Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ2=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ2=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ2=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.
ObjectiveTo analyze the effectiveness of PDCA cycle model in antibiotics management by comparison of antibiotics use before and after the use of PDCA in a tertiary hospital.
MethodsProspective study was adopted to analyze the using rate of antibiotics in outpatients, emergent patients and inpatients between June 2011 and December 2013.
ResultsThe reasonable antibiotics use was improved since the beginning of PDCA cycle model. The antibiotics using rates of outpatients were 33.00%, 29.09% and 19.31%, of emergent patients were 45.00%, 32.81% and 28.94%, and of inpatients were 71.00%, 57.76% and 53.28% in year 2011 (from June to December), 2012 (from January to December) and 2013 (from January to December) respectively. Meanwhile, ClassⅠ incision antimicrobial use also decreased and bacteria examination rate continuously increased during the last three years. As a consequence, patients' cost was reduced.
ConclusionThe PDCA cycle model promotes the standardized management of clinical medication application.
ObjectiveUtilizing PDCA circulation to enhance the quality of single photon emission computed tomography (SPECT) in whole body bone scan (WBS).
MethodsBased on a retrospective analysis of the quality of WBS in the first half of year 2012, advices and measurements to improve the quality were implemented by the technologists. In the following half year of 2012, monthly evaluation of the WBS quality were carried out to further improve the quality by focusing on fine details of the patient positioning, radiopharmaceuticals injection and image processing, etc.
ResultsBy utilization of PDCA circulation, WBS quality in the latter half year of 2012 constantly improved. Further more, effective and improved technical procedures were extracted from scattered individual experience, which was expected to improve the WBS quality effectively in the long run.
ConclusionApplication of PDCA circulation in SPECT in whole body bone scan improves the image quality, because it not only brings better communication and understanding between patients and physicians/technologists, but also enables better patient preparations and individualized procedures based on standard protocols.
ObjectiveTo explore medical waste management method in a large hospital and strengthen the standardized management of medical waste.
MethodsBetween July 2012 and December 2014, according to the PDCA cycle working procedures, existing problems were found in medical waste management through survey, the cause of which was analyzed to formulate and implement a new system of medical waste management, to help carry out employee training and cross examination, and give feedback to clinical departments to make improvements. Then, we analyzed the awareness rate of medical waste-related knowledge among medical staff, accuracy rate of medical waste disposal, average daily medical waste amount before and after the application of PDCA cycle to evaluate the effect of the measures taken.
ResultsAwareness rate of medical waste-related knowledge among medical staff (2012:55.59%, 2013:62.89%, 2014:94.43%) increased with statistical significance (χ2=410.871, P<0.001). Accuracy rate of medical waste disposal (2012:69.83%, 2013:87.29%, 2014:94.91%) increased with statistical significance (χ2=197.449, P<0.001). Rank correlation analysis showed that average daily medical waste amount declined as average daily inpatients number increased (rs=?0.590, P<0.001).
ConclusionUsing PDCA cycle can improve the awareness rate of medical waste-related knowledge and accuracy among medical staff to achieve continuous quality improvement of medical waste management.
ObjectiveTo explore the application of PDCA (plan, do, check, action) circulation method in basic life support (BLS) technique training among non-medical personnel in hospitals.
MethodsIn a third-level grade-A hospital, BLS technique training was carried out for 66 non-medical personnel of various working categories between July and September 2011. During the training process, PDCA circulation method was applied to each step. The existing problems were searched and causes of the problems were found. Improving strategies were made and carried out, and finally, the effect of training was statistically analyzed.
ResultsAfter the application of PDCA circulation method, the test scores in the three training stages were significantly different (P ＜ 0.05) .
ConclusionPDCA circulation method can help non-medical personnel to master the operation process and the technique points of BLS quickly, and it also can improve the quality of BLS technique training for non-medical personnel in hospitals.
