Continuous Improvement Of Nursing Quality Research Articles

Effects of a special continuous quality improvement in nursing on the management of adverse care events: a retrospective study

ObjectiveTo explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events.MethodsThe implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015–2018) and after implementation (2019–2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups.ResultsThe rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X2 = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001).ConclusionThe direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.

Analysis of the Application Value of Continuous Nursing Quality Improvement in Improving the Nursing Quality of Emergency Pre-examination Triage

Analysis of the Application Value of Continuous Nursing Quality Improvement in Improving the Nursing Quality of Emergency Pre-examination Triage

Application of Continuous Nursing Quality Improvement in Pediatric Outpatient Nursing Risk Management

Application of Continuous Nursing Quality Improvement in Pediatric Outpatient Nursing Risk Management

Evaluation of the effectiveness of specialized nursing team in the management of critical patients

Objective To explore the application effect of a specialized team consisting of specialist nurses and some emergency care′s or intensive care′s head nurses of critically ill patients in the hospital. Methods From 2016 to 2018, the Critical Care Professional Group of implemented a provincial and above specialist nurses and the backbone of the specialist care departments of the acute and critical departments. A total of 23 members were composed of core members. A total of 56 liaison officers from each ward were selected to participate. The training and assessment activities presided over by the core staff of the professional group; at the same time, the professional group liaison officer is also the leader of the critical care quality control team in this ward, and implements the quality control of critical care patients; the core members are responsible for the guidance of the nursing care of critical patients in the hospital. The liaison staff carries out the training and assessment of the intensive care knowledge, skills and related nursing standards, norms, as well as the sharing of new technologies and new projects or research topics for acute and critical care, and the training of intensive care posts in the hospital. Before and after the operation of the specialized nursing team, the quality control scores of critically ill patients in 2015-2018, the satisfaction survey of nursing, the number of patents published by nurses in 2-25 years, the mortality rate of patients, and the results of unplanned extubation in 2016-2018 Compare. Results The quality control scores of critical care patients in 2015-2018 were 93.91±1.23, 94.07±1.38,94.33±1.24, 95.42±1.56. The difference was statistically significant (F=49.597, P < 0.01). Satisfaction survey scores were 94.92±2.28, 97.08±1.37, 97.82±1.52, 97.94±1.68, the difference was statistically significant (F=30.882, P < 0.01); work 2-20 years The number of nurses was 678, 809, 853, and 925 respectively. The number of patents published was 76, 119, 147, and 237, respectively. The difference was statistically significant (χ2=36.77, P < 0.01). 2016-2018 unplanned extubation rate was 4.98‰(127/25 517), 4.01‰(115/28 713), 3.25‰(112/34 493), the difference was statistically significant (χ2=10.958, P <0.01). Conclusions The professional nursing team operation mode can improve the core ability and comprehensive quality of nursing staff's intensive care, improve the quality of care management of critically ill patients, ensure patient safety, and achieve continuous improvement of nursing quality. Key words: Specialist nurse; Intensive care; Professional team; Nursing quality

Establishment and Implementation of Central Venous Line Management Information System in Cancer Special Hospital

Objective To establish and implement a central venous linemanagement information system based on the hospital information system (HIS). Methods The central venous line information management system was developed by the infusion therapygroup and the information technology department according to the requirement of completed central venous line management and the Chinese intravenous nursing practice standard. Results ① A complete information management system was constructed for central venous line from placement, maintenance and management of complications to drawing tube, and it operated smoothly. ② Totally, 4304 cases of PICC, 14,330 cases of CVC and 123 cases of PORT were collected from January 2016 to December 2017. The information of the maintenance number, catheter retention time, complications can be counted. Conclusions The central venous vein management information management system can realize the whole-process management, and ensure the continuous evaluation, maintenance and tracking of the patient's central venous line, making detailed statistical analysis of catheter-related complications, whichcan provide reliable basis for continuous nursing quality improvement. Key words: Central venous; Information systems; Nursing care; Establishment

Effects of Nursing Quality Improvement on Thrombolytic Therapy for Acute Ischemic Stroke.

