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Currently, the number of clinical research projects continues to grow. Both sponsors and researchers hope to accelerate medical ethical review efficiency, and the regulatory agencies strengthen the control over the ethical review quality. The ethics committee (EC) offices of medical institutions are relatively insufficient in terms of human resource allocation and archiving space. Combined with the development goals of the EC and the requirements of the homogeneity construction of ethical review, it was urgent to optimize the ethics review process and accelerate the efficiency of ethics review through informatization construction. Through informatization construction, the process management of ethical review could be strengthened, the work steps could be simplified, the ethical review level could be improved, and the supervision ability and efficacy of EC on clinical research could be strengthened, which may provide continuous quality improvement strategies and specific optimization measures for the operation and management of the EC, so as to effectively protect the safety, the rights and interests of subjects.
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Objective:To systematically construct the foreign medical quality and safety management model by searching the English literature related to medical quality and safety management, so as to provide reference for improving the level of medical quality and safety management in China.Methods:The Web of Science database was used as the data source, the English literature related to medical quality and safety management in foreign countries was screened following the PRISMA guidelines, and the content of the screened literature was analyzed using qualitative text analysis based on the Structure Process System Outcome (SPSO) theoretical model.Results:In this study, a total of 37 articles were screened, 5 first-level themes of structure, process, system, outcome and continuous quality improvement were identified, 16 second-level themes were found, and their functional relationships were established. A theoretical model of the SPSO-Extension (SPSO-E) for medical quality and safety management was constructed, added new elements of the external environment, organizational outcome and employee outcome, and refined the continuous quality improvement into three segments of quality checking, problem handling and quality consolidation.Conclusions:In order to improve medical quality and safety management in China, the internal management model of the hospital should be dynamically adjusted according to the changes of external environment, and the result dimension should pay attention to the improvement of organization′s operational effectiveness and the physiological and psychological aspects of the staff. The final management results have a feedback effect on the hospital′s resource allocation, service delivery, organizational arrangements and cultural construction, promoting continuous improvement and enhancement of the hospital′s quality.
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Objective To understand the current situation of dispensing errors and effective prevention and control measures in outpatient pharmacies in domestic hospitals, in order to further improve the quality of drug dispensing. Methods The Chinese journal database was retrieved from 2015 to 2020 for the literature on the dispensing errors of outpatient pharmacies and the continuous improvement of the quality after the measures were taken in secondary and tertiary hospitals. Results Of the 146 literatures retrieved, 13 were included in the analysis (11 in tertiary hospitals and 2 in secondary hospitals). Before the improvement, the median of the drug dispensing error rate was 5.1‰, and after the improvement it was 1.1‰. Before and after the improvement, the types of drug dispensing errors were mainly quantity errors (52.5% vs. 51.3%), variety errors (28.3% vs. 28.7%), specifications and dosage forms errors (6.2% vs. 6.7%), and labeling errors (2.1% vs. 2.9%). The improvement measures taken for the reasons of dispensing errors have a high overlap rate, and they are concentrated in two aspects: personnel factors and drug factors. Conclusion The use of continuous quality improvement tools in hospital outpatient pharmacy to control and prevent dispensing errors is still a hotspot of current research. The composition of the types of errors after improvement has basically not changed. The implemen-tation of standardized operating procedures and other continuous improvement comprehensive measures can effectively reduce the incidence of dispensing errors, and contribute to the implementation of the “Expert Consensus on Medication Error Management in China”.
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Objective:To explore the effect of mind mapping combined with continuous quality improvement in the teaching of interns in gastroenterology department.Methods:The 55 students who interned in the gastroenterology department of our hospital from September 2019 to January 2020 were set as the control group and adopted traditional teaching methods; the other 54 students who interned in the gastroenterology department of our hospital from February 2020 to June 2020 were set as the control group; 55 students who interned in the gastroenterology department of our hospital from July 2020 to November 2020 were set as a combined group, and received mind mapping combined with continuous quality improvement teaching. The gastroenterology knowledge and theory assessment results, practical skills operation assessment results and learning initiative, self-study ability, comprehensive thinking ability, teamwork ability, analysis and problem-solving ability, induction and summary ability and so on were compared between the two groups, and the teaching satisfaction rate at the time of leaving the department were also compared. SPSS 20.0 was used for t test and chi-square test. Results:Before the training, there was no statistically significant difference in the three groups of theoretical assessment scores, practical skills operation assessment scores and various ability scores. When leaving the department, the theoretical assessment scores of the combined group and the mind mapping group were (89.74±4.18) points and (86.52±3.72) points, and the performance evaluation scores of practical skills were (90.04±4.86) points and (87.46±4.52) points, respectively. The theoretical evaluation scores and practical skills evaluation scores of the two groups were higher than those of the control group, and the combined group was higher than the mind mapping group, with statistically significant differences ( P<0.05). The scores of various abilities of the combined group and the mind mapping group were higher than those of the control group, and the scores of all indicators in the combined group were higher than those of the mind mapping group, with statistical significance ( P<0.05). The total teaching satisfaction of combined group and mind mapping group was higher than that of the control group, and the total teaching satisfaction of the combined group was higher than that of the mind mapping group. Conclusion:Mind mapping combined with continuous quality improvement has a significant effect on the teaching of gastroenterology interns, which can improve students' abilities and the teaching satisfaction.
