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Xu Y, Shi C, Liu Y. Application effect of PDCA circulation on nursing quality management and risk control in digestive endoscopy room. Medicine (Baltimore) 2023; 102:e35885. [PMID: 38050274 PMCID: PMC10695484 DOI: 10.1097/md.0000000000035885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 12/06/2023] Open
Abstract
To explore the application effect of plan, do, check, action (PDCA) cycle on nursing quality management and risk control in digestive endoscope room. Ninety patients who received digestive endoscopy care before undergoing PDCA circulation mode risk control from January 2022 to April 2022 were selected as the Common group. From May 2022 to December 2022, 156 patients who underwent digestive endoscopy care after undergoing PDCA cycle mode risk control were selected as the PDCA group. Compare the infection status of patients in the endoscope room and the qualification of the air in the endoscope room before and after PDCA circulation management. Compare the respiratory rate, heart rate, systolic blood pressure, diastolic blood pressure, and nursing satisfaction of patients in the Common group and the PDCA group. Compare the qualified rate of endoscopic cavity disinfection before and after PDCA cycle management, the qualified rate of endoscopic external disinfection, and the management score. Four patients in the Common group developed infection, with an infection rate of 4.44%. One case of infection occurred in the PDCA group, with an infection rate of 0.64%. The qualified rate of the endoscope room air in the Common group was 92.22%, while the qualified rate of the endoscope room air in the PDCA group was 98.72%. Compared with the Common group, the infection rate of patients in the PDCA group significantly decreased, and the qualified rate of air in the endoscope room significantly increased. The respiratory rate, heart rate, systolic blood pressure, diastolic blood pressure, nursing errors, and nursing complaint rates of patients in the PDCA group were significantly lower than those in the Common group, and nursing satisfaction was significantly higher than those in the Common group. The qualified rate of endoscopic cavity disinfection and endoscopic external disinfection in the PDCA group were significantly higher than those in the Common group. Compared with before management, the scores of post management, nursing safety, disinfection and isolation, instruments, theoretical tests, and operational tests of nursing personnel after management increased significantly. The PDCA cycle is well applied in nursing quality management and risk control in the digestive endoscope room.
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Affiliation(s)
- Yan Xu
- Department of Gastraintestinal Endoscopy Room, Jingmen Central Hospital, Jingmen, Hubei, P.R. China
| | - Chunhua Shi
- Department of Respiratory, Jingmen Central Hospital, Jingmen, Hubei, P.R. China
| | - Yun Liu
- Gastroenterology Department, Jingmen Central Hospital, Jingmen, Hubei, P.R. China
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Fan X, Chen D, Bao S, Dong X, Fang F, Bai R, Zhang Y, Zhang X, Tang W, Ma Y, Zhai X. Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study. BMC Health Serv Res 2023; 23:1014. [PMID: 37730673 PMCID: PMC10512621 DOI: 10.1186/s12913-023-09931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.
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Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Danxia Chen
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Siwei Bao
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Fang Fang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Rong Bai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yuyi Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaogang Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Weijun Tang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yabin Ma
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
| | - Xiaobo Zhai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
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Lv L, Sun Y, Yang B, Xin C, Zhang M. Impact of Pharmacist-Led PDCA Cycle in Reducing Prescription Abandonment: An Action Research from China. Patient Prefer Adherence 2023; 17:2145-2152. [PMID: 37663895 PMCID: PMC10474862 DOI: 10.2147/ppa.s418219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Taking medicine as prescribed in time plays an important role in the treatment of diseases. However, some prescriptions have not picked up in time for various reasons. To analyze the influencing factors in patients with prescription abandonment and the role of pharmacists in Plan-Do--Check-Act (PDCA) cycle, we conducted a study in our hospital of Hangzhou, China. Methods Based on the prescription abandonment from October 1, 2021 to March 31 2022, we collected and analyzed the possible causes. According to the PDCA management method, we conducted improvement measures and supervised the implementation of measures from April 1, 2022 to September 30, 2022. The number, the proportion and the amount of prescription abandonment before and after establishment of the PDCA cycle were analyzed. Results Three measures were proposed and applied to improve the prescription abandonment:(I) Enhancing the education and training to the staff. (II) Improving the medical environment for patients, especially the environment for taking medicine. (III) Updating the computer information software. After the implementation of PDCA, the number of prescription abandonment decreased from 2030 to 775, there was significant reduction in the proportion of prescription abandonment (4.75‰ vs 1.77‰, P<0.05), and the amount of prescription abandonment decreased from $36,161.11 to $17,041.59. The target compliance rate was 108.36%. Conclusion The implementation of pharmacist-led PDCA can effectively reduce the number, the proportion and the amount of prescription abandonment, Moreover, Pharmacists play an important role in improving the management quality of outpatient pharmacy, and PDCA is a feasible and effective management tool for reducing prescription abandonment.
