【推薦下載】ICU質(zhì)控綜述

SafetyandQuality

inICU北京市重癥醫(yī)學(xué)質(zhì)量控制和改進(jìn)中心

01/mpim/Beijingarea:77ICUunitsin71hospitals44membersuploaddate,34arecompleteSafetyisaglobalconceptEfficiencySecurityReactivitySatisfactionPatientsafetyhasemergedasamajortargetforhealthcareimprovement.WashingtonDCNationalAcademyPress;2001DataonadverseeventsinhealthcarefromseveralcountriesWorldHealthOrganization,ExecutiveBoard109thsession,provisionalagendaitem3,4,5December2001Patientsintheintensivecareunit(ICU)aremorelikelythanotherhospitalizedpatientsto

experiencemedicalerrors，duetothecomplexityoftheirconditions,needforurgentinterventionsconsiderableworkloadfluctuationIntensiveCareMed2006,32:1591-1598.Design:Observational,prospective,24hourcrosssectionalstudywithselfreportingbystaff.Setting:113intensivecareunitsin27countries.Participants:1328adultsinintensivecare.Mainoutcome:measuresNumberoferrors;impactoferrors;distributionoferrorcharacteristics;distributionofcontributingandpreventivefactors.Errorsinadministrationofparenteraldrugsin

intensivecareunitsBMJ2009;338:b814ObservedratesofparenteralmedicationerrorsClassesofdrugsandratesofassociatederrorsBMJ2009;338:b814ErrorswithsubsequentseriousharmbyrespectiveclassofdrugsandtypeoferrorBMJ2009;338:b814Preventionstrategiesmustbedevelopedandevaluated.ThekeystodevelopingacultureofpatientsafetyintheICUmustbefound.AnnalsofIntensiveCare2012,2:2structureoutcomeprocessfull-timeavailabilityofintensivecarephysicians“troubleshooting”analysisprocessesImplementprotocolAPACHESAPSSOFAICUQualityThepresentuseofqualityindicatorsinthe

intensivecareunitActaAnaesthesiolScand2012;56:1078–1083searchretrievednationalindicatorsfromeightcountries(UnitedKingdom,theNetherlands,Spain,Sweden,Germany,Scotland,AustriaandIndia).Atotalof63QIswereinuse,andnosingleindicatorwascommonforallcountries.Themostfrequentlyusedindicatorwasthestandardisedmortalityrate(SMR)Qualityindicators(QIs)fromtheeightcountriesusedinmorethanonecountryActaAnaesthesiolScand2012;56:1078–1083TheoriginalqualityindicatorsusedineightcountriesActaAnaesthesiolScand2012;56:1078–1083MethodsdescribedhowtoselectsuitablenationalqualityindicatorActaAnaesthesiolScand2012;56:1078–1083IntensiveCareMed(2012)38:598–60518expertsThroughamodifiedDelphiprocessseekinggreaterthan90%consensualagreementfromthisnominalgrouptheindicatorswerethenrefinedthroughaseriesofiterativeprocesses.Results111indicatorsofqualitywereinitiallyfound.9indicatorshadgreaterthan90%agreement.Theseindicatorscanbeusedtodescribethestructures,processesandoutcomesofintensivecare.Acrossthisinternationalgroup,itwasmuchmoredifficulttoobtainconsensualagreementontheindicatorsdescribingprocessesofcarethanonthestructuresandoutcomes.DelphiProcess一致性大于75%的13項指標(biāo)最終確定的9項核心指標(biāo)結(jié)構(gòu)&過程最終確定的9項核心指標(biāo)結(jié)果指標(biāo)1,ICUfulfilsnationalrequirementstoprovideIntensiveCare.2,24-havailabilityofaconsultantlevelIntensivist.3,Adverseeventreportingsystem4,Presenceofroutinemultidisciplinaryclinicalwardrounds5,StandardizedHandoverprocedurefordischargingpatients6,ReportingandanalysisofSMR7,ICUre-admissionratewithin48hofICUdischarge.8,Therateofcentralvenouscatheter-relatedbloodstreaminfection.9,Therateofunplannedendotrachealextubations國內(nèi)ICU質(zhì)控監(jiān)測指標(biāo)國家衛(wèi)計委ICU質(zhì)控指標(biāo)北京市ICU質(zhì)控指標(biāo)ICU患者收治率和ICU患者收治床日率ICU患者實際病死率actualmortality急性生理與慢性健康評分(APACHEⅡ評分)≥15分患者收治率（入ICU24小時內(nèi)）ICU患者標(biāo)化病死指數(shù)SMR感染性休克3h集束化治療（bundle）完成率ICU血管內(nèi)導(dǎo)管相關(guān)血流感染（CRBSI）發(fā)病率感染性休克6h集束化治療（bundle）完成率ICU導(dǎo)尿管相關(guān)泌尿系感染（CAUTI）發(fā)病率ICU抗菌藥物治療前病原學(xué)送檢率非計劃性拔管率(動靜脈導(dǎo)管，氣管導(dǎo)管，尿管，引流管及胃腸營養(yǎng)管)ICU深靜脈血栓（DVT）預(yù)防率ICU氣管插管拔管后48h內(nèi)再插管率ICU患者預(yù)計病死率轉(zhuǎn)入ICU發(fā)生壓瘡率ICU患者標(biāo)化病死指數(shù)（StandardizedMortalityRatio）轉(zhuǎn)出24h內(nèi)非計劃重返ICU發(fā)生率ICU非計劃氣管插管拔管率ICU氣管插管拔管后48h內(nèi)再插管率非計劃轉(zhuǎn)入ICU率轉(zhuǎn)出ICU后48h內(nèi)重返率ICU呼吸機(jī)相關(guān)性肺炎（VAP）發(fā)病率ICU血管內(nèi)導(dǎo)管相關(guān)血流感染（CRBSI）發(fā)病率ICU導(dǎo)尿管相關(guān)泌尿系感染（CAUTI）發(fā)病率1.Nursingadmissionassessment.Completewithin24hours2.hyperglycimiaandhypoglycimiaoccurrence3.centrallineinsertionchecklistapplicationrate4.VAPbundleschecklistapplicationrate5.