ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectiveTo explore the supervision and inspection mechanism of hospital-acquired infection management at hospital-level in order to promote continuous quality improvement of hospital-acquired infection control. MethodsInstead of inspecting hospital departments only by hospital infection control professionals, the clinical hospital infection control nurses were also involved in the two cross-inspections carried out respectively in September and December, 2013, which shared the same contents, methods, and the inspectors. According to standard procedures, on-site view and inquiry methods were adopted to check the implementation of the system and measures and the infection control knowledge among medical staff. Inspection results were written down to feed back to each department with a unified form. The problems found during the two inspections were classified to be analyzed and solved. The results of the two inspections were compared to understand whether the effect of continuous quality improvement can be achieved through cross-inspections and subsequent work. ResultsThe excellent rate of department and overall accuracy rate of the second inspection increased with statistical significance compared to that of the first inspection (χ2=619.902, P=0.000; χ2=40.347, P=0.000). Meanwhile, the correct rate of each module and infection control knowledge among all kinds of medical staff also increased compared with the first inspection with statistically significant differences (P<0.05). ConclusionLong-term mechanism of cross-inspection involving hospital infection control nurses should be established to facilitate the continuous quality improvement of hospital-acquired infection management.
ObjectiveTo evaluate the clinical effects of continuous quality improvement (CQI) in the care of peripherally inserted central catheter (PICC). MethodsWe retrospectively analyzed the clinical data of 40 patients who received PICC treatment in our hospital between January and December 2011, and then we found out the main problems of PICC catheter care, analyzed the related factors for complications of PICC, and formulated corresponding nursing countermeasures. PICC receivers between January and December 2012 were regarded as controls. Then, we compared the complication incidence and satisfaction of patients between the two groups before and after the implementation of CQI. ResultsAfter the implementation of CQI, complication incidence was significantly lower (P<0.05). The satisfaction degree of patients toward caring rose to 87.8%, which was statistically significant (P<0.05). ConclusionThe implementation of CQI is beneficial to reduce complications of PICC treatment, and patients'satisfaction rate is also significantly increased.
ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
ObjectiveTo explore the impact of continuous quality improvement on the quality of life and complications in end-stage hemodialysis patients. MethodWe reviewed the clinical data of 128 end-stage renal disease patients undergoing hemodialysis from January 2013 to January 2014. The patients were divided into observation group and control group randomly with 64 patients in each. Patients in the control group received routine nursing only during hemodialysis, while those in the observation group received extra continuous quality improvement nursing on the basis of routine one. Quality of life of the two groups of patients was evaluated by World Health Organization Quality of Life Scale-brief before and after intervention. Adverse reactions during hemodialysis were also observed in these two groups. ResultsThe incidences of hypotension, malnutrition, thrombosis, infection and arrhythmia in the observation group were significantly lower than those in the control group (P<0.05). Psychological dimension, social dimension, physiological adaptability and total scales of quality of life in the observation group were significantly better than those in the control group (P<0.05). ConclusionsContinuous quality improvement of nursing reduces the rates of complications and improves patients' quality of life.
ObjectiveTo analyze and reduce the defects in nursing records for blood transfusion by continuous quality improvement (CQI) method, in order to prevent blood transfusion related medical disputes. MethodsIn October 2014, CQI team was established to analyze the reason for transfusion record defects and make standardized process and quality monitoring forms for nursing record of blood transfusion. Six months after the implementation of CQI, 40 records were randomly selected before the CQI implementation (April to September 2014) and after the implementation (April to September 2015) for comparison and analysis. ResultAfter 6 months of implementation of CQI, nursing record defects of blood transfusion decreased significantly from 228 to 55 items. ConclusionUsing CQI method can effectively reduce nursing record defects of blood transfusion. CQI can also improve the quality of nursing records and prevent medical disputes caused by blood transfusion.
This paper introduces the background, significance, definition and types of clinical audit and describes five stages of clinical audit, including preparing for clinical audit, selecting criteria, measuring performance and sustaining improvement. This paper also introduces the international and national status quo of implementing clinical audit in nursing practice and describes the reporting guideline for articles of clinical audit. Finally, this article suggests that providing methodological training and creating a supportive environment are crucial strategies to promote the implementation of clinical audit and bridge the gaps between evidence and practice.