University of Sao Paulo Nursing College, Ribeirão Preto, São Paulo, Brazil
Faculty of Economics Business and Accountancy of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil.
BMJ Open Qual. 2023 Jun;12(2). doi: 10.1136/bmjoq-2022-002183.
Evaluate the impact of a quality improvement programme on the reduction of feeding tube obstruction frequencies, analyse the predictive variables of this safety incident, and estimate the economic costs related to the quality improvement programme during the period from 2014 to 2019.
Plan-Do-Study-Act cycles were performed to test the changes in drug preparation and administration processes via a nasoenteral feeding tube and to evaluate the outcome, process and balance measures. Statistical control charts were elaborated, and the bottom-up direct costing methodology was used to estimate the costs of the improvement programme. The impact of the programme on the monitoring measures was evaluated using logistic regression analysis.
The following changes were tested in the hospital participating in the study: acquisition of the Easy Crush equipment for tablet crushing, use of appropriate packaging to crush hard tablets, standardise procedures for scheduling administration times and/or substitution of the pharmaceutical form, educational activities for the nursing team and elaboration and availability of infographics for the nursing team, patients and/or family/caregivers.
There was a significant improvement in the frequency of tube obstructions, from 41.1% in 2014 to 57.9% in 2015-2017 and 9.6% in 2018-2019 (p=0.0010). After the execution of the improvement programme, it was estimated that the cost of dose preparation was reduced from R$1067.50 in 2014 to R$719.80 in 2015-2017 and R$433.10 in 2015-2019.
By re-establishing the processes of drug preparation and administration via a nasoenteral feeding tube, through the acquisition of appropriate equipment for crushing hard tablets, together with educational activities for the nursing team, we could observe a reduction in tube obstructions and the cost of processes.
评估质量改进计划对减少喂养管堵塞频率的影响，分析这一安全事件的预测变量，并估计 2014 年至 2019 年期间与质量改进计划相关的经济成本。
通过鼻肠喂养管进行计划-实施-研究-行动循环，测试药物准备和给药过程的变化，并评估结果、过程和平衡措施。制定了统计控制图，并使用自下而上的直接成本核算方法估算改进计划的成本。使用逻辑回归分析评估该计划对监测措施的影响。
参与研究的医院测试了以下变化：购买易粉碎设备粉碎片剂，使用合适的包装粉碎硬片剂，规范安排给药时间的程序和/或替代药物剂型，对护理团队进行教育活动，并为护理团队、患者和/或家属/照顾者制作和提供信息图表。
管腔堵塞的频率显著改善，从 2014 年的 41.1%降至 2015-2017 年的 57.9%和 2018-2019 年的 9.6%（p=0.0010）。在实施改进计划后，估计 2014 年的药物准备成本从 R$1067.50 降至 2015-2017 年的 R$719.80 和 2015-2019 年的 R$433.10。
通过重新建立经鼻肠喂养管的药物准备和给药过程，使用适当的硬片粉碎设备，并对护理团队进行教育活动，我们观察到管腔堵塞和流程成本的减少。
