The Application Of Comprehensive Unite-based Safety Program In Noninvasive Positive Pressure Ventilation Management In Emergency Department

ObjectivesThis study was guided by the Comprehensive Unit-based Safety Program(CUSP).The study constructed a management scheme for noninvasive positive pressure ventilation(NPPV)in the emergency department.Then we implemented the safety program to improve clinical outcomes of patients and improve the safety culture atmosphere in the emergency department.MethodsThis study took CUSP model as the theoretical framework and carried out research according to three modules:program preparation module,application of CUSP module,and outcome measures module.We assembled the team and constructed the management plan in the program preparation module.The application of CUSP module included five steps:understanding the science of safety,identifying defects,engaging the senior executive,implementing teamwork and communication and implementing interventions.Then we evaluated the effect of program in the outcome measures module.1.Program preparation module:the management scheme for NPPV in the emergency department was developed.The CUSP team was composed of senior managers,evidence-based experts,respiratory therapists,and medical staff on the front-line.The module was based on the present situation of NPPV management.We retrieved and integrated the best evidence of NPPV management through a review of current guidelines and literature.The quality of the literature was evaluated and the draft of NPPV management scheme was formed via the discussion.Then the expert meeting method was adopted to revise the program and form the management scheme of NPPV in the emergency department.2.Application of CUSP module:the management project of NPPV was fully implemented.An emergency department of Grade A tertiary hospital in Shandong province was selected as the pilot area.The study period was divided into a 6-month baseline period(December 1,2020,to May 31,2021)and a 6-month intervention period(July 1,2021,until December 31,2021),the program was fully implemented.3.Outcome measures module:The effect of NPPV management project was evaluated.An uncontrolled before-and-after study was performed and the results were evaluated from the perspectives of patients,medical staff,and the organization.The failure rate and complication rate of NPPV were used to evaluate the improvement of patient outcomes.A safety attitude questionnaire and evidence-based practice knowledge,attitude,and behavior scale were used as research tools to evaluate the evidence-based ability of medical staff and safety culture atmosphere of the emergency department.Results1.15 articles were included in this study,and 40 interventions were summarized and evaluated.Through expert meeting methods to simply the solution and revision,eventually,the NPPV management Scheme in the emergency department was formed.It included 24 interventions,with patient assessment,preparation,ventilator management and weaning four aspects.2.A total of 136 patients were enrolled,64 patients in the baseline group and 74 patients in the intervention group.There was no significant difference in age,sex,education combined diseases and BMI(P>0.05).The failure rate of NPPV was 31.25%(20/64)in the control group and 13.89%(10/72)in the intervention group,with statistical significance(P<0.05).The incidence of pressure injury was significantly decreased after project practice(P<0.05).But there was no significant difference in the incidence of flatulence(P>0.05).3.About 80.9%of employees learned safety science.The five dimensions in teamwork,safety atmosphere,job satisfaction,management perception,working conditions,and the total score of medical staff were significantly higher than the baseline level,with statistically significant(P<0.05).The medical staff’s knowledge level and the evidence-based practice knowledge,attitude,and behavior ability were significantly improved(P<0.05).Conclusion1.In this study,a scientific and practical NPPV management scheme in emergency department was constructed following the requirements of clinical scenarios.Thus,the results will provide a theoretical basis for the management of NPPV for medical staff.2.The application of CUSP in NPPV management can effectively reduce the incidence of failure and complications.It promoted team communication and collaboration,meanwhile,the program improved the safety culture of the ward,which is suitable for future promotion and application.