Construction And Application Of Nursing Sensitive Quality Indicators System During Anesthesia

Objective:Based on Donabedian “structure-process-result” three dimensional quality assessment model,the scientific and objective nursing-sensitive quality indicators system during anesthesia were established by literature analysis(Johns Hopkins evidence-based nursing method),Delphi method and analytic hierarchy process and used in clinical practice.Aiming to provide standard and professional quantitative basis for monitoring and evaluating nursing quality during anesthesia.Methods:(1)Literature analysis: The research was based on “structure-process-result”quality structure model.Johns Hopkins evidence-based nursing method was used to evaluate literature and evidence quality and synthesize the indicators,to lay the foundation for establishing nursing sensitive quality indicators system during anesthesia.(2)Delphi method: The nursing sensitive quality indicators system during anesthesia was preliminarily constructed by two-round of expert consultation.The Cronbach’s coefficient was used to test conducted reliability.(3)Analytic hierarchy process: AHP was used to calculate the original weights and the combination weights of indicators,and to carried out the consistency test.(4)Field survey method: Three tertiary indicators were used to conduct an empirical study using the checklist: “the compliance rate of knowledge education related anesthesia”,“the implementation rate of handover process” and “the compliance rate of follow-up on postanesthesia analgesia”.Results:(1)A total of 30 literatures were included,of which 7(23.3%)were in class IIIA,8(26.7%)in class IVA,1(3.3%)in class IVB,11(36.7%)in class VA,and 3(10.0%)in class VB.The nursing sensitive quality indicators system during anesthesia were synthesized including 3 first-level indicators,12 second-level indicators and 45third-level indicators.(2)The effective questionnaire response rates for the 2 rounds of expert consultation all were 100%;the expert authority coefficient were 0.903 and 0.910respectively;and the Kendall harmony coefficients were 0.139 and 0.189 respectively,the significance test results were all P<0.05 showing statistical significance.The nursing sensitive quality indicators system during anesthesia were preliminarily constructed including 3 first-level indicators,15 second-level indicators and 66 third-level indicators.(3)The weighted value of the 3 first-level indicators were in the following order:process(0.5396),outcome(0.2970),structural(0.1634).From the combined weighted value of the 15 second-level index,“anesthesia recovery period”(0.1302),“specialized adverse events”(0.1188),“adverse nursing events”(0.1188),“preanesthetic preparation”(0.0876),“follow-up after anesthesia”(0.0876),“infection control management”(0.0876)were ranked in the top 5 in order.Among the 66 third-level indicators,the top 10 combined weights were respectively “the compliance rate of follow-up on postanesthesia analgesia”(0.0584),“the incidence of hypothermia enter PACU”(0.0466),“the implementation rate of handover process”(0.0335),“the accurate rate of observing,identifying and assistance in dealing with early complications”(0.0335),“the delay rate of transfer from PACU”(0.0330),“the qualified rate of emergency materials”(0.0302),“the error rate of administration”(0.0297),“the incidence rate of fall bed”(0.0297),“the incidence rate of pressure injury”(0.0297),“patients’ satisfaction of health education”(0.0293).The result shows that the consistency of all index at all levels has been verified by the consistency test with CR < 0.10.(4)The compliance rate of knowledge education related anesthesia,the implementation rate of handover process and the compliance rate of follow-up on postanesthesia analgesia were 72.2%(130/180),88.9%(160/180),93.9%(169/180)respectively,ICC = 0.979.Conclusion:(1)This study was based on “structure-process-result” quality assessment framework.Through a rigorous literature search strategy,the Johns Hopkins evidence-based nursing approach was used to evaluate and synthesize the evidence,avoiding simplex literature description and empirical summary.Thus,the construction of nursing sensitive quality indicators system during anesthesia was scientific.(2)The present study organized two Delphi questionnaire surveys.The activity and authority coefficients of experts were all promising,and the concentration and coordination of expert opinion were all increasing,which could ensure the reliability of the results.(3)This study combined Delphi and AHP method,which could ensure the logical and scientific results.All hierarchical indicators were passed the consistency test,and the weights assignment was reasonable.(4)Three indicators were verified to have highly nursing sensitivity and clinical applicability.