Shao Ying, Li Qianfei, Bian Meirong, Wang Yue, Zhang Xiaohong
Department of Ophthalmology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
College of Nursing, Shanxi Medical University, Taiyuan, People's Republic of China.
J Multidiscip Healthc. 2024 Sep 10;17:4441-4452. doi: 10.2147/JMDH.S474702. eCollection 2024.
The "Key Points of the Core System of Medical Quality and Safety" (hereinafter referred to as the "Key Points") was promulgated by the National Health Commission of China in 2018, requiring that nursing ward rounds should be carried out with reference to the three-level ward round system; In 2020 and 2022 editions of the "Evaluation Standards for Tertiary Hospitals", which were implemented in China, required that nursing ward rounds should be carried out with reference to the "Key Points". Additionally, the Action Plan for Comprehensively Improving Medical Quality (2023-2025) also mentions the need to improve the quality of three-level ward rounds. However, there are no detailed guidelines regarding implementing "Nursing Three-level Ward Rounds".
This study aimed to investigate the current situation of nursing three-level ward rounds in tertiary hospitals after the promulgation of the "Key Points of the Core System of Medical Quality and Safety" to provide insights and guidelines regarding relevant standards, so as to better implement of the requirements of "nursing ward rounds" in the "Evaluation Standards for Tertiary Hospitals" and "improving the quality of three-level ward rounds" in the "Action Plan".
A multi-center study was conducted in February 2024, including all tertiary public hospitals in the Shanxi Province, China. A questionnaire survey using the self-designed "Questionnaire on the Implementation of Nursing Three-level Ward Rounds" was carried out. The questionnaire included the basic information of the hospital and the implementation of the three-level (namely I, II, and III) rounds (including "five aspects": ward round personnel, object, content, frequency, and record), which is expressed by quantity and composition ratio. Next is the text analysis method. First, the "five aspects" of the hospital that filled in the questionnaire survey with "nursing three-level ward rounds have been carried out" were assessed. Second, the five aspects of each hospital were assessed for consistency with the "Nursing Three-level Ward Rounds System" (hereinafter referred to as the "System") of their respective hospitals.Third, the consistency of the "System" of the hospital with the "Key Points" was assessed. The results of the analysis of the former are expressed in terms of quantity and composition ratio; the results of the latter two were analyzed using Fisher's exact test method to compare any differences.
Notably, 14 of the 67 tertiary public hospitals (20.9%) carried out nursing three-level ward rounds. There were 4-10 situations in the five aspects of I, II, and III ward rounds filled in by the hospitals. The five aspects of the I, II, III ward rounds in 14 hospitals were significantly comparable with the "System", which, in turn, was comparable with the "Key Points" (P < 0.05).
Not all tertiary public hospitals in the Shanxi Province have not all carried out nursing three-level ward rounds. Furthermore, the five aspects of the hospitals that carried out nursing three-level ward rounds were not entirely consistent in terms of ward round personnel, object, content, frequency, and record. The filling in of the nursing three-level ward rounds carried out by the hospitals is inconsistent with the respective "System"; the "System" of the hospital is not in line with the "Key Points".
Nursing administrators should be aware of the newly issued norms and requirements in their workplace, and revise the relevant systems in accordance with the norms and requirements in a timely manner. Additionally, the revision of the system should cover the core requirements of the norms and be practicable. The system should be supervised to ensure that 100% of the implementation is in accordance with the system.
中国国家卫生健康委员会于2018年颁布了《医疗质量安全核心制度要点》（以下简称《要点》），要求参照三级查房制度开展护理查房；中国实施的《三级医院评审标准（2020年版）》和《三级医院评审标准（2022年版）》要求参照《要点》开展护理查房。此外，《全面提升医疗质量行动计划（2023—2025年）》也提到要提高三级查房质量。然而，关于实施“护理三级查房”尚无详细指南。
本研究旨在调查《医疗质量安全核心制度要点》颁布后三级医院护理三级查房的现状，为相关标准提供见解和指南，以便更好地落实《三级医院评审标准》中“护理查房”的要求以及《行动计划》中“提高三级查房质量”的要求。
2024年2月开展了一项多中心研究，纳入了中国山西省所有三级公立医院。采用自行设计的《护理三级查房实施情况调查问卷》进行问卷调查。问卷包括医院基本信息以及三级（即Ⅰ级、Ⅱ级和Ⅲ级）查房的实施情况（包括“五个方面”：查房人员、对象、内容、频次和记录），以数量和构成比表示。接下来是文本分析法。首先，对问卷中填写了“已开展护理三级查房”的医院的“五个方面”进行评估。其次，评估各医院的五个方面与各自医院的《护理三级查房制度》（以下简称《制度》）的一致性。第三，评估医院的《制度》与《要点》的一致性。前一项分析结果以数量和构成比表示；后两项结果采用Fisher确切概率法进行分析以比较差异。
值得注意的是，67家三级公立医院中有14家（20.9%）开展了护理三级查房。医院填写的Ⅰ级、Ⅱ级和Ⅲ级查房五个方面存在4～10种情况。14家医院的Ⅰ级、Ⅱ级、Ⅲ级查房五个方面与《制度》有显著可比性，而《制度》又与《要点》具有可比性（P<0.05）。
山西省并非所有三级公立医院都未开展护理三级查房。此外，开展护理三级查房的医院在查房人员、对象、内容、频次和记录方面并非完全一致。医院开展的护理三级查房填写情况与各自的《制度》不一致；医院的《制度》与《要点》不符。
护理管理者应了解工作场所新发布的规范和要求，并及时根据规范和要求修订相关制度。此外，制度修订应涵盖规范的核心要求且具有可操作性。应对制度进行监督以确保100%按制度执行。
