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OBJECTIVE To evaluate the effect of PDCA cycle on prophylactic use of antibiotics in laparoscopic cholecystectomy during perioperative period and to conduct pharmacoeconomic analysis. METHODS Using retrospective analysis method， 80 discharged patients of each group underwent laparoscopic cholecystectomy were randomly selected from Hefei Second People’s Hospital before PDCA cycle （from May to June 2019）， after the first round of PDCA cycle （from May to June 2020）， after the second round of PDCA cycle （from May to June 2021） according to real or basic reasons for irrational drug use. The rationality of prophylactic use of antibiotics for patients was evaluated. The general situation， antibiotic use， clinical efficacy and treatment cost of patients were compared before cycle and after the first and second rounds of PDCA cycle. Cost-effectiveness analysis method and sensitivity analysis method were adopted to evaluate pharmacoeconomic significance of PDCA cycle. RESULTS After two rounds of PDCA cycle， the irrational rate of antibiotics， cost ratio of antibiotics， the number of days of antibiotics use， DDDs， drug utilization index， the frequency of antibiotics use per capita， the total amount of antibiotics， the cost of antibiotics， the total amount of drugs， and the total cost of hospitalization all decreased significantly （P＜0.05）. The results of cost-effectiveness analysis indicated that the pharmacoeconomic effect was the best after two rounds of PDCA cycle； the results of sensitivity analysis were consistent with it， which confirmed the reliability of the research results. CONCLUSIONS PDCA CPA- cycle promotes the rational use of antibiotics of laparoscopic cholecystectomy during perioperative period， reduces the cost of antibiotics and relieves the economic burden of patients.
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Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.
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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 observe the effect of applying PDCA cycle method to promote the management of key monitoring drug, and provide a basis for the management of key monitoring drug in medical institutions. Methods To compare the consumption of drugs and prescription reviews before and after the adoption of PDCA management in a hospital. The control group was the inpatients with traditional management method in 2019, and the observation group was the inpatients with PDCA method in 2020. Results After the implementation of PDCA cycle, the consumption amount of key monitoring drugs decreased significantly (P<0.001); The problems of irrational prescription such as drug use without indication, repeated drug use, inappropriate dosage and route of administration, and long course of treatment were effectively controlled (P<0.05). The qualified rate of prescription increased from 65.96% to 90.76% (χ2=27.010, P<0.001). The incidence of adverse reactions was significantly decreased (χ2 =37.044, P<0.001). Conclusion PDCA method aims at continuous closed-loop management of key monitoring drugs in medical institutions, which can control drug costs to the greatest extent, reduce the economic burden of patients, promote rational drug use, reduce the incidence of adverse reactions, and ensure the quality of medical care.
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Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.
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To evaluate effects of PDCA cycle in improving residency diagnosis and treatment ability of endocrine and metabolic diseases, this paper selected the problems of insufficient diagnosis and treatment ability in the results of the endocrinology examination paper as the research breakthrough point, and investigated 62 residents receiving standardized residency training to analyze main reasons of the problems such as "busy clinical work", "special clinical thinking" and "difficult to remember knowledge of endocrinology". The study implemented information-based teaching and daily self-education, followed the law of memory, strengthened the construction of teaching staff, improved teaching methods, etc., and effects of these methods were assessed after the teaching. It's found that the application of PDCA cycle can improve the residents' ability of clinical diagnosis and treatment in endocrine and metabolic diseases.
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In the COVID-19 outbreak, several general hospitals in Wuhan were transferred to designated hospitals. However, most of the designated hospitals had suffered from insufficient oxygen supply in different degrees. Taking a designated hospital as an example, this paper summarized the emergency management system of oxygen supply from the aspects of engineering transformation, process formulation and safety management through the PDCA cycle theory, discussed the management experience of oxygen supply under the epidemic situation, and explored the management mode of emergency normalization from the perspective of peacetime and wartime integration. The purpose was to provide reference for the management of medical oxygen supply in public health emergencies and normal operation.
