| Objective:To construct a scientific,systematic and practical nursing quality index system in intravenous infusion therapy.The index system was used in a three grade first class general hospital to investigate the process nursing quality of peripherally inserted venous catheters,analyze and improve the existing problems,to comparing the process nursing quality improvement effect of peripherally inserted venous catheter after application of index system and provide a practical basis for the nursing quality management of intravenous infusion therapy.Methods:1.The construction of index system: based on “structure-process outcome” theory,analysis intravenous infusion items point by point involved in “infusion therapy nursing technical operation standard” for nursing care of intravenous therapy,on the basis of referring to a lot of relative documents and literatures,combined with the clinical actual situation to determine the expert consultation draft.Adopting expert interview to interview and make a pre survey of 2 nursing managers and 4 intravenous therapy specialist nurse,through analysis and discussion,increase,delete,modify the proposed index and determine the formal release of expert consultation draft,comprised 3 first level indicators,10 second level indicators,and 38 third level indicators.Then using Delphi expert consultation method screen index,finally constructed nursing quality indicator in intravenous infusion therapy.and determine the weight of each index.2.The application of the index system: according to the nursing quality index system in intravenous infusion therapy of constructed formulate evaluation criteria and checklist of process quality index.Based on investigation on spot process nursing quality of PVC in a three grade first class general hospital,summarize and analysis the problems of process nursing quality in intravenous infusion therapy in hospital,quality improvement has been carried out continuously.The second surveys were carried out to compare with the results of the first survey after 6 months,evaluating the effect of index system in nursing quality management.Results:1.Delphi expert consultation and index system construction:Choosing 20 experts who was engaged in nursing management,intravenous infusion over a long period of time,The index system was determined after 2 rounds Delphi expert consultation,including 3 first level indicators,10 second level indicators,and 49 third level indicators.In two rounds of surveys,the effective response rates were 90.4%,100%;Cr coefficients were0.864,0.940,the enthusiasm and authority of the experts are high;The average,standard deviation and full score of the importance index of experts were 3.70?5.00,0.00?1.15,25.0%?100.0% of the first round,the second round is 4.00?5.00,0.00?0.60,15.0%?100.0%,expressed it is concentration of experts' opinions.W coefficients of the first level indicators were 0.152?0.264,W coefficients of the second level indicators were0.275?0.316,W coefficients of the third level indicators were 0.259?0.324,totality W coefficients o were 0.254?0.310,the chi square test was statistically significant(P<0.05).The 2 round of expert consultation questionnaire of coefficient of variation(CV)were 0.00?0.258,0.00?0.129,expert opinion coordination degree is good.2.The application of the index system: A total of 2 investigations were carried out,and the methods of investigation were consistent.The 46 clinical departments of the hospital were investigated,including 17 surgical department,17 internal medicine department,6 intensive care unit,4 oncology department,1 newborn room,1 Liver Disease branch.A total of 184 nurses(92 catheterize,92 protect)were examined for intravenous infusion.The first investigation results showed that the quality of nursing in intravenous infusion need promote,especially hand hygiene,three check seven pairs,disinfection,the method of tube flushing and tube sealing.After the continuous quality improvement,the nursing quality was significantly improved,especially lack of normative operation including 6 step washing technique,check before puncture,check after puncture and standard of disinfection range before quality improvement,the improvement rate of operation normalization is 134.78%,140.63%,151.61% and 100% respectively after quality improvement.Conclusions:1.The nursing quality index system of intravenous infusion therapy is reasonable,the construction process is scientific,and it has high scientific and reliability.It can provide objective and quantifiable basis for nursing managers to evaluate the quality of intravenous infusion treatment.2.The process nursing quality of PVC need to improve,especially the aseptic concept,standard checking,disinfection and the method of tube flushing and tube sealing,etc.After continuous quality improvement,the nursing quality has been improved significantly.It shows that the application of quality index system to the nursing quality management can effectively improve the quality of nursing. |
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