With the rapid development of information technology, medical reforms in various countries are moving towards informatization, and internet medical projects have been carried out gradually. Internet hospitals, as one of the manifestations of internet medical projects, have the advantages of improving the efficiency of medical services, revitalizing and effectively sinking high-quality medical resources, and therefore has become the focus of China’s next stage of medical reform. However, internet hospitals are innovative and local products of China, leading its practices lack of domestic and foreign theoretical research, as well as experience, which results in government policies and hospital management strategies are both moving forward in groping, and the construction outcomes vary. Therefore, this article aims to analyze the comprehensive dilemmas currently confronted by internet hospitals in China in different stages of construction, operation and management based on PDCA cycle, and thus, puts forward corresponding construction thinking and analysis in a targeted manner, and proposes guidance for the further development of internet hospitals.
ObjectiveTo explore the application of PDCA cycle in the examination of medical quality of Tibetan area hospitals.
MethodsIn the October 2014, PDCA cycle theory was introduced into the examination of Tibetan hospital medical quality. We collected quality problems existing in the medical activities actively, analyzed the reason and influencing factors and made corresponding plans. Then we implemented the plans and measures strictly, surveyed the results, found out and analyzed the problems, summarized the results of the examination, and turned the unsolved problems to the next PDCA circulation. Continuous follow-up was performed until the results were satisfactory. Based on Sichuan Province Secondary Comprehensive Hospital Evaluation Standard, we analyzed the medical quality of the hospital before PDCA application (July to September 2014) and after PDCA application (October to December 2014).
ResultsThe incidence of medical nursing documents writing defects decreased from 12.4% to 5.9%. Hospital infection management defect rate declined from 13.5% to 5.3% and drug safety management defect rate declined from 11.8% to 2.5%, and all the differences were statistically significant (P<0.05).
ConclusionPDCA cycle in the Tibetan hospital for medical quality examination has greatly improved the medical quality of Tibetan hospitals.
ObjectiveTo study the effects of PDCA cycle in the control of surgical site infection (SSI).
MethodsA total of 1 761 surgeries between January 2012 and December 2013 were chosen to be monitored. PDCA cycle was used as a tool of total quality management evaluation to enhance the control of SSI.
ResultsAfter 2 to 4 cycles of PDCA, the preventive medication rate of ClassⅠ operation incision was decreased significantly (χ2=309.513，P<0.001) and the postoperative incision infection rate did not change significantly (χ2=1.474，P=0.669).
ConclusionUsing PDCA cycle can increase SSI management level and quality significantly and total quality management can be operated effectively.
ObjectiveTo discuss the application and effect of PDCA cycle in urgent values management in surgical intensive care unit.
MethodsWe analyzed the quality of 141 cases of urgent value reports in surgical intensive care unit from May to July 2013 before the application of PDCA management. The quality of urgent values were totally controlled by PDCA circle. There were 135 cases of urgent value reports after the use of PDCA cycle. The data including qualify rate of specimens, record specification rate, and handover of urgent values were compared between the two groups of urgent values.
ResultsAfter the application of PDCA cycle management, the awareness rate of urgent value content and disposal processes among medical staffs increased from 75% to 95%, with significant improvement in the quality rate of samples, recording and processing of urgent values and the quality rate of recording.
ConclusionThe application of PDCA circle management can constantly correct the problems and ensure the policy implementation in the urgent values system in clinical departments, which can promote continuous quality improvement.
Objective To explore the application effect of PDCA cycle management on reducing the unplanned overnight recovery rate in patients undergoing transabdominal preperitoneal inguinal hernia repair (TAPP) under the same-day surgery model. Methods The unplanned overnight recovery rate in patients who underwent TAPP at West China Tianfu Hospital of Sichuan University between January and October 2023 (pre-improvement phase) was analyzed. A quality control group was established, and PDCA cycle management was employed to define control objectives and implement strategies to reduce the unplanned overnight recovery rate. The unplanned overnight recovery rate in patients who underwent TAPP between November 2023 and April 2024 (post-improvement phase) was compared with that in the pre-improvement phase. Results After the implementation of PDCA cycle management, the unplanned overnight recovery rate in patients undergoing TAPP under the same-day surgery reduced from 23.87% (37/155) in the pre-improvement phase to 9.05% (19/210) in the post-improvement phase, with a statistically significant difference (P<0.05). Conclusion The application of PDCA cycle in the process management of TAPP under the same-day surgery model significantly reduces the unplanned overnight recovery rate in patients.
