Hollingsworth Jessa, Baliko Beverly, McKinney Selina, Rosenquist Peter
From the Department of Graduate Nursing, College of Nursing, University of South Carolina.
J ECT. 2019 Mar;35(1):21-26. doi: 10.1097/YCT.0000000000000497.
The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT.
The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy.
An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings.
Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States.
This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.
关于使用电休克疗法（ECT）治疗精神疾病的有效质量保证策略，文献中提供的指导很少。已发布了许多关于护理提供的指南；然而，对于一个项目或机构如何确保在实施ECT时符合安全、耐受性和有效性的最佳实践，几乎没有采取什么措施。
本项目的目的是创建一个针对ECT的质量保证策略。确定优质护理标准并阐明机构政策是建立有效质量保证策略的关键成果。
利用从ECT实践指南的系统综述、同行评审和机构政策中得出的质量标准，开发了一种审计工具。对2017年5月至6月这两个月期间发生的所有ECT程序进行回顾性审计，并与为该机构的ECT项目设定的目标合规率进行比较。调整机构政策以反映质量标准，审计结果用于为可能的实践变革举措提供信息，用于创建持续质量监测的基准，并纳入医院定期质量会议。
明确ECT护理标准和临床审计的使用是制定质量保证策略的有效起点。审计结果成功纳入医院的整体质量计划，对实践合规性的认可为美国东南部这家小型社区医院未来的质量发展和政策修订指明了方向。
本项目为质量保证策略奠定了基础，该策略可用于帮助监测程序安全性，并指导未来在实施ECT方面的改进工作。尽管这只是实现有意义的质量改进的第一步，但明确标准并确定最迫切的临床需求领域是这家医院不断发展的项目的关键开端。
