| Objective:This research is based on the continuing in-depth development of Pharmacy Intravenous Admixture Services(PIVAS)model in recent years.It is the first time in PIVAS of a hospital to carry out quality control circle(QC group,about six people in general)activities to explore the impact of quality control circle(QCC)activities on the quality management of PIVAS.On the other hand,it may enhance the awareness of PIVAS staff about their work,and improve the ability of PIVAS team cooperation as well.This QCC activity reduced the average number of leaking bags per day of PIVAS soft bag products in a hospital;provided practical experience for the future comprehensive development of QCC in PIVAS of a hospital;explored the application value of QCC activities in the management of PIVAS work mode.Method:This study searches for domestic and foreign literatures,such as CNKI,VIP database,Wanfang database and other related literatures.It is the first time to use quality control tools to solve practical problems without previous activities.First,the quality control circle activities conducted a survey on issues which need to be solved in intravenous drug dispensing center.Four themes were picked out from multiple themes according to the weight,and finally determined the urgently need to be addressed theme from the four themes.PIVAS in a hospital has a heavy task,and the leakage problem needs to be solved urgently.When leakage occurs in PIVAS,it not only causes the waste of liquid and other drugs,but also increases the workload and postpones the time of drug dispensing.When the liquid of finished product is dispatched,the leakage will be found during the infusion process of patient,which is disadvantageous to guarantee the safety of the patient,and it may cause medical disputes and affect the harmony between doctors and patients.Therefore,reducing the amount of liquid damage in PIVAS products becomes the most important task in PIVAS work.After establishing the theme,a series of QCC activities,such as P-plan,D-execution,C-inspection and A-action were set up implementation in PDCA cycle theory,including objective and feasibility analysis,main cause analysis,main cause demonstration,formulation of countermeasures and measures,effect evaluation and consolidation measures.by establishing leak status checklist,thesamples two samples before and after QCC activities were compared.,and explore the influence of of QCC activities on the average leakage of PIVAS soft bag products every day.Result:1.Investigate the leakage situation of PIVAS in a hospital from August 15 to August 28,2016.The total number of leaks collected was 76 bags,and the number of leaking bags of finished PIVAS soft bags was 5.43 bags per day before improvement.Through the application of quality control circle to find out the real cause,make the countermeasures to implement,and investigate the leakage of PIVAS in a hospital from December 12,2016 to December 25,2016 again.The total number of leaking bags was26,and the number of leaking bags of PIVAS soft bags was 1.85 bags per day after improvement.T test was used for comparison between groups,and the counting data was expressed as rate(%)and the comparison test between the two groups.P < 0.05 was statistically significant.2.This study found that the main factors affecting the leakage of PIVAS soft bag products in a hospital were: incomplete clearance of the operating table,insufficient coarse zoning,unclear provisions for liquid basket loading,and excessive insertion of drugs.3.After the implementation of quality control circle,the clearance operation standards of PIVAS staff were standardized,and then the data from 2016.10.10 to2016.10.16 were collected.The results showed that the number of leakage bags in PIVAS in a hospital decreased from 1.86 bags per day to 0.86 bags per day due to incomplete clearance of operation desk.The number of leakage was significantly reduced,and the effect was significantly higher than before the implementation of QCC activities.Statistical analysis showed that the difference was statistically significant(P < 0.01).4.After the implementation of QCC,we make coarse regional identification and placement requirements,and check the PIVAS area into five areas of the north and South buildings,make corresponding identification,so as to reduce the total amount of liquid in each area and reduce extrusion.It is stipulated that the big ear baskets should be placed neatly in rough time sharing without folding the valves and up to five layers.Collecting data from 2016.10.24 to 2016.10.30,the number of leaking bags may be reduced from1.14 bags per day to 0.29 bags per day in the true cause verification and inspection,and the number of leaking bags is significantly reduced.The effect is significantly higher thanbefore the implementation of QCC activities.Statistical analysis shows that the difference is statistically significant(P < 0.01).5.After the implementation of quality control circle,the standard of liquid packing for soft bags was formulated,and the data from 2016.11.07 to 2016.11.20 were collected.Due to the improper method of liquid packing,the number of leakage bags could be reduced from 0.57 to 0.14 bags per day in the true cause verification inspection.The number of leakage was significantly reduced,and the effect was significantly higher than before the implementation of QCC activities.Statistical analysis showed that the difference was statistically significant(P < 0.01).6.After the implementation of quality control circle,through training and formulation of PIVAS staff needle insertion standards.After the implementation of this strategy,data from 2016.11.28 to 2016.12.11 were collected.The number of leaking bags decreased from 0.43 bags/day to 0.14 bags/day in the real cause verification and inspection,and the number of leaking bags decreased significantly.The effect was significantly higher than before the implementation of QCC activities.Statistical analysis showed that the difference was statistically significant(P < 0.01).Conclusion:1.Through systematic analysis,it is found that the four causes of leakage of PIVAS soft bag products in a hospital are incomplete clearance of operation table,inadequate coarse zoning,unclear stipulation of liquid basket filling,and excessive needling when adding medicine.2.This study found that the leakage rate of PIVAS significantly decreased after the QCC activity,which avoided drug loss and waste,shortened the time of intravenous drug dispensing,reduced useless work and improved work efficiency.The finished liquid can be delivered to the ward in time,which effectively reduces the probability of pyrogen reaction and ensures the safety of intravenous infusion.Reduce medical disputes,ensure the quality of hospital services and harmonious cooperation between departments.3.The development of quality control circle in PIVAS of a hospital has stimulated the critical thinking ability among circle members and improved the ability of using quality management tools.Moreover,we won the first prize of the 5th National Quality Control Circle Competition,which gained honor for a hospital.At the same time,it improved the enthusiasm of the circle staff and the sense of achievement.I hope this research will open the door of PIVAS application in a hospital and point out a better wayfor the future work of PIVAS mode. |
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