Applied Research Of QCC In Reducing The Rate Of Unplanned Extubation In The Department Of Neurology With Indwelling Gastric Tube

Objectives:In the Department of Neurology,the rate of unplanned extubation of the nasogastric tube is high,extubation caused by nutrition interrupted,aspiration,aggravating illness,even endanger the patient's life.To introduct the concept of evidence-based medicine and the using of health failure mode and effect analysis(HFMAEA)and root cause analysis method(RCA)in quality control circle(QCC)process,to explore this 3 tools synthesis model in clinical nursing management,investigate the effect of this method in reducing unplanned extubation of nasal tube in neurology department,provide scientific basis for its application in the continuous improvement of nursing quality.Methods:We use convenient sampling method to select the Department of Neurology in the fourth affiliated hospital of Kunming Medical University.Before 3 tools synthesis model management,there are indwelling nasogastric tube 50 cases as control group on July to August,2015.After 3 tools synthesis model management,there are indwelling nasogastric tube 51 cases as experimental group on December 2015 to February 2016.QCC management include four stages.The first stage:in September 2015,QCC team was establish,then selected topic,draw up activity plan,grasp the current status.In the step of grasp the current status,we use health care failure mode and effect analysis(HFMAEA)to analysis high risk areas in indwelling nasogastric tube,due to in the process of the lack of a nasogastric tube effective fixed link,HFMAEA crisis score more than 8 cent,the existence of serious harm to the quality and safety of nursing care.So we seize the main contradiction,though root cause analysis method,the lack of effective nasogastric tube fixed due to did not evaluate numerous nasogastric tube fixation method.Through Meta analysis and comparison of different methods of nasogastric tube fixed,strategies for tie method.For the HFMAEA crisis score below 8 points,it did not cause serious harm to the patient,can follow the steps of quality control circle.The second stage:November 2015,QCC into the strategy implementation steps.The third stage:from January to February 21st,2016,the QCC effect to confirm the effective countermeasures.The fourth phase,February 22,2016 to in March 13th,in thestandardization,the quality control circle activity review and improvement,published the results of the activities.The contents of the survey include:The rate of unplanned extubation of nasogastric tube,working hours in indwelling nasogastric tube,nursing cost before and after the QCC management mode in Department of Neurology.Statistical analysis of data using SPSS 17.0 statistical software.Results:In the two groups,general informations which include gender age,educational level,residence,working status,caregiver,state of consciousness,the types of diseases had no significant difference(P>0.05).The nasogastric tube unplanned extubation rate of experimental group nurses(17.65%)is lower than the control group(62%)(P<0.01),the difference was statistically significant;the experimental group patients with nasogastric tube insertion in the cost of materials(7.30±2.53 yuan/person)is less than control group(11.81±9.08 yuan/person)(P<0.05),the difference was statistically significant;the nasogastric tube placement working hours of experimental group nurses(7.48±2.56 minutes/person)is lower than the control group(13.22±10.77minutes/person)(P<0.05),the difference was statistically significant;the comprehensive quality score of experimental group nurses(34.22±6.96)is higher than the control group(19.33 ± 10.82),P<0.05,the difference was statistically significant After QCC management mode in experimental group,the score of comprehensive competence for nurses increased from 19.33±10.82 to 34.22±6.96,P<0.05,the difference was statistically significant.Conclusions:This is the first study describe 3 tools synthesis model based on QCC,it was used in clinical nursing quality management,was applied to reduce the UEX of neurological indwelling nasogastric tube,we make Meta analysis of nasogastric tube fixation method,reduce neurological nasogastric tube unplanned extubation rate and nursing cost,improve the neurological nursing quality and the comprehensive quality of nurses.This 3 tools synthesis model promote the nursing quality continuous improvement,strengthen nursing safety guarantee mechanism,promote nursing management become fine and modern.