基于共识的开发和实践测试一个通用的质量指标集在家里的肠外给药:一项兰德适当性方法研究。

IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jedidja Lok-Visser, Roald Hunneman, Cecile H J Bekkers, P Margreet G Filius, Anke Lenferink, Gréanne Leeftink, Jan Gerard Maring
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引用次数: 0

摘要

目的:由于护理短缺、人口老龄化和护理需求的增加,人们对在家给药(PMAaH)越来越感兴趣,包括在患者家中给药。这种PMAaH护理途径的操作设计是复杂的,导致采用的许多变化,表明需要一个质量框架。虽然已经提出了质量指标(QIs)来监测特定护理途径的质量,但缺乏所有类型PMAaH的通用质量框架。因此,本研究提出了PMAaH的通用质量集,包括结构和过程质量指标,以基准和重新设计PMAaH的护理路径,以确保高质量。设计:使用第三阶段采用的系统RAND适当性方法,为PMAaH开发了通用QI集。该方法包括确定指标的范围审查,专家小组评级阶段(包括在线问卷和随后的小组会议),评估指标的适当性,以及回顾性实践测试,评估指标的可行性、清晰度和可测量性。实践测试包括一份在线问卷,专家可以在其中指出其医院所有指标的实施情况。在实践测试之后,第三个专家组调整了该集合,以增加在实践中实施的可能性。环境:采用滚雪球抽样技术从荷兰三家大型教学医院招募专家,所有参与PMAaH流程的医疗保健专业人员。随后,在荷兰七家大型教学医院进行了自我评估的实践测试。参与者:分别有17名和7名不同背景的医疗保健专业人员参加了在线问卷调查和小组会议。结果:范围审查产生了36个PMAaH的QIs。经过两轮专家小组评估(在线问卷调查和小组会议),两个指标被删除:一个是与旅行距离政策相关的QI,因为它是不相关和冗余的,另一个是指出临床医生应该在pmaah团队中发挥领导作用的QI,这被认为限制太大。实践测试后,删除了两个质量指标:一个与临床反应文件相关的质量指标,对于实践测试受访者来说,这是不清楚的,并且已经被其他质量指标所覆盖;另一个与生存文件相关的质量指标,被第三专家组认为是不可行的,不希望与其他患者不同。最终一套指标共有32项(其中15项为结构指标,17项为过程指标)。最后一组主要包括以患者安全为目标的质量指标,但也包括以卫生保健工作者的工作条件为重点的质量指标。17.6%的质量指标目前在所有七家医院全面实施。实践测试表明,在实践中,操作性质量指标比系统性质量指标更频繁地得到实施,医院需要一个结构化的质量保证方案。结论:本研究提出了PMAaH的通用质量集,医院可以使用它来重新设计和基准PMAaH护理路径,以确保高质量。实践测试证实了该结构化质量集的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Consensus-based development and practice testing of a generic quality indicator set for parenteral medication administration at home: a RAND appropriateness method study.

Objectives: Due to nursing shortages, an ageing population and increasing care demand, there is a growing interest in parenteral medication administration at home (PMAaH), comprising the administration of parenteral medication in the home situation of patients. The operational design of such PMAaH care pathways is complex, resulting in many variations of adoptions, showing a need for a quality framework. Although quality indicators (QIs) have been proposed to monitor the quality of specific care pathways, a generic quality framework for all types of PMAaH is lacking. Therefore, this study proposes a generic quality set for PMAaH, which includes structure and process QIs, to benchmark and redesign PMAaH care pathways to ensure high quality.

Design: A generic QI set was developed for PMAaH using a systematic RAND appropriateness method adapted at the third phase. This method consisted of a scoping review to identify indicators, an expert panel rating phase including an online questionnaire and subsequent panel meeting to assess the appropriateness of the indicators and a retrospective practice testing to evaluate the feasibility, clarity and measurability of the indicators. After the practice testing, which consisted of an online questionnaire where experts could indicate the implementation state of all indicators in their hospital, a third expert panel adjusted the set to increase the likelihood of implementation in practice.

Setting: The experts, all healthcare professionals involved in PMAaH processes, were recruited using the snowball sampling technique from three large Dutch, teaching hospitals. Subsequently, a practice testing by self-assessment was conducted in seven large Dutch teaching hospitals.

Participants: 17 and seven healthcare professionals with diverse backgrounds participated in the online questionnaire and panel meeting, respectively.

Results: The scoping review resulted in 36 QIs for PMAaH. After two expert panel rating rounds (online questionnaire and panel meeting), two indicators were removed: a QI related to travel distance policy since it was irrelevant and redundant, and a QI stating that a clinician should take the lead in a PMAaH-team, which was deemed too restrictive. After the practice testing, two QIs were removed: a QI related to clinical response documentation, which was unclear for the practice testing respondents and already covered by other QIs, and a QI related to survival documentation, which was deemed infeasible and undesirable to measure this differently than other patients by the third expert panel.The final set consists of 32 indicators (of which 15 were structure indicators and 17 were process indicators). The final set predominately includes QIs that are aimed at patient safety but also QIs focusing on the working conditions of the healthcare workers. 17.6% of the QIs are currently fully implemented in general in all seven hospitals. The practice testing revealed that operational QIs are more frequently implemented in practice than systemic QIs and that a structured quality assurance programme is needed in the hospitals.

Conclusions: This study proposes a generic quality set for PMAaH that hospitals can use to redesign and benchmark PMAaH care pathways to assure high quality. The practice testing confirmed that there is a need for this structured quality set.

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来源期刊
BMJ Open
BMJ Open MEDICINE, GENERAL & INTERNAL-
CiteScore
4.40
自引率
3.40%
发文量
4510
审稿时长
2-3 weeks
期刊介绍: BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
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