Wellington Regional Hospital, Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Wellington, New Zealand.
Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, New Zealand.
Nurs Crit Care. 2017 Nov;22(6):339-347. doi: 10.1111/nicc.12266. Epub 2016 Dec 14.
Quality of care is a major focus in the intensive care unit (ICU).
To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU.
A framework for QI was developed and implemented as part of a practice change initiative.
Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies.
Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily).
The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing.
The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued.
在重症监护病房（ICU），医疗质量是一个主要关注点。
描述一个由护士主导的质量改进（QI）项目，该项目改善了新西兰一家三级 ICU 中危重症患者的护理。
QI 框架是作为一项实践变革举措的一部分而开发和实施的。
在七个受护士影响的患者护理标准中收集、分析和报告审核数据。这七个标准是入院后 24 小时内给予肠内营养、及时给予抗生素、对符合条件的患者进行镇静保留、早期活动和三种预防压疮的策略。
对 2014 年和 2015 年收集的审核数据进行比较，显示七个标准中有五个标准得到了改善。实践改进最大的标准与以下标准有关：所有符合条件的患者在 ICU 入院后的头 24 小时内开始接受肠内营养（增加 3%）；所有符合条件的患者在处方时间后 30 分钟内接受抗生素（增加 6%）；所有符合条件的患者每天进行镇静中断（DSI；增加 24%）；所有符合条件的患者在 ICU 期间每天都进行活动（每天活动的患者比例增加 11%）。
由护士主导的 QI 项目表明，在早期肠内营养开始、DSI 以及早期和每日活动方面，患者的 ICU 护理得到了改善。
使用包含审核和反馈的护理 QI 框架是评估和提高护理质量并改善患者结局的一种方法。该举措证明了 ICU 患者护理质量的提高，特别是在早期肠内营养开始、及时使用抗生素、DSI 和每日活动方面。因此，它与重症护理团队高度相关，特别是那些致力于创造一种安全、可实现和重视变革的文化的团队。
