality of pharmaceutical service. Methods According to the PDCA cycle, existing problems were found in dispensing between January and June 2013, and the causes were analyzed. Then, from July 2013, strategies were developed to decrease the dispensing error rate. The variation trend of dispensing error rate from January 2013 to June 2017 were observed. Result The dispensing error rate decreased since the beginning of PDCA cycle, from 0.042‰ (the first quarter of 2013) to 0.003‰ (the second quarter of 2017). Conclusion The PDCA cycle is an effective intervention to detect the errors during drug delivery in inpatient pharmacy, which could improve the quality of pharmaceutical service and insure the patients’ safety.