ICU质控综述

Safety and Quality in ICU,北京市重症医学质量控制和改进中心,01/mpim/,Beijing area:77 ICU units in 71 hospitals44 members upload date,34 are complete,Safety is a global concept EfficiencySecurityReactivitySatisfaction Patient safety has emerged as a major target for healthcare improvement.,Washington DC National Academy Press;2001,Data on adverse events in health care from several countries,World Health Organization, Executive Board 109th session, provisional agenda item 3,4,5 December 2001,Patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors，due tothe complexity of their conditions,need for urgent interventionsconsiderable workload fluctuation,Intensive Care Med 2006,32:1591-1598.,Design: Observational, prospective, 24 hour cross sectional study with self reporting by staff.Setting: 113 intensive care units in 27 countries. Participants: 1328 adults in intensive care.Main outcome: measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors.,Errors in administration of parenteral drugs in intensive care units,BMJ 2009;338:b814,Observed rates of parenteral medication errors,Classes of drugs and rates of associated errors,BMJ 2009;338:b814,Errors with subsequent serious harm by respective class of drugs and type of error,BMJ 2009;338:b814,Prevention strategies must be developed and evaluated.The keys to developing a culture of patient safety in the ICU must be found.,Annals of Intensive Care 2012, 2:2,structure,outcome,process,full-time availability of intensive carephysicians,“trouble shooting” analysis processesImplement protocol,APACHESAPSSOFA,ICU Quality,The present use of quality indicators in the intensive care unit,Acta Anaesthesiol Scand2012; 56: 10781083,search retrieved national indicators from eight countries (United Kingdom, the Netherlands, Spain, Sweden, Germany, Scotland, Austria and India). A total of 63 QIs were in use, and no single indicator was common for all countries.The most frequently used indicator was the standardised mortality rate(SMR),Quality indicators (QIs) from the eight countries used in more than one country,Acta Anaesthesiol Scand2012; 56: 10781083,The original quality indicators used in eight countries,Acta Anaesthesiol Scand2012; 56: 10781083,Methods described how to select suitable national quality indicator,Acta Anaesthesiol Scand2012; 56: 10781083,Intensive Care Med (2012) 38:598605,18 expertsThrough a modified Delphi process seeking greater than 90% consensual agreement from this nominal groupthe indicators were then refined through a series of iterative processes.,Results111 indicators of quality were initially found.9 indicators had greater than 90% agreement.These indicators can be used to describe the structures, processes and outcomes of intensive care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outcomes.,Delphi Process一致性大于75%的13项指标,最终确定的9项核心指标,结构&过程,最终确定的9项核心指标,结果指标,1, ICU fulfils national requirements to provide Intensive Care.2, 24-h availability of a consultant level Intensivist.3, Adverse event reporting system4, Presence of routine multidisciplinary clinical ward rounds5, Standardized Handover procedure for discharging patients6, Reporting and analysis of SMR7, ICU re-admission rate within 48 h of ICU discharge.8, The rate of central venous catheter-related blood stream infection.9, The rate of unplanned endotracheal extubations,国内ICU质控监测指标,1.Nursing admission assessment . Complete within 24 hours 2.hyperglycimia and hypoglycimia occurrence 3.central line insertion checklist application rate 4.VAP bundles checklist application rate5. restrain application and ord