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OBJECTIVE: To investigate the use of PDCA mode for risk assessment and risk management of pharmacy intravenous admixture service. METHODS: A retrospective analysis was made on the errors recorded in the intravenous drug dispensing center from Monday 2019 to March 2019. The types and links of errors were counted and classified, and the causes were analyzed. Targeted preventive measures were implemented from April to June 2019 to observe the incidence of errors before and after prevention in intravenous drug dispensing centers. RESULTS: Through the PDCA cycle management intervention, the main errors in intravenous drug dispensing center are dispensing, labeling, reviewing, checking and issuing. The incidence of errors in each link after prevention is lower than that before prevention, and the difference is statistically significant (P<0.001). CONCLUSION: The PDCA cycle management and risk assessment are conducted. The paper analyzes the types and causes of common errors in intravenous drug dispensing center, so as to formulate corresponding preventive measures, which can reduce the risk factors of errors, reduce the incidence of errors, improve the quality of finished product infusion and the safety of intravenous drug use.
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Objective To explore the effect of the intervention of clinical pharmacists on the rational use of piperacillin-tazobactam by using PDCA cycle, in order to provide reference for rational drug use. Methods The problems of piperacillin-tazobactam in our hospital was analyzed. PDCA cycle was used to manage the problems. Then, the data before and after PDCA cycle was compared and analyzed. Results After using PDCA cycle, the irrational use rate of piperacillin-tazobactam gradually decreased, from 9% in February 2018 to 2% in February 2019; the doses decreased from 4380 in February 2018 to 3346 in February 2019; and the frequency of usage decreased from 391 DDDs in February 2018 to 298 DDDs in February 2019. The effectiveness and continuous improvement of PDCA cycle in managing piperacillin-tazobactam were significant. Conclusion PDCA cycle can effectively improve the management effectiveness of piperacillin-tazobactam administration.
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Objective To analyze problems existing in our scientific research methodological service process in our hospi-tal and realize the continuous improvement of service quality through project management .Methods We took the method of PDCA cycle management model and combined with the project management tools (such as fishbone diagram brainstorming method was used to perform causal analysis ,adopting the Gantt chart making project plan ,using SMART principle to set the target theme ,etc .) ,by using some strategies such as improving the standard of service system for departments ,establishing a professional and partitioned service flow ,adjusting the division of labor according to professional specialties ,communicating and learning to optimize solutions regularly ,equipping with professional technicians to improve operation and maintenance secu-rity of service platform ,etc .Results We completed the three target themes of service quality improvement about "shortening the period of service statistics analysis report","improving the accuracy of scientific research design"and"reducing the number of service data platform problem report".Conclusions The adoption of PDCA cycle management can effectively improve the quality of scientific research methodological service in the hospital .
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Objective To explore the effect of PDCA [plan (P), design (D), check (C), act (A)] cycle on primary cardiopulmonary resuscitation (CPR) training for medical assistants in hospitals. Methods PDCA cycle was used to enhance continuous quality improvement (CQI) of team members to carry out brain storming to find out the root causes of the training difficulty, and directing to the 3 main root causes: lack of emergency rescue consciousness, without systematic training system and improper education procedure, it was proposed to arrange 3 great strategies: emergency rescue knowledge training, design of systematic training system and proper arrangement of training process. The changes of medical assistants' subjective willingness to perform the first aid, the accurate rates of answering questions on CPR location, frequency, depth, ratio of compression to breathing and awareness degree of CPR before and after training were observed. Results After training, the medical assistants' subjective willingness to perform the first aid was higher than that before training [91.7% (121/132) vs. 2.3% (3/132), P＜0.05]. The accurate answer rates on questions concerning CPR basic knowledge, such as location, frequency, depth and compression-breathing ratio had been greatly improved after training compared with those before training [location: 65.2% (86/132) vs. 4.5% (6/132), frequency: 40.2% (53/132) vs. 0 (0/132), depth: 90.2% (119/132) vs. 0 (0/132), compression-breathing ratio: 84.8% (112/132) vs. 1.5% (2/132 ), all P＜0.05]. After training, the percentage of medical assistants having very familiar awareness degree of CPR was significantly higher than that before training [65.2% (86/132) vs. 3.0% (4/132), P＜0.05]. Conclusion Via CPR training PDCA cycle, not only the efficiency of CPR training management is greatly improved, but also the training effect of participants is significantly elevated.