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Introducción: Las instituciones de educación superior que forman recursos humanos para la salud, se esfuerzan por perfeccionar los perfiles de egreso en armonía con las necesidades de la población. Mientras, se incrementan los cuestionamientos a la calidad académica, como producto de las relaciones de poder entre el mercado y el estado. La Facultad de Enfermería es el único centro estatal responsable de la formación de grado y posgrado. Disponer de una tecnología para la autoevaluación de la calidad institucional, podría impactar en la mejora de las funciones universitarias y en la misión social. Objetivos: Diseñar una guía metodológica para implementar el proceso de autoevaluación de la calidad institucional y validar la misma, para desarrollar un proceso sistemático y confiable. Métodos: Consistió en un proyecto de desarrollo tecnológico. El diseño preliminar fue ajustado en función de la consulta a expertos y las mediciones de los coeficientes de Alfa de Cronbach y correlación de Pearson. Se implementó una prueba de autoevaluación mediante la técnica de informantes clave. Resultados: La opinión de los expertos fue favorable para la totalidad de los contenidos. Las pruebas estadísticas demostraron un alto índice de consistencia interna y confiabilidad. El diseño obtenido, integró las pautas universitarias establecidas y las particularidades del servicio. Las recomendaciones se orientaron a mejorar la información disponible y formalizar una metodología participativa. Conclusiones: El diseño de la guía fue validado y permitió un autoconocimiento de la calidad institucional con mayor rigurosidad científica. Se identificaron limitaciones en la fase de intercambio entre los evaluadores(AU)
Introduction: Higher education institutions that train human resources in health strive to improve graduation profiles in harmony with the population needs. Meanwhile, the questioning increases for academic quality, as a product of power relations between the market and the state. The School of Nursing is the only state-run center responsible for undergraduate and postgraduate training. Having a technology for the self-evaluation of institutional quality could have an impact on the improvement of the functions and social mission of the university. Objectives: To design methodological guidelines for implementing the process of self-assessment of institutional quality and to validate it, in order to develop a systematic and reliable process. Methods: This consisted in a technological development project. The preliminary design was adjusted based on expert consultation and measurements of the Cronbach's Alpha coefficients and Pearson's correlation. A self-assessment test was implemented using the key informant technique. Results: The opinion of the experts was favorable for all the contents. The statistical tests showed a high index of internal consistency and reliability. The design obtained integrated the established university guidelines and the service particularities. The recommendations were aimed at improving the available information and at formalizing a participatory methodology. Conclusions: The design of the guidelines was validated and allowed a self-knowledge about institutional quality with greater scientific rigor. Limitations were identified in the exchange phase between the evaluators(AU)
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Humans , Self-Evaluation Programs/methods , Health Human Resource Evaluation , Schools, Nursing , Uruguay , Total Quality ManagementABSTRACT
Objective To establish a management mode for patients with chronic kidney disease (CKD) of stage 3 to 4 by continuous quality improvement (CQI), and to observe the effect of CQI on renal function in CKD patients. Methods A total of 86 patients with CKD (50 in stage 3 and 36 in stage 4) were enrolled in this study, and they were regularly followed-up in the CKD outpatient of the Department of Nephrology of Jing’an District Zhabei Centre Hospital of Shanghai. The patients were randomly divided into observation group and control group, with 43 cases in each group. In the observation group, we used the management mode combining medical intervention and health education by plan-do-check-act (PDCA) four-step method; in the control group, we used the traditional management mode of medical intervention. All the patients were followed up once a month for one year. The end points included doubling serum creatinine (Scr) or entering end-stage renal disease, and occurence of cardiovascular and cerebrovascular events. The follow-up on time rate (%), Scr level, and estimated glomerular filtration rate (eGFR) were compared between the two groups. Results In the observation group, the average follow-up times were 10.7±2.8 and the follow-up on time rate was (89.9±12.8)%; while those were 4.1±2.2 and (34.2±4.9)% in the control group, and there were significant differences between the two groups (all P0.01). During the 1-year follow-up period, two cases had end-stage renal disease and one case had acute angina in the control group, while no end point was found in the observation group. Before the implementation of CQI, there were no significant differences in eGFR or Scr level between the two groups (all P0.05). The eGFR of the observation group after implementation of CQI was (39.35±12.23) mL/(min • 1.73 m2), which was significantly higher than those of the observation group before implementation ([37.22±11.02] mL/[min • 1.73 m2], P0.05) and the control group after implementation ([35.04±12.31] mL/[min • 1.73 m2], P0.05). The Scr level of the observation group after implementation of CQI was (139.25±14.15) µmol/L, which was significantly lower than those of the observation group before implementation ([145.16±15.41] µmol/L, P0.05) and the control group after the implementation ([148.06±15.63] µmol/L, P0.05). Conclusion CQI management method with the combination of medical intervention and health education can improve the renal function of patients with CKD stages 3-4, and reduce the incidence of end-stage renal disease and cardiovascular and cerevascular events.
