【推荐下载】ICU质控综述

SafetyandQuality

inICU北京市重症医学质量控制和改进中心

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,ICUfulfilsnationalrequirementstoprovideIntensiveCare.2,24-havailabilityofaconsultantlevelIntensivist.3,Adverseeventreportingsystem4,Presenceofroutinemultidisciplinaryclinicalwardrounds5,StandardizedHandoverprocedurefordischargingpatients6,ReportingandanalysisofSMR7,ICUre-admissionratewithin48hofICUdischarge.8,Therateofcentralvenouscatheter-relatedbloodstreaminfection.9,Therateofunplannedendotrachealextubations国内ICU质控监测指标国家卫计委ICU质控指标北京市ICU质控指标ICU患者收治率和ICU患者收治床日率ICU患者实际病死率actualmortality急性生理与慢性健康评分(APACHEⅡ评分)≥15分患者收治率（入ICU24小时内）ICU患者标化病死指数SMR感染性休克3h集束化治疗（bundle）完成率ICU血管内导管相关血流感染（CRBSI）发病率感染性休克6h集束化治疗（bundle）完成率ICU导尿管相关泌尿系感染（CAUTI）发病率ICU抗菌药物治疗前病原学送检率非计划性拔管率(动静脉导管，气管导管，尿管，引流管及胃肠营养管)ICU深静脉血栓（DVT）预防率ICU气管插管拔管后48h内再插管率ICU患者预计病死率转入ICU发生压疮率ICU患者标化病死指数（StandardizedMortalityRatio）转出24h内非计划重返ICU发生率ICU非计划气管插管拔管率ICU气管插管拔管后48h内再插管率非计划转入ICU率转出ICU后48h内重返率ICU呼吸机相关性肺炎（VAP）发病率ICU血管内导管相关血流感染（CRBSI）发病率ICU导尿管相关泌尿系感染（CAUTI）发病率1.Nursingadmissionassessment.Completewithin24hours2.hyperglycimiaandhypoglycimiaoccurrence3.centrallineinsertionchecklistapplicationrate4.VAPbundleschecklistapplicationrate5.