持续质量改进在老年结直肠病变患者内镜黏膜下剥离术围手术期管理中的应用-现代医学

持续质量改进在老年结直肠病变患者内镜黏膜下剥离术围手术期管理中的应用

单位：解放军福州总医院消化内科, 福建福州 350025

分类号：R473.5

出版年·卷·期（页码）：2017·36·第七期（1028-1031）

摘要：

目的：探讨持续质量改进（CQI）在老年结直肠病变患者内镜黏膜下剥离术（ESD）围手术期管理中的应用效果。方法：2014年本院在老年结直肠病变患者ESD围手术期管理中推行CQI模式，分析围手术期存在的问题、制定并实施质量改进措施。其中CQI实施前2年间75例，CQI实施后2年间92例。通过对比CQI实施前后患者肠道准备的质量、不良反应和术后并发症发生率，调查患者对疾病认知度和对护理工作满意度，综合评价CQI模式实施效果。结果：与CQI实施前相比，CQI实施后患者肠道准备清洁度显著增高（92.4% vs.80%，P<0.05），不良反应（5.3% vs.0，P<0.05）和术后并发症（5.4% vs.16%，P<0.05显著降低，患者对疾病认知度显著提高（55.4% vs.38.7%，P<0.05），患者对护理工作满意度显著提高（84.44% vs 61.9%，P<0.05）。结论：持续质量改进提高了老年结直肠病变患者ESD围手术期管理质量，主要表现在肠道清洁质量的提高、不良反应和术后并发症的降低，患者对疾病认知度、遵嘱依从性以及对护理工作满意度的提高。

Objective: To investigate the effect of continuous quality improvement (CQI) in perioperative nursing management of endoscopic submucosal dissection (ESD) in elderly patients with colorectal diseases. Methods: CQI model was introduced in the perioperative nursing management of ESD in elderly patients with colorectal diseases in the hospital during the period of 2014. The existing problems, the formulation and implementation of quality improvement measures were analyzed. Among them, 75 cases underwen the operation 2 years before CQI, 92 cases in 2 years after the implementation of CQI. By comparing the quality of bowel preparation, adverse reaction and postoperative complication rate of patients before and after CQI implementation, the awareness of disease and the degree of satisfaction of nursing work, and the effect of CQI model were evaluated. Results: Compared with the period before CQI, the bowel cleanness after the implementation of CQI increased significantly (92.4% vs.80%, P<0.05), adverse reactions (5.3% vs.0, P<0.05) and postoperative complications (5.4% vs.16%, P<0.05) were significantly lower, the disease awareness increased significantly (55.4% vs.38.7%, P<0.05), the patient satisfaction with nursing increased significantly(84.44% vs 61.9%, P<0.05).Conclusion: The continuous quality improvement in perioperative nursing management of endoscopic submucosal dissection (ESD) in elderly patients with colorectal diseases improves the quality of cleaning, reduces the main adverse reactions and postoperative complications, and improves the awareness, compliance and the satisfaction of nursing work.

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