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The quality control centers of the city level supervise and manage the medical quality of related clinical and technical specialties of medical institutions.The paper researches the comprehensive control and management of various professional subjects according to the standard of quality control,improving the medical quality of the Department,improving the level of discipline development,promoting the continuous improvement of medical quality in hospitals.
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OBJECTIVE: To improve dispensing rate of automatic dispensing equipment, and to shorten dispensing time.METHODS: Continuous quality improvement (CQI) group was established, and COI was conducted by using PDCA (Plan, Do, Check, Action) cycle. The influencing factors for slow drug delivery of automatic dispensing equipment were analyzed to set up the target, adjust multi-package drugs, develop appropriate improvement plans and implementation methods, monitor result and evaluate effect (calculated the first 10 in usage frequency of the multi-package drugs). RESULTS: Through adjusting the specification and list of multi-package drugs, the utilization rate of multi-package drug increased from 63. 91％ to 86. 23％ of 10 drugs during Jun. -Oct. in 2016; compared with the single-package dispensing mode, and dispensing time shortened 7. 86-13. 73 h per month of 10 drugs. CONCLUSIONS: Through the CQI, the dispensing rate of automation dispensing equipment is greatly increased by drug multi-package dispensing mode.
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Objective To analyze the change in isolation rates of multidrug-resistant organisms (MDROs) before and after adopting plan-do-check-act (PDCA) cycle method for management of MDROs. Methods Bacterial culture specimen submission and isolation of MDROs in a tertiary first-class hospital before the implementation of PDCA cycle (January 2013-December 2014) and after implementation of PDCA cycle (January 2015-December 2016) were collected and analyzed. Results A total of 14 889 specimens were sent for detection before the implementation of PDCA cycle, 6 345 strains were isolated, 650 of which were MDROs, isolation rate of MDROs was 10. 24％; after the implementation of PDCA cycle, 17 856 specimens were sent for detection, 7 568 strains were isolated, 476 were MDROs, isolation rate of MDROs was 6.29％; difference in MDRO detection rate before and after the implementation of PDCA was statistically significant (X2=72.567, P＜0.001). After Cochran-Armitage trend test, the isolation rates of MDROs in 2013-2016 showed a decreased trend (Z= - 7.8856). The amount and cost of hand hygiene products have increased. Conclusion By carrying out PDCA cycle for MDROs management, the isolation rate of MDROs in hospital is reduced. PDCA cycle management method can effectively promote the continuous quality improvement of hospital MDROs management.
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The application of continuous quality improvement program in standardized residency training examination in the central Hospital of Shanghai Jiading was introduced to inquire into the way to improve the quality of standardized training of resident doctors. Through the steps of FOCUS-PDCA, we continuously improved the examination content and quality compliance training personnel, and developed the examination process including test, training, supervision, learning and using. After the implementation of the project, the percentage of the departments that meet the residency training examination requirements has been increased from 33.3%to 100%in our hospital. The percentage of the students that passed the licensed medical skills examination was 96.6%in that year. 100%of the students passed the graduation comprehen-sive examination. Year-end evaluation showed that the students' satisfaction degree to the teachers increased from 94.5%to 98.2%. Thus, through the implementation of CQI project, we achieved the goal of promoting teaching and promoting learning.