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Objective to explore the value of scenario simulation combined with PDCA cycle in the training of newly recruited staff of the radiology department. Methods thirty newly recruited members of the radiology department were selected as research subjects and received three months of training using scenario simulation combined with PDCA cycle teaching. The subjects took examinations before and after the training to estimate its effect on the their first-aid related knowledge and skills, as well as the apprehension of professional knowledge; questionnaires were used to collect the subjects' self-evaluation and their feedbacks for the training. T test was conducted using SPSS 20.0. Results the scores of first aid related knowledge, first aid instrument use, first aid skills and first aid ability after training were significantly higher, and the differences were statistically significant. After the training, the staff's performance in terms of noun explanation, problem solving and essay questions was significantly higher than that before the training, and the overall performance was significantly improved. More than 90％of the new recruits believed that scenario simulation combined with PDCA had practical effects on improving clinical practice ability , knowledge understanding, comprehensive analysis, problem solving ability and cooperative ability. More than 85％ of the subjects considered it helpful for mastering the teaching content , improving learning efficiency , developing independent learning ability and stimulating learning interest. Conclusion scenario simulation teaching combined with PDCA can improve new employee's learning interest and teaching satisfaction, and further improve doctor-patient communication ability and training effect.
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Objective@#To explore the application and effect of the PDCA cycle nursing management model in the treatment of peri-implant mucositis.@*Methods @#Thirty patients with peri-implant mucositis were treated nonsurgically. Before treatment, the 30 patients had no history of systemic diseases, drug allergies, or bad habits. According to the principle of single-blind randomized control, the patients were divided into two groups: 15 patients were assigned to the control group and received routine clinical nursing and oral hygiene education according to the doctor′s prescription; and 15 patients were assigned to the intervention group, in which the PDCA cycle nursing management model was adopted. The four steps of “plan, do, check and act” were carried out. The plaque index (PL), gingival index (GI) and probe depth (PD) in the two groups were recorded before treatment and 3 and 6 months after treatment.@*Results@# There was no significant difference in the PL, GI or PD between the intervention group and the control group before treatment (P > 0.05). Three months after treatment, the PL in the intervention group was 1.25 ± 0.44, while the PL in the control group was 1.49 ± 0.39, with a significant difference (t=2.56, P=0.008); the GI in the intervention group was 1.21 ± 0.43, while the GI in the control group was 1.56 ± 0.37, with significant difference (t=2.94, P=0.006); and the PD in the intervention group was 4.39 ± 0.41 while the PD in the control group was 4.47 ± 0.52 mm, with no significant difference (t=2.24, P=0.062). Six months after treatment, the PL in the intervention group was 1.26 ± 0.48, while the PL in the control group was 1.51 ± 0.42, with a significant difference (t=2.66, P=0.007); the GI in the intervention group was 1.34 ± 0.28, while the GI in the control group was 1.74 ± 0.48 (t=2.98, P=0.008); and the PD in the intervention group was 4.46 ± 0.52 mm, while the PD in the control group was 4.54 ± 0.66, with no significant difference (t=2.28, P=0.077).@*Conclusion @#The PDCA cycle nursing management model can enhance patients′ awareness of oral health maintenance, reduce gingival plaque accumulation, and effectively improve the health status of peri-implant tissues.
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s] Objective To understand the influence of PDCA cyclecombined with LBL/TBL teaching models on the problem-solving ability and clinical training of pharmacy interns so as to improve the teaching quality of hospital pharmacy practice. Methods A total of 126 hospital pharmacy interns were randomly divided into the control group (63 interns) and the experimental group (63 interns). The control group was taught with LBL/TBL teaching models, while the experimental group was taught with PDCA cycle combined with LBL/TBL teaching models . Questionnaires were used to investigate the problem-solving ability , the teaching effect of clinical training , and the satisfaction in the two groups after the clinical training. Results The scores of positive problem orientation and rational problem solving were higher in the experimental group than in the control group (P<0.05). The scores of negative problem orientation, avoidance style, impulsivity/carelessness style were lower in the experimental group than in the control group(P<0.05). The scores of theoretical knowledge ( 86 . 5 ± 8 . 5 ) and clinical skills ( 87 . 0 ± 7 . 2 ) were higher in the experimental group than in the control group (P<0.05). Besides, the investigation on the satisfaction to clinical training showed that the practical ability, teamwork consciousness and self-learning ability were better in the experimental group than in the control group (P<0.05). The total satisfaction of the experimental group was 92.2％, higher than that of the control group (83.5％) (P<0.05). Conclusion PDCA cycle combined with LBL/TBL teaching models can improve the problem-solving ability and the teaching effect of clinical training in pharmacy interns, which deserves wider application.
