Application Study Of Continuous Quality Improvement In Reducing Postoperative Pressure Ulcers Of Esophageal Cancer Patients

Objectives Continuous nursing quality improvement was implemented in the esophageal cancer patients from three perspectives of nursing, patients and management. Thus to provide basis and support for reducing pressure ulcers incidence and improving the quality of nursing.Methods Convenience sampling was used. From July in2010to June in2011, a total of159esophageal cancer patients in thoracic surgery from one class A tertiary hospital of Shandong province were extracted as control group, while a total of140esophageal cancer patients in the same department from July in2011to June in2012were extracted as observation group. Continuous nursing quality improvement was implemented in the patients of observation group. Continuous quality improvement group was established, From perspectives of nursing, patients and management, we summarized the reasons of postoperative pressure ulcers of esophageal cancer patients through the brainstorming method, then presented the reasons by fishbone diagram and perceived them as the entry and key points of continuous nursing quality improvement. Through the analysis, lack of pressure ulcer knowledge in nursing staffs, postoperative nutritional deficiencies and limited activity of patients, health education and pressure ulcer risk management mode in low efficiency, poor pain and psychological nursing were the main causes of postoperative pressure ulcer in patients with esophageal cancer. According to the reasons, formulate improvement measures were formulated, evaluation and feedback were proceeded in a timely manner. Questionnaires on general information, Norton pressure sore risk-assessment, pain analogue were used to investigated on the patients, and then compared pressure ulcers understanding, pain, hours of get out of bed for the first time, hospital stay, cases and stage differences of pressure ulcer in two groups patients. SPSS16.0statistical software was used for data entry and analysis, including descriptive analysis, t-test, chi-square test and Fisher’s exact probability.Results A total of299patients were involved in this study, among them,159cases were extracted as control group,140cases were extracted as observation group. There were no statistical differences in sex, age, weight, operation approach and duration of two groups. Detailed informations were follows:1. There were9cases occurred pressure ulcers in control group(5.66%). Among them, male and female cases were7(77.8%) and2(22.2%) respectively, stage I and stage II cases were4(44.4%) and5(55.6%), sacrococcygeal region, buttock and hip cases were5(55.6%),3(33.3%) and1(11.1%) respectively. While there were2cases occurred pressure ulcers in observation group(1.43%). All of the cases were male and stage I. And among them, sacrococcygeal region and buttock cases were1(50.0%) and1(50.0%) respectively. Pressure ulcer healing rate in the two groups were all100%. There were statistical differences in pressure ulcer prevalence, sex distribution and stages of two groups(P<0.01).2. Postoperative pain intensity of two groups declined with time. The pain scores at each time point of observation group were all lower than those of the control group, the differences were statistically significant(P<0.05).3. The hours of getting out of bed for the first time in the observation group were significantly shorter than those of the control group(P<0.01), the hospital stay of the observation group were also significantly shorter than those of the control group(P<0.05).4. The pressure ulcers understandings of two groups were at a lower level, there were no statistical differences(P>0.05). After the continuous nursing quality improvement, the level of pressure ulcers understanding of the observation group significantly increased compared with the previous. The acknowledge of pressure ulcers concept, factors, skin manifestations, predilection sites and the protection and processing capacity of pressure ulcers were all enhanced. The differences of pressure ulcers understandings between two groups were statistically significant(P<0.05).Conclusions CQI can reduce the postoperative incidence of pressure ulcers and improve the recovery in patients with esophageal cancer. By enhancing the level of nursing staff knowledge of pressure ulcers, risk consciousness and nursing quality, CQI can also improve the overall quality of nursing team, and it’s worthy of further promotion.