持续质量改进：长期降低非呼吸机相关性医院获得性肺炎发病率
Sustaining Quality Improvement: Long-Term Reduction of Nonventilator Hospital-Acquired Pneumonia.
作者信息
Baker Dian, Quinn Barbara, Ewan Victoria, Giuliano Karen K
机构信息
School of Nursing, California State University, Sacramento, Sacramento (Dr Baker); Sutter Medical Center, Sacramento, California (Ms Quinn); James Cook University Hospital, Middlesbrough, and Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Ewan); and Northeastern University, and Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston (Dr Giuliano).
出版信息
J Nurs Care Qual. 2019 Jul/Sep;34(3):223-229. doi: 10.1097/NCQ.0000000000000359.
BACKGROUND
Hospital-acquired pneumonia is now the number one hospital-acquired infection. Hospitals have addressed ventilator-associated pneumonia; however, patients not on a ventilator acquire more pneumonia with significant associated mortality rates.
LOCAL PROBLEM
In our hospital, non-ventilator-associated pneumonia was occurring on all types of units.
METHODS
The Influencer Model was used to reduce nonventilator hospital-acquired pneumonia rates. Statistical process control R and X-bar-charts were monitored monthly.
INTERVENTIONS
After a gap analysis, an interdisciplinary team implemented enhanced oral care before surgery and on the units, changed tube management, and monitored stress ulcer medication.
RESULTS
We achieved a statistically significantly reduction (P = .01) in pneumonia rates that have been sustained over 4 years.
CONCLUSIONS
Sustaining change requires (a) a continued team-based, collaborative approach, (b) ongoing stakeholder and executive leadership engagement, (c) monitoring that easy-to-use protocols and required equipment remain in place, and (d) embedded analytics to monitor results over a prolonged period.
背景
医院获得性肺炎目前是头号医院获得性感染。医院已针对呼吸机相关性肺炎采取措施；然而，未使用呼吸机的患者发生更多肺炎，且伴有显著的死亡率。
当地问题
在我们医院，各类病房均出现了非呼吸机相关性肺炎。
方法
采用影响者模型降低非呼吸机医院获得性肺炎发生率。每月监测统计过程控制R图和X均值图。
干预措施
经过差距分析后，一个跨学科团队在术前和病房实施强化口腔护理，改变管道管理方式，并监测应激性溃疡用药情况。
结果
我们实现了肺炎发生率在统计学上的显著降低（P = .01），且这一成果持续了4年。
结论
维持变革需要（a）持续的基于团队的协作方法，（b）利益相关者和行政领导层的持续参与，（c）监测易于使用的方案和所需设备是否到位，以及（d）嵌入分析以长期监测结果。
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