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Continuous quality improvement is the essence and core of modern hospital quality management.Our hospital attaches great importance to quality management and constantly improves the system of management and takes charge of implementation of implement.Continuous quality improvement is based on actual condition in order to stimulate the staff′s enthusiasm, initiative and form the hospital culture of participating in quality management jointly.It can improve the overall quality of the hospital management in the process of the implementation of continuous quality improvement by finding and analyzing problems, actively implementing, and strengthening staffs′ consciousness of quality gradually.
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Objective To explore the continuous improvement to reduce the suctioning pediatrics lumen instruments return-cleaning rate of the first time washing, improve work efficiency and reduce the cost by applying root cause analysis. Methods Using causal analysis of fishbone diagram to analysis and verify the main reason of leading to high lumen instruments return-cleaning rate. According to the three terminal factors of continuous quality improvement, quality control group was set up, lumen instruments cleaning quality control standards was made, water flow mode of lumen instruments cleaning was changed, selected the appropriate cleaning tools and real picture show, synchronize quality control measures of publishing the quality and safety board. Compared before and after return-cleaning rate of three different detection methods and the different parts of the same suction lumen instruments. Results Before carrying out eye-measurement, cotton swab to wipe, ATP bioluminescence back washing rate was 0.89% (2/225), 7.11%(16/225), 27.11%(61/225), respectively after implementation of 0, 0.44%(1/226), 3.98%(9/226), visual observation before and after the return rate of washing was no statistically significant difference (χ2=2.018, P>0.05);Cotton swab to wipe, ATP bioluminescence back washing rate difference was statistically significant (χ2=13.820, 45.999, P0.05). Conclusions ATP bioluminescence assay has fine effects to detect the return-washing rate of the inner wall of the lumen instruments. The Root Cause Analysis method significantly reduced the return-washing rate of the inside surface of the suction lumen instruments, improve the efficiency, save the medical cost and reduce the hospital infection.
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Objective:To explore the influence of continuous quality improvement of nursing care on the compliance of senile patient with gastroscopy.Methods: 100 senile patients with gastroscopy were selected, and they were divided into control and improvement groups ( each group included 50 cases ) depended on the different time of hospitalization. The control group was treated with routine nursing quality method, while the improvement group was treated with continuous quality improvement method. A series of indicators in the endoscopic examination, such as the success rate of one time intubation, the used time, yes or no cough and other adverse reactions and the patient's satisfaction for nursing services were compared between the two groups.Results:After 5 months of continuous quality improvement nursing, the success rate of one time intubation in the improvement group was significantly higher than that in the control group, and the checking time of improvement group was significantly less than that of control group, the differences were statistically significant(t=7.162,t=6.61; P<0.01). Besides, on check process, the incidence of adverse reactions in the improvement group was significantly lower than that in the control group and the satisfaction of nursing service was significantly higher than that of the control group, the differences were statistically significant(x2=23.077,x2=10.699,P<0.01).Conclusion:The application of continuous quality improvement nursing for senile patients during gastroscopy can improve the success rate of one time intubation, shorten the gastroscopy time, reduce the incidence of adverse reactions, enhance compliance of gastroscopy and satisfaction for nursing service, and its clinical effect is obvious.
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Objective:To explore the effect of continuous quality improvement theory on patients' satisfaction and nurses'perception of working environment.Methods:Quality nursing service satisfaction survey was conducted in 450 patients,at the same time,100 nurses were investigated for the situation of working environment.Patients' satisfaction and the status of nurses' perception of their own work environment were compared before and after the implementation of continuous quality improvement theory.Results:After the implementation of continuous quality improvement theory,both patients' satisfaction and nurses' perception of working environment were significantly improved (P ＜ 0.05).Gonclusions:Continuous quality improvement theory can improve the satisfaction of patients with high quality nursing service,and enhance the nurses' perception of their working environment.
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Objective To investigate the effect of continuous quality improvement on subjective well-being quality of life and satisfaction of esophageal cancer patients. Methods A total of 120 esophageal cancer patients in our hospital were randomly divided into two groups, 60 cases in the observation group treated with continuous quality improvement while the other 60 cases in the control group treated with routine care. The two groups were compared in terms of subjective well-being,quality of life and nursing satisfaction. Results Before the intervention, there were no significant differences between the two groups in view of the quality of life scale score and subjective well-being score (P>0.05). After the intervention, in view of symptoms, the scores on all the items in the boservation group were significantly lower than those in the control group (P<0.05), except constipation, economic difficulty and diarrhea and the function items were higher. The subjective satisfaction of the observation group was significantly better than that of the control group (P<0.05). Conclusion Continuous quality improvement care can promote the improvement of subjective well-being, improve the quality of life and satisfaction of patients with esophageal cancer.
