Construction And Application Of Nursing-sensitive Quality Indexes For Venous Thrombosis Prevention Based On Evidence

Objectives Based on the mode of “structure-process-result”as the theoretical framework,a scientific and sensitive quality indicators system of VTE prevention nursing was constructed,which was in line with the nursing situation in China,and provided monitoring and reference basis for clinical VTE prevention nursing quality evaluation and continuous quality improvement.Methods1.Literature review: Developed rigorous literature search strategy,systematically reviewed relevant literature on VTE prevention and nursing,screened and evaluated the literature quality by adopting the JBI 2014 edition of evidence grading and quality assessment method in Australia,and summarized the evaluation indicators of VTE prevention and nursing quality.2.Group discussion:Set up a expert discussion group to analyze the connotation,calculation formula and data collection method of nursing quality index for prevention of venous thrombosis,draw up the VTE prevention nursing sensitive quality indicators preliminarily,and make the expert letter form to confirm the expert.3.Delphi method: Selecting experts with advanced knowledge of VTE preventive care management,consult expert opinion in the form of mail or writing on the importance of the initial indicators entry,the rationality of calculation formula,the operability of data collection method,and improve and determine the VTE prevention care sensitive quality indicators system.4.Analytic Hierarchy Process: Compare the relative importance of each element according to the Saaty scale separately,construct the judgment matrix and carry on the consistency test,determine the weight of the indicators system.5.Questionnaire survey method: based on the constructed VTE prevention nursing sensitive quality indicators as the basis of the design of VTE prevention nursing quality questionnaire for clinical practice investigation,to understand the current situation of VTE prevention nursing quality management and existing problems,with a view to the corresponding VTE prevention nursing quality improvement.6.Data analysis: Using Excel 2016,SPSS23.0 and yaahp software for statistical analysis of expertletter and questionnaire data.Results1.A total of 2098 articles were examined,48 articles were collected after screening,and11 related studies on VTE preventive care quality evaluation were included:7articles in level5 b,3articles in level2 c,1 article in level2 d,collated and summed up 28 structural,process,and outcome indicators related to VTE preventive care quality evaluation.2.The discussion group analyzed the connotation of the VTE preventive care quality indicators entry,the formula and the data collection method in the first draft,and preliminarily worked out the first round letter questionnaire of the VTE preventive care sensitive quality indicators including 3first level indicators,6 secondary indicators and 28 third degree indicators.3.The results of the letter indicated:(1)The positive coefficients of the experts in the two rounds of correspondence were 84.85% and 96.43%(>70%),and the authority coefficients were 0.860 and0.865,respectively.(2)In the first round,the average score of the item importance was 3.75-4.96,the standard deviation was 0.19-1.23,the full score rate was 0.2857-0.9286,In the second round,the mean score of the item importance 、the standard deviation and the full score rate were 4.63-5.00、0.00-0.63 and 0.6667-1.0000.(3)The coordination coefficient of the two rounds of correspondence experts were 0.099-0.163,0.096-0.135(P<0.001),and the degree of coordination of expert opinions is good.4.The weigh of the structure,process and result respectively were 0.158、0.493 and 0.311,and the weights of the 6 secondary indicators were management system(0.131)、equipment configuration(0.065)、nursing assessment(0.247)、nursing measures(0.247)、patient clinical outcome(0.207)、nursing effect evaluation(0.104).The top 10 of the 22 third class indicators included :hospital VTE incidence(0.155),VTE risk assessment correctly(0.086),patient with good awareness of VTE prevention knowledge(0.078),nurse VTE knowledge training qualification(0.065),VTE prevention team with regular training(0.065),gradient pressure elastic socks use correctly(0.052),VTE risk re-evaluation(0.052),bleeding(0.052),VTE risk assessment(0.046),monitoring of adverse anticoagulant reactions(0.044),and the CR values for all levels of indicators were less than 0.1.5.The rate of VTE risk re-evaluation was 98.67%,the rate of VTE risk assessment was 92.00%,the rate of bleeding risk re-evaluation was 74.67%,the rate of gradient pressure elastic socks was89.33%,the rate of intermittent inflatable pressure device was 90.67%,and the rate of monitoring anticoagulant adverse reaction was 90.67%.Except for the VTE risk first evaluation implementation rate indicator,the above indicators difference has the statistical significance.Conclusions1.Based on the scientific theory of quality management,uses evidence-based thinking and various research methods to construct the VTE prevention nursing sensitive quality indicators system scientifically and reasonably to provide reliable evidence support for clinical evaluation and improvement of nursing quality.2.Through the control of the expert and the process of the inquiry,the enthusiasm and authority of the expert were high,and the degree of concentration and coordination of the expert opinion was good,which ensured the reliability of the result of the inquiry.3.This research used the analytic hierarchy process to set the indicators system weight,all the hierarchical indexes have passed the consistency test,the weight allocation was scientific and reasonable.4.All the 7 indexes showed different degrees of fluctuation when they were put into clinical practice,indicating that the indexes were of good clinical applicability and feasibility.