Background and purpose: Intravenous thrombolytic therapy significantly improves the outcomes of acute ischemic stroke patients in a time-dependent manner. The aim of this study was to investigate whether continuous nursing quality improvement in stroke nurses has a positive effect on reducing the time to thrombolysis in acute ischemic stroke.Methods: The implementation of nursing quality improvement measures includes establishing full-time stroke nurses, pre-notification by emergency medical services (EMS), stroke team notification protocols, rapid triage, publicity and education, etc. Using a history-controlled approach, we analyzed acute ischemic stroke patients with intravenous thrombolysis during a pre-intervention period (April 1, 2015-July 31, 2016), trial period (August 1, 2016-October 31, 2016), and post-intervention period (November 1, 2016-September 30, 2017). This was done in accordance with the implementation of nursing quality improvement measures, including the general characteristics of the three groups, the time of each step in the process of thrombolysis, and the prognosis.Results: After the implementation of nursing quality improvement measures, the median door-to-needle time (DNT) was shortened from 73 min (interquartile range [IQR] 62–92 min) to 49 min (IQR 40-54 min; p < 0.001) in the post-intervention period. The median onset-to-needle time (ONT) was reduced from 193 min (IQR 155–240 min) to 167 min (IQR 125-227 min; p < 0.001). The proportion of patients with DNT ≤ 60 min increased from 23.94% (51/213) to 86.36% (190/220; p < 0.001) while the proportion of patients with DNT ≤ 40 min increased from 3.29% (7/213) to 25.00% (55/220; p < 0.001). The median time for door-to-laboratory results was decreased from 68 min to 56 min (p < 0.001). There was no significant difference in the fatality rate, 90-day modified Rankin score, length of stay or hospitalization expenses between the three groups of patients (p> 0.05).Conclusions: Implementation of nursing quality improvement measures in stroke nurses is an important factor in shortening the time of medication in patients with thrombolytic therapy, reducing the delay of intravenous thrombolysis in the hospital and helping to expedite presenting patients' arrival to the hospital post-stroke.

Research about evaluation index system of home treatment quality for chronic wound patients with negative pressure therapy

Objective To study the evaluation index system for home treatment quality of negative pressure therapy. Methods Two-round Delphi expert consultation method was used to consult 20 experts, so as to initially establishthe quality evaluation index system. Results An evaluation index system for home treatment quality of negative pressure therapy was formed, including 4 items of primary indexes, 13 items of secondary indexes and 30 items of tertiary indexes. Conclusions The evaluation index system for home treatment quality of negative pressure therapy in patients with chronic wounds has a clear hierarchy, the reliability of the research results is high, which provides a standardized reference for the objective evaluation of the work and the continuous improvement of nursing quality. Key words: Chronic wounds; Delphi expert consultation method; Quality evaluation index system; Home treatment of negative pressure therapy

Implementation and effects assessment of precise quality control model mediated by nursing quality indexes in nursing quality management

Objective To explore the implementation methods and effects of precise quality control model mediated by nursing quality indexes in quality management. Methods Fifty-seven care units with complete quality control data were collected. From January to December 2015, the 57 using the traditional quality control mode were selected as control group, whilst from January to December 2016 57 units were chosen for the intervention group using precision quality control mode, that was, to select the number of indicators and target values, screening quality control points, unified the acquisition path of indicators, lock the key departments and monitoring points affecting the quality to carry out quality management performance. We observed the changes of the two groups of quality indicators. Results The nine process quality indicators including wards 6S management, first aid techniques, health education, primary care, first class and critical care nursing, safe treatment, operating nursing documents, drug and sterile product quality and pass rate of identity verification were significant difference between the two groups (P<0.05) . The five outcome quality indicators including hospitalized patients fall, dosing defects, hospital pressure sores, burns and urinary uncontrolled extubation rates were significant difference between the two groups (P<0.05) as well. Conclusions The quality control model, which is mediated by the nursing quality index, is helpful to improve the nursing quality. It is an effective quality control mode to achieve continuous improvement of nursing quality. Key words: Nursing quality; Target management; Quality index; Quality control point; Concise quality control

Evidence based practice of catheter removal in patients with short-term indwelling catheter after partial nephrectomy

Objective To evaluate evidence-based practice of catheter removal strategy in patients with short-term indwelling catheter after partial nephrectomy. Try to apply the best evidence into practice, and further to improvethe quality of clinical nursing through quality review. Methods Two rounds of quality review were carried out in the 2 wards from July to December in 2016. Using the 5 review criteria of best evidence, we reviewed baseline of catheter removal strategies for patients with short-term indwelling catheter after partial nephrectomy and developed appropriate evidence-based practice. Further, the best evidence was integrated into clinical nursing practice, and the prognosis was reviewed after then. Results In the baseline review, the compliance of the 5 review criteria was 0. However, after introducing the best evidence into nursing practice, the compliance was up to 100%. The mastering of evaluation knowledge of catheter removal of nurses increased from 73.00±9.35 to 94.81±3.38 with significant difference (t=12.72, P < 0.01). The indwelling time of catheter shorted from (5.69±0.79) d to(4.24±0.82) d. The difference was significant (t=5.47, P<0.01). Conclusions Evidence-based nursing practice improvesthe strategies of short-term catheter removal after partialnephrectomy, while closer cooperation between nurses and doctors are still needed to promote the continuous improvement of nursing quality. Key words: Catheter removal strategy; Evidence-based medicine

