Research On The Formulation And Application Of Quality Standardization Scheme Of PICC Nursing Clinic

ObjectiveIn view of the current maintenance problems and needs of PICC patients at home,the quality standardization scheme of PICC nursing clinic was developed,which was in line with the characteristics of quality management of PICC nursing clinic in the region.The intervention effect of the standardization scheme was evaluated through clinical application.The present study aims to standardize the homogeneous nursing level of PICC nursing clinic in the region,to improve the quality of nursing service and the self-management ability of PICC patients at home,so as to reduce the incidence of PICC related complications.MethodsThe first part used Delphi method to make the quality standardization scheme of PICC nursing clinic: setting up a standard development group,forming the prototype of the quality standardization scheme of PICC nursing clinic based on literature review and theoretical analysis.Then 21 intravenous care specialists,nosocomial infection specialists and doctors were invited to make two rounds of inquiries on the first draft to define the items and contents.The questionnaire effective recovery rate was used to evaluate experts enthusiasm,expert authority coefficient was used to evaluate the reliability of correspondence results,and Kendall harmony coefficient was used to determine the coordination and consistency of expert opinions.In the second part,the application effect of PICC nursing clinic quality standardization scheme was evaluated by quasi experimental study method: the sample size was calculated as 280 based on the incidence of PICC phlebitis reported in the literature.According to the inclusion and exclusion criteria,280 patients were recruited by convenience sampling from October to December 2018 as the control group and 280 patients from October to December 2019 as the intervention group.The intervention group adopted the PICC nursing clinic quality standardization scheme,receiving three months of the municipal and hospital level training and six months of hospital application.The intervention methods included centralized training,operation demonstration,on-site one-to-one guidance,etc.The control group implemented the PICC maintenance requirements according to the routine method,without any intervention.The ability of self-management of PICC of the intervention group and the control group were investigated by “scale of self-management ability of PICC in cancer patients”(CPSM),and the incidence of phlebitis,unplanned extubation and infection of PICC catheters in the two groups were counted.The difference of self-management ability scores between the two groups was statistically analyzed by t-test of two independent samples,and the difference of complication rate was statistically analyzed by chi square test.P<0.05 was statistically significant.ResultsPart Ⅰ: After two rounds of Delphi consultation,the effective recovery rate of questionnaire is 100%.The authority coefficient of experts was 0.85 and 0.86 respectively,and Kendall harmony coefficient was 0.53 and 0.34 respectively.The final management standard scheme included 8 dimensions and 19 items.Part Ⅱ: A total of 560 subjects were recruited,including 280 in the experimental group and 280 in the control group.The results showed that the incidence of PICC catheter-related bloodstream infection in the experimental group was 1.07%,which was significantly lower than that in the control group(1.79%).Total score of PICC self-management ability of cancer patients in the experimental group was 151.60± 14.82,which was significantly higher than 145.18±15.12 in the control group(P<0.05).The scores of the three dimensions of maintenance compliance,catheter management confidence and abnormal situation treatment in the intervention group,which were significantly higher than the scores of the control group(all P<0.05).ConclusionThe quality standardization program of PICC nursing out-patient service has comprehensively standardized the PICC nursing out-patient service from eight dimensions: management system,layout facilities,environment management,goods management,personnel management,operation management,record specification and quality control management.Authoritative,scientific theory,in practice level through the implementation of standardized patients with belt tube maintenance services,education and health,can significantly improve patients with tube during the maintenance of compliance,catheter management confidence and exception handling capacity,so as to reduce the patients with PICC catheter related complications,improve the ability of self management,reduce the patients’ medical costs,improve the social benefits,is worth popularizing in area usm nurse clinics and application.