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OBJECTIVE： To promote the implementation of the pre-prescription review work， and to ensure the rational drug use of patients. METHODS： With the idea of PDCA （Plan， Do， Check， Action） cycle management， the phased improvement of three PDCA cycles was gradually implemented in the operation of the pre-prescription review system， aiming at the establishment of the working mode of the prescription review work， the improvement of the rules of knowledge base in the review system and the improvement of the ability of pharmacists to review prescriptions. The operation results of the system were evaluated by comparing the irrational prescription rate of outpatient pharmacies before and after the operation of pre-prescription review system. RESULTS： Through adopting the prescription review mode of “rigid” and “flexible” interception， regular revision of knowledge base rules， regular training and examination of prescription pharmacists， pre-prescription review system operated smoothly， and the pre-prescription review work was carried out in the process of continuous improvement. In the three PDCA cycles， the irrational rate of prescriptions decreased significantly， such as after the first PDCA cycle， the irrational rate of TCM outpatient prescriptions decreased from 22.0％ （1 393/6 332） in Jan. 2017 to 7.4％ （416/5 627） in Jun. 2017； after the second PDCA cycle， the irrational rate of outpatient prescriptions in hospital decreased from 4.87％ （5 244/107 691） in Mar. 2018 to 2.21％ （2 219/100 412） in Aug. 2018. After the third PDCA cycle， the percentage of over-treatment course prescriptions in total prescriptions decreased from 16.97％ （15 728/92 684） in Jun. 2018 to 5.55％ （5 394/97 275） in Sept. 2018. CONCLUSIONS： The pre-prescription review system can effectively intercept and interfere with irrational prescriptions， and PDCA cycle management can effectively promote the operation of the pre-prescription review work.
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OBJECTIVE： To promote rational use of proton pump inhibitors （PPIs） during perioperative period. METHODS： PDCA （Plan， Do， Check， Action） cycle management was used， the irrational use of PPIs of 300 medical records in neurosurgery department of our hospital were collected. The reasons were analyzed， management target was formulated and measures were implemented. The effects of management were evaluated through comparing the rate of irrational drug use and ratio of irrational type of PPIs in 300 medical records of neurosurgery department during perioperative period after management. RESULTS： Through collecting related data to confirm risk factors of stress ulcer， establishing rationality evaluation criteria for perioperative prophylactic use of PPIs， conducting rational drug use training among medical staff， drawing up various management systems and strengthening supervision and management， the rate of irrational use of PPIs was decreased significantly in our hospital； the number of irrational drug use cases decreased from 240 before management to 156 after management， among which the rate of prophylactic drug use without indication decreased from 37.33％ to 29.00％ （P＜0.05）； the irrational dosage rate decreased from 11.33％ to 6.33％ （P＜0.05）； the rate of irrational dosing frequency dropped from 12.67％ to 5.00％ （P＜0.01）. CONCLUSIONS： PDCA cycle management of our hospital can standardize the prophylactic use of PPIs in neurosurgery department during perioperative period and promote rational use of PPIs.
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This paper introduced the design of medical quality management system on department level ,and its application and the effect in a large-scale hospital. Our practice demonstrated that this department-level quality management system with the PDCA cycle in the whole process of quality management ,can promote the medical quality management activities to be carried out in an organized ,regulated ,planed ,well checked and concluded manner .
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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 laboratory of science and technology center at general hospital explored the appli-cation of PDCA cycle in the bio-safety training for research-oriented medical postgraduates, and then analyzed the effect of the training. The laboratory applied the PDCA cycle (Plan-Do-Check-Act) into the bio-safety training practice based on its own characteristics. The 4 links of bio-safety practice including bio-safety factors analysis, training plan implementation, training effectiveness evaluation and problems feed-back were integrated with 4 processes of PDCA cycle management. In view of the problems existing in the laboratory bio-safety training, the PDCA cycle model was applied to bio-safety training. Though the PDCA cycle, the laboratory can establish a bio-logical safety quality monitoring mechanism and achieve the system-atization, standardization and normalization of biosafety training.
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Objective To enhance the intact rate of the equipment for emergency treatment and life support. Methods Closed-loop management was realized by introducing PDCA cycle, developing regulation, process and plan, strengthening personnel training,implementing inspection and maintenance,executing quality control and etc.Results The intact rate of the equipment for emergency treatment and life support was increased from 60.2% to 100%. Conclusion The hospital is improved in emergency treatment,and passes the recheck of the grade-A tertiary hospital.