Establishment and application of specific nursing quality indicators for infectious disease

Objective To explore the establishment and application of specific nursing quality indicators for infectious disease. Methods On the basis of nursing system, nursing criterion, nursing routine and nursing process, the specific nursing quality indicators were established and implemented in our hospital from October 2015 to June 2016. The specific nursing quality indicators were established according to different characteristics of patients, including psychological nursing, isolation protection, high fever nursing and so on. Every indicator was standardized by structure, process and result modules. The 3 modules included 7 items, which is organization management, nursing assessment, measures implementation, shift execution, nursing records, health guidance and related knowledge, and every item was composed of several standard rules. The correct rate of nursing assessment, the rate of measures implementation, the awareness rate of patients′ disease knowledge, the accuracy of nursing record writing, the qualified rate of shift duty, patients′ satisfaction and qualified rate of specific nursing knowledge were compared before and after implementing the specific nursing quality indicators. Results After the implementation of the specific nursing quality indicators, the correct rate of nursing assessment increased from 74.89% to 89.33%, the rate of measures implementation increased from 75.79% to 88.44%, the awareness rate of patients′ disease knowledge increased from 65.47% to 79.56%, the accuracy of nursing record writing increased from 65.02% to 88.00%, the qualified rate of shift duty increased from 60.08% to 81.33%, patients′ satisfaction increased from 92.06% to 97.08%, the qualified rate of specific nursing knowledge increased from 69.59% to 86.49%. Conclusions The establishment and application of specific nursing quality indicators for infectious disease can normalize and standardize nursing work, improve the process quality and final quality of nursing care, help continuous improvement of nursing quality, and ensure the effective implementation of nursing care. Key words: Infectious disease; Specific nursing; Nursing quality management

Application effects of ACMMM falling prevention management model in geriatric wards

Objective To explore the effect of ACMMM management model in preventing the elderly inpatients from falling. Methods Patients hospitalized in geriatric ward in a certain comprehensive third-level grade-A hospital from January 2014 to December 2015 were selected as objects, with those hospitalized from January to December 2014 as control group, and others as intervention group. ACMMM falling prevention management model was carried out from January 2015, including falling risk assessment at admission of the patients, strengthening communication between medical workers and patients and their relatives, monitoring safety risk of the patients, improving patients′ condition, improving environment and maintaining facilities in the ward. Incidence rates of falling were compared between the two groups. Results Incidence rate of falling in the intervention group was 0.45% (6/1 316), which was significantly lower than that of the control group 1.99% (24/1 204)(χ2 =12.634, P<0.05). Conclusions The implementation of ACMMM falling prevention management model can drop the incidence rate of falling, promote continuous improvement of nursing quality and reduce incidence of medical disputes. Key words: Falling; Elderly; ACMMM management model

Application of continuous quality improvement in pediatric nursing quality management

Objective To investigate the clinical effect of continuous quality improvement in pediatric nursing quality management. Methods The implementation of continuous nursing quality improvement measures were carried out in 24 in-service nursing staffs from March 2012 to April 2015, and 82 hospitalized children in our hospital from March 2012 to March 2014 were selected as the control group before the nursing quality improvement was carried out.And another 82 hospitalized children in our hospital from April 2014 to April 2015 were selected as the experimental group after the nursing quality improvement was carried out.The improvement of nursing quality, children's adverse events and their families' satisfaction in the two groups before and after the implementation of nursing quality improvement were observed. Results The nursing score of the nursing staffs after the implementation of continuous quality improvement was significantly higher than that before the implementation, and the difference was statistically significant (P<0.05); the incidence of adverse events of the experimental group was just 1.22%, which was significantly lower than that of the 8.54% of the control group, and the difference was statistically significant (P<0.05); patients' families' satisfaction rate in the experimental group reached 96.34%, which was significantly higher than that of 87.80% of the control group, and the difference was statistically significant (P<0.05). Conclusions The implementation of continuous quality improvement in pediatric nursing management can significantly improve the quality of care, reduce the incidence of adverse events, and improve the family satisfaction, it is worth promoting. Key words: Pediatric nursing; Quality management; Continuous quality improvement; Effect

Application effects of continuous quality improvement on fall prevention of hospitalized patients in Department of Ophthalmology