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Objective:To explore the effect of continuous quality improvement for enhancing the ability of application and management of nurses of hepatobiliary surgery for physiological monitor.Methods: The data of clinical work were researched by using retrospective analysis, and they were divided into quality improvement group(n=40) and routine management group(n=40) according to different management method. The score of examination, satisficing of patient for physical monitor, false alarm situation and processing time between the two groups were researched and analyzed.Results: The score of examinations both of theory and operation of quality improvement group were significantly higher than those of routine management group (t=4.303,t=3.182,P<0.05), respectively. The reasonable storing rate, understanding rate of whereabouts and satisficing of maintenance about physical monitor of quality improvement group (92.5%, 100.0% and 87.5%) were significantly higher than those of routine management group(32.5%, 40.0% and 52.5%) (x2=5.02,x2=7.38,x2=9.35,P<0.05), respectively. The false alarm rate of quality improvement group (10.0%) was significantly lower than that of routine management group (35.0%) (x2=11.14,P<0.05). And the processing time of false alarm of quality improvement group was significantly shorter than that of routine management group (t=2.776,P<0.05).Conclusion: The method of continuous quality improvement can effectively enhance the ability of application and management level of the nurses of hepatobiliary surgery for physical monitor.
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Objective To study the recogniting patients identity for the safety and reliability of radiotherapy. Methods Through PDCA 4 footwork, namely, plan, do, check, action the technicians in the hospital to improve patients' identity verification.Results After 4 months of PDCA cycle,the patient identity verification qualified rate increase gradually,from 88.17% up to 99.07%,the privacy of patients satisfaction rate rose from 52. 69% to 98. 15%. The patients identification accuracy rate of 100%, technicians working efficiency has been greatly improved. Conclusions The measure of patient identification can improve the working process of radiotherapy for safety and efficiency and can get better privacy protection.
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Background: Ascendancy of Intensive Care Medicine in the realm of healthcare has made Continuous Quality Improvement (CQI) in Intensive Care Units (ICUs) most imperative for hospital administrators worldwide. Perspicuous identification of all clinical and non-clinical drivers warranting contemplation is the most arduous step in achieving the same. This study avers the effectiveness of a statistically-sound, novel approach using Delphi technique in identifying various drivers to be prioritized for strategizing CQI in the postoperative ICU of a premier tertiary care hospital in Asia. Methods: Three rounds of Delphi survey were initially planned. Mean Rank Scores (MRS) was used to rank the opinions in this study. Results: Statistically validated consensus was reached among expert participants on five drivers that should galvanize hospital administration vis-à-vis strategizing quality implementation in the post-operative ICU. Foremost among these was adequate staff that is tantamount to desirable staff-patient ratio (MRS: 9.4), and regular medical audit for sustainable quality in healthcare delivery (MRS: 9.1). Experts further concurred that communication skills of ICU staff (MRS: 8.9), continuous medical education and training of these staff (MRS: 7.6) along with perspicuous ‘Standard Operating Procedures’ (MRS: 7.1) were other points to be considered. Conclusions: With regard to the process of planning, identification of correct drivers holds the crux in strategizing quality implementation in any setup. Implementing change management is equally imperative. This approach can be used to realize both of these.
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Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.
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Objective We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal di-alysis ( PD) . Methods In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 ( control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place.Per-itonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. Results In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy.After implementation of the CQI initiative, the peritonitis rate de-clined to 1 episode in 77.3 patient-months from 1 episode in 22.6 patient-months.In the CQI group, the complicance of blood pressure was more significantly improved than the control group ( 67.8% vs 47.4%,P<0.05).During the 3 years of follow-up,cardiothoracic ratio and IVST were significantly increased in the control group [0.55 ± 0.08 vs 0.51 ±0.05,P<0.05,11.07 ±1.66 mm vs 10.25 ±1.38 mm, P<0.05〗.The difference of LVID between the two groups was signifi-cant at the 2nd and 3rd year of follow-up(P<0.05).Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3%respectively) than in the control group (92.6%, 82.4%, and 67.3%respectively, P<0.001).Imple-mentation of the CQI initiative also appeared to significantly improve technique survival rates:95.6%, 92.6%, and 92.6%in the CQI group compared with 89.6%, 79.2%, and 76.8%in the control group (P<0.001) after 1, 2, and 3 years respectively. Conclusion Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes.