中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (10): 775-779.doi: 10.3969/j.issn.1671-4091.2022.10.016

• 护理研究 • 上一篇    下一篇

动静脉内瘘上机规范化操作质量改进中查检表的构建及应用的多中心研究

王 颖  张秋月  梁俊卿  马思慧  丁 红  罗 莉  侯玉霞  郭 苹  于海艳  平金超  彭 颖  姜晓蕊  甘良英  左 力  王 梅
  

  1. 100044 北京，1北京大学人民医院肾内科
    101149 北京，2北京市潞河医院血液净化中心
    101500 北京，3北京市密云区医院血液净化中心
    102200 北京，4北京大学国际医院血液净化中心
    100043 北京，5北京市石景山区医院血液净化中心
    100012 北京，6北京航空总医院血液净化中心
    100068 北京，7中国康复研究中心北京博爱医院血液净化中心 
    102200 北京，8北京市昌平区医院血液净化中心
    100044 北京，9北京市西城区展览路医院血液净化中心
    266300 胶州，10青岛市胶州胶东白求恩血液净化中心

  • 收稿日期:2022-03-03 修回日期:2022-07-11 出版日期:2022-10-12 发布日期:2022-10-12
  • 通讯作者: 甘良英 E-mail:ganl@bjmu.edu.cn
  • 基金资助:
    北京市科学技术委员会首都临床特色应用研究支持项目(Z131107002213122)

Construction and application of a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis: a multi-center study 

WANG Ying, ZHANG Qiu-yue, LIANG Jun-qing, MA Si-hui, DING Hong, LUO Li, HOU Yu-xia, GUO Ping, YU Hai-yan, PING Jin-chao, PENG Ying, JIANG Xiao-rui, GAN Liang-ying, ZUO Li, WANG Mei   

  1. epartment of Nephrology, Peking University People’s Hospital, Beijing 100044, China; 2 Center of Blood Purification, Beijing Luhe Hospital, Beijing 101149, China; 3Center of Blood Purification, Miyun District Hospital, Beijing 101500, China; 4Center of Blood Purification, Peking University International Hospital, Beijing 102200, China; 5Center of Blood Purification, Shijingshan District Hospital, Beijing 100043, China; 6Center of Blood Purification, Beijing Aviation General Hospital, Beijing 100012, China; 7Center of Blood Purification, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China; 8Center of Blood Purification, Changping District Hospital, Beijing 102200, China; 9Center of Blood Purification, Xicheng District Zhanlan Road Hospital, Beijing 100044, China; 10Jiaodong Bethune Center of Blood Purification, Jiaozhou 266300, China
  • Received:2022-03-03 Revised:2022-07-11 Online:2022-10-12 Published:2022-10-12
  • Contact: 100044 北京，1北京大学人民医院肾内科 E-mail:ganl@bjmu.edu.cn

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摘要： 探讨在动静脉内瘘规范化上机操作的质量改进中，查检表的构建及其应用价值。 方法  采用多中心前瞻性研究。根据动静脉内瘘上机操作流程结合文献制定查检表初稿，经过“专家咨询—修订—预调查—再修订”的方法构建查检表。各参研中心使用查检表进行初次自评，针对检出的问题，通过PDCA[即plan(计划)、do(执行)、check(检查)、action(处理)]循环法进行护理质量改进后再次进行自评。改进前、后查检表评分间的比较采用配对t检验，P＜0.05为差异有统计学意义。 结果  ①查检表概况：查检表包括10个维度(共22个条目)：身份识别及核对、医嘱核对、病情评估、职业防护、手卫生时机、血管通路穿刺与药物注射、安全核查、垃圾分类及擦拭消毒、人文关怀、耗材使用，满分20分。②规范化操作护理质量持续改进后各维度查检表得分较前均提高，改进前、后总分为(14.87±3.29)和(17.66±1.97)(t=-3.276，P=0.010)；其中身份识别(赋分：0.5)[(0.17±0.19)比(0.46±0.08)；t=-4.529，     P=0.001]、手卫生时机(赋分：4.0)[(2.83±0.87)比(3.51±0.35)；t=-3.127，P=0.012]改进后得分较前提高。 结论  查检表可以促进规范化操作的护理质量改进，可以作为护理质量管理工具加以应用。

关键词: 查检表, 动静脉内瘘, 血液透析, 规范化操作, 质量改进

Abstract: Objective  To explore the effect of applying a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis.  Methods  This was a perspective and multi-center study. A quality control checklist was constructed based on the guidelines for arterio-venous access operation and the related information in the literature. The primary checklist was revised by the procedures of “consultation from experts – revision – preliminary investigation – second revision”. Self-evaluation was then conducted after use of the checklist by the several blood purification centers. The drawbacks of the checklist found by the blood purification centers were corrected through several circles of PDCA process, i.e. plan, do, check and action, to improve the nursing quality. Self-evaluation was conducted again. Paired T test was used to compare the scores from the checklist before and after the improvement. P <0.05 was considered to be statistically significant.   Results   ①The checklist comprised of 10 dimensions and 22 items, including identity identification, doctor's order checking, condition assessment, occupational protection, hand hygiene timing, access puncture and drug injection, safety verification, garbage classification and wiping disinfection, humanistic care, and consumables use, with the full score of 20 points. ②After continuous improvement of the nursing quality of standardized operation, the scores of every dimension in the checklist increased; the total scores were 14.87±3.286 and 17.66±1.973 before and after quality control respectively (t=-3.276, P=0.010), in which the scores of identity identification (score: 0.5) (0.17±0.189 vs. 0.46±0.084; t=-4.529, P =0.001) and hand hygiene timing (score: 4.0) (2.83±0.871 vs. 3.51±0.354; t=-3.127, P=0.012) increased significantly after quality control.  Conclusion  The checklist can promote the improvement of nursing quality in standardized arterio-venous access operation, and can be used as a tool for the management of nursing quality.

Key words: Quality checklist, Arterio-venous fistula, Hemodialysis, Standardized operation, Quality improvement

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