Objective To explore the influencing of continuous quality improvement on fall prevention of hospitalized patients in Department of Ophthalmology. Methods It was established fall program team of continuous quality improvement, in order to focus specialty, bring into knowledge-attitude-behavior model so as to improve cognition of medical staff and patients, coordinate and cooperate, carry out predictive and targeted nursing according to evaluate, inform, prevent, rescue and improve safety management procedure. The fall incidence and nursing quality were compared in inpatients between before (2011 to 2012) and after (January 2013 to June 2014) continuous quality improvement. Results Before improvement, the fall incidence in inpatients was 0.27% (7/2 569) and dropped to 0 after improvement (χ2=6.50, P<0.05); after improvement, nurse educated rate and executed rate were 100% and 97.52%; patient′s awareness rate, executed rate and satisfaction rate were 91.98%, 90.01% and 98.49% better than those before improvement (χ2=224.67, 78.09, 58.37, 256.70, 135.56; P<0.01). Conclusions Nursing procedure is used to develop nursing quality continuous improvement, enhance safety awareness, improve cognition and behavior, so as to effectively prevent hospitalized patients to fall down in Department of Ophthalmology, enhance nursing quality, patient′s safety and satisfaction. Key words: Department of Ophthalmology; Hospitalized patients; Fall; Safety management; Continuous improvement of nursing quality

Development and performance of a nursing quality indicators system in OPD at the Hospital

For scientific and objective evaluation and promotion of the quality of nursing care in Out Patient Department(OPD), a nursing quality indicators system of OPD was established.This system is built based on the principles and methodology of nursing indicators, with reference to various appraisal standards and the hospital-wide nursing appraisal indicators, as well as the outpatient practice.It consisted of the nursing quality supervision indicators of hospital-wide practice, and those made for outpatient practice.It is recommended to determine the contents, baselines and assessment methods of evaluation criteria, to ensure continuous nursing quality improvement, and to increase the quality awareness for outpatient nursing staff standardization and management awareness, promoting the clinic nursing quality effectively. Key words: Outpatient nursing quality; Quality Indicators; Quality Analysis

Application of quality control circle on reducing the incidence of peritonitis among peritoneal dialysis patients

Objective To evaluate the efficacy of quality control circle (QCC) on reducing peritonitis rate in patients with peritoneal dialysis. Methods From January to November in 2012, 50 patients with peritoneal dialysis were chosen as the control group (before QCC). During January to November in 2013, 66 patients with peritoneal dialysis were selected for the experimental group (after QCC). Routine nursing was implemented in two groups, but QCC, which establish activity subject, investigate the reason of present situation, analysis the reason of peritonitis, set goals, develop strategies and implement, was carried out in the experimental group. We compared the differences between before and after the implementation of QCC activity in patients with peritonitis rates. Results The peritonitis incidence decreased from 30.0% to 7.5% in patients with peritoneal dialysis who carried out quality control circle at home, and there was statistically significant difference (χ2=10.026, P<0.01). Conclusions we can promote the continuous improvement of nursing quality by cooperating between QCC members, find out and analyzing the cause of the problems, set goals, develop strategies and implementation, and perform the evaluation. Key words: Peritoneal dialysis; Peritonitis; Quality control circle

Clinical study progress of continuous improvement of nursing quality

Continuous improvement of nursing quality was core content of nursing management .In this paper, some problems suchas the advancement trend of nursing quality management , existing problems, influencing factors, improvement methods and effects and so onwere studied to provide the basis for deepening high -quality nursingservice. Key words: Nursing quality; Continuous improvement; Study progress

Application effect of tracking control method in the evaluation of nursing quality management

Objective To investigate the application effect of tracking control method in the evaluation of nursing quality management , in order to provide the basis for the establishment of overall assessment standards for nursing quality .Methods The structured evaluation method of traditional quality control was used in the control group and the tracking control method was used in the observation group .The nursing quality in the hospital was evaluated at different time intervals .The comprehensive score of nursing quality and patients ’ satisfaction with nursing in each month were evaluated in the two groups .Results The comprehensive score of nursing quality in each month from July to December 2012 in the observation group was significantly higher than that in the control group from July to December 2011 [（92.5 ±177;0.7） vs （89.0 ±177;0.6）, （93.5 ±177;0.6） vs （90.0 ±177;0.6）, （94.0 ±177;0.4） vs （91.0 ±177;0.6）, （92.5 ±177;0.6） vs （89.0 ±177;0.9）, （93.5 ±177;0.5） vs （90.5 ±177; 0.8）, （92.0 ±177;0.3） vs （88.5 ±177;0.4）], and the differences were statistically significant （t=2.570, 2.862, 2.842,2.670, 3.014, 2.942, respectively; P ＜0.05）.The result of patients ’ satisfaction survey in the observation group was considered satisfactory in 238 cases, basic satisfactory in 16 cases and dissatisfactory in 10 cases, and 225,15 and 24 cases in the control group , respectively, with statistically significant difference （Z=2.543 1, P＜0.05）.Conclusions Application of tracking control method in the evaluation of nursing quality management can improve the nursing quality , increase the patients ’ satisfaction with nursing , and promote the continuous improvement of nursing quality . Key words: Nursing audit; Tracking control method; Continuous quality improvement

