Construction Of Nursing Quality Evaluation System For Neonatal Blood Exchange Transfusion

Hyperbilirubinemia is a common disease in the newborn, and can lead to the occurrence of acute bilirubin encephalopathy if with delayed treatment, leaving sequel including hearing impairment, cerebral palsy and mental retardation and so on, which may bring heavy burdens to the families and the society.Exchange transfusion can quickly remove the sensitizing or deficient erythrocytes, alleviate the hemolysis and lower down the bilirubin level, and is considered as the fastest and most efficient method to treat hyperbilirubinemia in the newborn, and is the preferred choice for the treatment for children with mild ABE(for the treatment of moderate and severe ABE, Exchange transfusion can cause more complications and higher risks, and it requires weighing the advantages and disadvantages). Exchange transfusion is also a special nursing care technique with operative difficulties and high risk with various complications. It is categorized as Class II Medical Technique in the supervision and management system in some regions in order to further standardize its clinical practices and to ensure medical safety. But due to lacking of systematic management specifications and provisions, there aren’t valid references or directions for the clinical practices.Nursing quality evaluation is an effective measure for quality management, by which the managers can timely detect and correct errors by the systematic monitor of the nursing care activities, so as to achieve the objectives of system optimization and continuous quality improvement. Meanwhile, nursing quality evaluation is also the working guidance for nursing practices to better guarantee the smooth and successful developing and implementing of nursing work. Therefore, nursing quality evaluation system is an effective way to improve the development of exchange transfusion.Objective:By combining the practical problems in clinical application of blood exchange transfusion, a scientific, systematic and practical quality evaluation system of the blood exchange transfusion nursing is established to provide clinical care work guidelines, basis for relevant systems and norms formulated by managers.Methods:1. Literatures on exchange transfusion were reviewed to investigate the development of the researches on the nursing care of exchange transfusion and existing problems in such practices, so as to set up the theoretical basis for later establishment of nursing quality evaluation system.2. Semi-structured interviews were conducted with 3 neonatal nursing managers, 1 neonatal medical experts and 3 senior neonatal clinical nurse specialists from different regions, to learn about the practices and management status of exchange transfusion and the key points and difficulties in such practices, and to draft the preliminary outline of the nursing quality evaluation system for neonatal blood exchange transfusion.3. Two rounds of consultation with the 12 neonatal nursing managers、3 neonatal medical experts and 4 neonatal clinical nurse specialists included by screening standards according to the Delphi method, and the consultation results were analyzed and discussed to determine the specific contents of the nursing quality evaluation system for neonatal blood exchange transfusion.4. The weights of all criteria were calculated by the analytic hierarchy processing software Yaahp0.5.2, so as to evaluate the relative importance of each criterion in the whole quality evaluation system and to identify the key points in the nursing management.Results:1. Representativity of the consultation experts: all the experts in this study have very good representativity and authority, with the education levels all bachelor degree and above, with the professional technical title levels all intermediate and above, average age=40.84±5.81, average service years=20.00±6.96, and the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively.2. The reliability of the consultation results: the responsive rates of the 2 rounds were 95% and 100% respectively, the Kendall’s coefficients of concordance were 0.33 and 0.25 respectively, and X2 test showed P<0.01, which indicate high participation and good reliability of the panelists.3. Criteria screening of the nursing quality evaluation system for neonatal blood exchange transfusion: after the 2 rounds of panel consultation, the nursing quality evaluation system for exchange transfusion was finally formed with the frame of structure quality, process quality and outcome quality, including the 4 layers of objective layer, principle layer, factor layer and criterion layer, with 3 level-1 criteria,10 level-2 criteria and 73 level-3 criteria.4. Establishment of the weight coefficient of each criterion: for level-1 criteria the weight coefficients of structure quality, process quality and outcome quality were determined as 0.3338, 0.5247 and 0.1416; the first 3 level-2 criteria were intra-transfusion nursing care, pre-transfusion preparation and training, and the weight coefficients were 0.2573, 0.1636 and 0.1344 accordingly, with the suggestion that the key points in the nursing management should be process control and personnel training.Conclusion:1.In this study, the consultation panelists presented high representativity, authority and reliability, and the contents of the nursing quality evaluation system for neonatal blood exchange transfusion from the consultation were very comprehensive and of great significance to guide the clinical nursing practices.2. Structure quality management should be the necessary precondition of the safe practices of exchange transfusion, and the managers should enhance the organization structure, optimize the facilities, improve the rules and provisions, as well as strengthen the personnel training of exchange transfusion with access control system only for trained staff.3. Process control is the key point to ensure the smooth procedure of exchange transfusion and the technical management. In actual practices, the procedures and standards should be followed strictly with the highlight on the rescue quality of "the first period".4. The outcome quality monitor is the necessary guarantee for continuous quality improvement of exchange transfusion. The nursing managers should analyze the clinical data of the therapy regularly with comprehensive assessment of the effectiveness and results of the therapy, so as to discover the errors timely and to improve the quality of exchange transfusion continuously.