基于目标管理降低呼吸机相关性肺炎发生率的临床实践  

Objective management reduces the incidence of ventilator-associated pneumonia based

作　　者：谢艳芳 李云玲[1] 唐荣登 XIE Yanfang;LI Yunling;TANG Rongdeng(The First People’s Hospital of Zhaoqing,Zhaoqing 526060,China)

机构地区：[1]肇庆市第一人民医院,广东肇庆526060

出　　处：《现代医院》2023年第5期710-712,716,共4页Modern Hospitals

基　　金：广东省医学科研基金(B2021447)。

摘　　要：目的 旨在探讨通过制订目标、实施目标、达成目标的目标管理方案对呼吸机相关性肺炎(VAP)发生率的影响。方法 2020年1月—2021年12月,采用标杆对比法对医院重症监护室留置气管插管使用呼吸机的患者应用目标管理方案,设定一个年度为一个质量周期,通过目标制定、目标计划、目标实施并对其过程及结果进行质量评价,观察并记录10项预防VAP集束化护理措施执行率、呼吸机相关性肺炎感染发生率。通过对重点环节实施管理及控制,对比各周期质量评价,进而实现持续的质量改进。结果 呼吸机使用期10项护理措施在整个质量改善周期中的执行率都是呈正向变化。其中,气道分泌物、肠内营养、冷凝水管理3项质量改进措施保持了较高的完成率,与基准线比较没有统计学差异;手卫生在第二周期中执行率与基线以及第一周期有了明显的改善;在床头抬高、声门下吸引、气囊压力监测、口腔护理、每日唤醒、早期康复训练等6项措施从第一周期至第二周期的执行过程持续提高。而在质量改善周期内,VAP发生率总体趋势明显降低。结论 应用目标管理方案可将目标具体化,客观测量护理质量,促进护理质量提高和提高VAP的护理相关措施的执行率,降低重症患者VAP的发生率,使重症患者的安全得到进一步保障。Objective To explore the effect of objective management on the incidence of ventilator-associated pneumonia(VAP)by setting,implementing and achieving objectives.Methods Benchmarking comparison method was used in the objective management among patients with ventilators by endotracheal intubation in the intensive care unit of the hospital from January 2020 to December 2021.With one year as a quality cycle,the process and results of the objective management were evaluatedthrough setting,planning,and implementing objectives.The rate of implementing ten cluster nursing measures for preventing VAP and the incidence of VAP infection were observed.The key links were monitored and controlled and the quality evaluation was compared across cycles so as to continuously improve the quality of management.Results The implementation of ten nursing measures forusing ventilators was positivein the whole quality improvement cycle.Among them,the three quality improvement measures such as airway secretion,enteral nutrition,and condensate management maintained at a high completion rate with no statistical difference compared with the baseline.Hand hygiene performance rates were significantly improved in the second cycle from baseline and in the first cycle.From the first cycle to the second cycle,six measures,including bedside elevation,subglottic suction,airbag pressure monitoring,oral care,daily wake-up,and early rehabilitation training,were continuously improved.The overall trend of VAP incidence decreased significantly during the quality improvement period.Conclusion Objective management can make the objective specific,measure the quality of nursing objectively,improve nursing quality and nursing measures related to VAP and reduce the incidence of VAP in severe patients,thereby guaranteeing the safety of severe patients.

关 键 词：目标管理 呼吸机相关性肺炎 标杆对比 

分 类 号：R473[医药卫生—护理学] R472.2[医药卫生—临床医学] R459.7