Application of clinical nursing pathways in renal transplant recipients during the perioperative period

Objective To evaluate the effect of CNP （Clinical Nursing Pathways） on renal transplant recipients during the perioperative period. Methods 60 renal transplant recipients was divided into CNP group （28 cases） and control group （32 cases） according to their admission time, and the method of comparison was used. The control group only received conventional care while CNP group received CNP care in addition. Two group＇ s average length of stay, average hospitalization expense, satisfaction with the care and incidence rate of postoperative complication were compared during the perioperative period to evaluate the effect of CNP. Results The average length of stay of CNP group was （ 27.6 ± 4.3 ） d, shorter than （ 32.5 ± 6.8 ） d of the control group, and the difference was statistically significant （ t = - 3. 245, P = 0. 002 ）. The average hospitalization expense of CNP group was （ 48 621 ± 10 506 ） yuan, lower than （ 54 788 ± 8 521 ） yuan of the control group, and the difference was statistically significant （t = -2. 509 ,P = 0.015 ）. The rate of ＂satisfied＂, ＂less satisfied＂ and ＂not satisfied＂ of CNP group was 67.9%, 28.6% and 3.6% respectively, and that of the control group was 37.5% , 43.8% and 18.8% respectively. The satisfaction in the CNP group was better than that in the control group, and the difference was statistically significant （ χ2 = 6.551 ,P = 0. 038 ）. However, the difference between two group＇ s incidence rate of postoperative complication was not statistically significant （ P 〉 0.05 ）. Conduslons CNP nursing method for renal transplant recipients during the perioperative period is scientific, reasonable and feasible, which can shorten the length of stay, reduce average hospitalization expense, improve satisfaction with nursing and promote the continuous improvement of nursing quality. Key words: Renal transplantation; Perioperative period; Clinical nursing pathways; Recipient

Application of nursing quality control system in improving nursing quality

Objective To explore the application of nursing quality management system in improving nursing quality.Methods According to the nursing quality assessment standards of three stage hospital in Jiangsu,nurses' awareness of quality control was strengthened,nursing quality control system was improved,all kinds of software data was established and perfected and PDCA method was used to conduct inspection by quality control group.Nursing quality was compared before and after the application of the system.Results In 2011,the scores of nursing service satisfaction,inpatients' nursing quality,ward management,disinfection and segregation,first-aid drugs and equipment,nursing paper writing and functional department in nursing quality examination were (98.5 ±0.5),(94.5 ±0.6),(96.6 ±0.3),(98.4 ±0.4),(99.4 ±0.2),(98.8 ±0.3),( 94.8 ± 0.3 ),respectively,all of which were significantly higher than those in 2009 [ ( 92.5 ± 0.5 ),( 90.5 ±0.5),(91.5 ±0.3),(90.4 ±0.2),(96.4 ±0.3),(95.5 ±0.3),(91.3 ±0.5),respectively],and the differences were statistical significant (t =25.456,17.741,36.062,53.666,24.962,23.335,18.007,respectively;P ＜ 0.01 ).Conclusions Improvement of nursing quality control and nursing quality management has an important effect on the continuous improvement of nursing quality. Key words: Quality control; Quality management group; Nursing quality; Continuous improvement

Study on the application of dynamic field theory in nursing management

Objective To improve nursing quality by paying attention to management of nurses' psychology and behavior and changing individual and collective behavior.Methods Guided by dynamic field theory,giving nursing staff continuous periodic training and counseling,establishing a staff interview system,giving systematic support and enhancement to develop a high-performance team.A case-control study was carried out in eight wards to evaluate implementation effect by comparison study.Results Before and after introducing dynamic field theory,there were significant differences in job satisfaction of nurse staff (P<0.01),in patients' satisfaction(P<0.05),in evaluation of nursing staff management efficiency(P<0.05).Conclusions Application of dynamic field theory in nursing management can improve job satisfaction of nurse staff,patients' satisfaction and nurses' post suitability,and obtain continuous nursing quality improvement. Key words: Dynamic field theory; Nursing management; Application research