The Construction And Clinical Application Of Nursing Quality Evaluation Index System For Intrahospital Transport Of Critically Ill Patients

ObjectiveTo construct the evaluation index system of intrahospital transport nursing quality for critically ill patients,conduct reliability and validity test and clinical application,provide standard and quantitative basis for the the nursing quality in intrahospital transport of critically ill patients,and promote the continuous improvement of nursing quality based on the index data.Methods1.Based on literature analysis and semi-structured interview,Donabedian's "structureprocess-result" three-dimensional quality structure model was used as the theoretical framework to preliminarily formulate the evaluation index system framework of intrahospital transport nursing quality for critically ill patients.2.Using Delphi method,23 experts from 13 provinces and cities across the country conducted 2 rounds of consultation and demonstration.3.The analytic hierarchy process is used to determine the weight of all levels of indicators and conduct consistency test.4.According to the constructed index system,a questionnaire on the nursing quality of intrahospital transport for critically ill patients was prepared,and 213 nurses in the direction of critical care and 6 critical care experts were selected to preliminarily test the reliability and validity of the index system.5.The field investigation method was used to carry out clinical application of four indicators,"Assess patient risk execution rate","preparation execute rate before transportation","incidence of disease-related adverse events" and "incidence of equipmentrelated adverse events",and the quality of care was continuously improved based on the index data.Results1.The final evaluation index system of intrahospital transport nursing quality for critically ill patients consists of 3 first-level indexes,13 second-level indexes and 40 thirdlevel indexes.2.The positive coefficient of experts in the two rounds of consultation was 100%,and the expert authority coefficient(Cr)was 0.85.The positive degree and authority degree of experts were relatively high.Kendall's W of the two rounds was 0.400 and 0.316,According to the significance test,the difference was statistically significant(P<0.01),and the coordination degree of expert opinions was relatively high.3.The weighted values of the three first level indexes were structural index(0.1429),process index(0.4285),and outcome index(0.4286).Among the 13 secondary indexes,the top 3 of combined weight were patient outcome(0.1927).Transfer nursing assessment implementation rate(0.1707),and incidence of adverse events(0.1113).40 third level indexes indexes in patients with combined weight of the top five were risk factors control success rate(0.1135),assess patient risk execution rate(0.0919),the total transfer process(0.0585),equipment related incidence of adverse events(0.0506),the transport personnel related incidence of adverse events(0.0506).All indicators consistency check CR value at the level of < 0.1,the index weight distribution is reasonable.4.The Cronbach's ? coefficient of the general index system was 0.985,the Cronbach's ? coefficient of the first level index ranged from 0.970 to 0.980,and the Cronbach's ? coefficient of the second level index ranged from 0.886 to 1.000.I-CVI of each item in the scale was 0.833?1.000,S-CVI/UA of the total scale was 0.800,S-CVI/Ave was 0.968.Confirmatory factor analysis showed that the correlation coefficient between the first level index and the overall index was between 0.852?0.953,which was greater than the correlation coefficient between the first level index.The correlation coefficient between the second level index and the corresponding primary index was between 0.847 and 0.958,which was greater than the correlation coefficient between the second level index and other indicators.All P<0.05 showed a significant positive correlation,and the difference was statistically significant.Preliminary results showed that index system could reflect the quality of intrahospital transport nursing quality for critically ill patients and had good reliability and validity.5.In July and October 2019,the assess patient risk execution rate were 62.53%and 91.35%,respectively.preparation execute rate before transportation was 71.72% and 87.82%,respectively.The incidence of disease-related non-events was 31.80% and 20.48%,respectively.The incidence of equipment-related adverse events was 31.62% and 12.78%,After statistical analysis,the difference was statistically significant,all indicators were improved,no serious adverse events occurred from September to December 2019.indicating that the intrahospital transport nursing quality for critically ill patients continued to improve.ConclusionThe evaluation index system of intrahospital transport nursing quality for critically ill patients is scientific and reasonable,which can be used to evaluate the intrahospital transport nursing quality for critically ill patients.Continuous improvement of nursing quality can be promoted based on index data.