icu质控综述课件.pptx

1、Safety and Quality in ICU.北京市重症医学质量控制和改进中心 http:/210.75.199.101/mpim/.Beijing area:77 ICU units in 71 hospitals 44 members upload date,34 are complete.Safety is a global concept EfficiencySecurityReactivitySatisfaction Patient safety has emerged as a major target for healthcare improvement.Washingto

2、n DC National Academy Press;2001.Data on adverse events in health care from several countriesWorld Health Organization,Executive Board 109th session,provisional agenda item 3,4,5 December 2001.Patients in the intensive care unit(ICU)are more likely than other hospitalized patients to experience medi

3、cal errors，due to the complexity of their conditions,need for urgent interventions considerable workload fluctuationIntensive Care Med 2006,32:1591-1598.Design:Observational,prospective,24 hour cross sectional study with self reporting by staff.Setting:113 intensive care units in 27 countries.Partic

4、ipants:1328 adults in intensive care.Main outcome:measures Number of errors;impact of errors;distribution of error characteristics;distribution of contributing and preventive factors.Errors in administration of parenteral drugs in intensive care unitsBMJ 2009;338:b814Observed rates of parenteral med

5、ication errors.Classes of drugs and rates of associated errorsBMJ 2009;338:b814.Errors with subsequent serious harm by respective class of drugs and type of errorBMJ 2009;338:b814.Prevention strategies must be developed and evaluated.The keys to developing a culture of patient safety in the ICU must

6、 be found.Annals of Intensive Care 2012,2:2.structureoutcomeprocessfull-time availability of intensive carephysicians“trouble shooting”analysis processesImplement protocolAPACHESAPSSOFAICU Quality.The present use of quality indicators in the intensive care unitActa Anaesthesiol Scand2012;56:10781083

7、 search retrieved national indicators from eight countries(United Kingdom,the Netherlands,Spain,Sweden,Germany,Scotland,Austria and India).A total of 63 QIs were in use,and no single indicator was common for all countries.The most frequently used indicator was the standardised mortality rate(SMR).Qu

8、ality indicators(QIs)from the eight countries used in more than one countryActa Anaesthesiol Scand2012;56:10781083.The original quality indicators used in eight countriesActa Anaesthesiol Scand2012;56:10781083.Methods described how to select suitable national quality indicatorActa Anaesthesiol Scand

9、2012;56:10781083.Intensive Care Med(2012)38:598605 18 experts Through a modified Delphi process seeking greater than 90%consensual agreement from this nominal group the indicators were then refined through a series of iterative processes.Results111 indicators of quality were initially found.9 indica

10、tors had greater than 90%agreement.These indicators can be used to describe the structures,processes and outcomes of intensive care.Across this international group,it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outc

11、omes.Delphi Process一致性大于一致性大于75%的的13项指标项指标.最终确定的最终确定的9项核心指标项核心指标结构结构&过程过程.最终确定的最终确定的9项核心指标项核心指标结果指标结果指标.1,ICU fulfils national requirements to provide Intensive Care.2,24-h availability of a consultant level Intensivist.3,Adverse event reporting system4,Presence of routine multidisciplinary clinical

12、 ward rounds5,Standardized Handover procedure for discharging patients6,Reporting and analysis of SMR7,ICU re-admission rate within 48 h of ICU discharge.8,The rate of central venous catheter-related blood stream infection.9,The rate of unplanned endotracheal extubations.国内ICU质控监测指标国家卫计委国家卫计委ICU质控指标

13、质控指标北京市北京市ICU质质控指标控指标ICU患者收治率和ICU患者收治床日率ICU患者实际病死率 actual mortality急性生理与慢性健康评分(APACHE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

14、患者预计病死率转入ICU发生压疮率ICU患者标化病死指数（Standardized Mortality Ratio）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.Nursing admission assessment.Complete within 24 hours 2.hyperglycimia and hypoglycimia occurrence 3.cen

15、tral line insertion checklist application rate 4.VAP bundles checklist application rate 5.restrain application and orders made within 24 hours 6.Multidicipline rounding twice a week 7.nutritionist referral on ICU admission 8.critacal valum sign out by physician and stamp on print out lab paper with in 30min.Thank You!.