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Affiliation(s)
- Lisong Lv
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, People’s Republic of China
| | - Yunfeng Sun
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, People’s Republic of China
| | - Bo Yang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, People’s Republic of China
| | - Chuanwei Xin
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, People’s Republic of China
| | - Mingwan Zhang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, People’s Republic of China
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Impact of proton pump inhibitor management committee's multifaceted interventions on acid suppressant prescribing patterns in outpatient and emergency departments. BMC Health Serv Res 2022; 22:417. [PMID: 35351121 PMCID: PMC8966235 DOI: 10.1186/s12913-022-07820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background A nationwide campaign for rational proton pump inhibitor (PPI) use launched in 2015 had a positive impact for hospitalized patients PPI use. But there were few studies focusing on the rational use of PPIs in outpatients. In 2018, the PPI management committee conducted a year-long intervention on the appropriate use of PPIs in outpatient and emergency departments, including clinical pharmacist interventions and stewardship interventions. The purpose of this study was to examine the impact of the PPI management committee’s multifaceted interventions by comparing the real-world acid suppressant prescribing patterns for outpatients before (2017) and after intervention (2019) at a Chinese tertiary teaching hospital. Methods Prescriptions containing any acid suppressant in outpatient and emergency departments in baseline (2017) and postintervention (2019) periods were extracted from the hospital information system and the prescription automatic screening system. Acid suppressant prescribing patterns were evaluated based on primary diagnoses and patient demographics. The prescribed acid suppressants stratified using age groups (< 7, 7–17, 18–45, 46–65, 66–85 and > 85 years) were also examined. Result The utilization rate of acid suppressant in 2017 and 2019 was 2.5% (41,165/1,619,366) and 2.2% (49,550/2,236,471), respectively (P < 0.0001). 60,135 acid suppressant prescriptions were obtained in 2017 and 73,275 in 2019. The rate of acid suppressant prescriptions for the approved indications significantly increased from 62.6% (2017) to 65.4% (2019) (P < 0.0001). Prescriptions diagnosed as abnormal symptoms, signs and clinical manifestations, decreased in 2019 (13.0% vs. 16.5%, P < 0.0001). The most frequently prescribed PPIs differed between 2017 and 2019 (rabeprazole 2017 vs. esomeprazole 2019). Omeprazole was the most common PPI and cimetidine was the most common H2RA prescribed to patients aged < 18 years in 2017 and 2019. A total of CNY11.83 million was spent on acid suppressants in 2019, accounting for about 48.7% of total medication cost, increased by 11.3% from 2017 (37.4%). Conclusion The proportion of acid suppressant prescriptions for approved indications was enhanced after the PPI management committee’s multifaceted interventions, but there were still some problems in the selection of acid suppressants.
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Fan X, Chen D, Bao S, Bai R, Fang F, Dong X, Zhang Y, Zhang X, Ma Y, Zhai X. Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists' Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221081437. [PMID: 35610968 PMCID: PMC9136448 DOI: 10.1177/00469580221081437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non–anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.
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Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Danxia Chen
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Siwei Bao
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Rong Bai
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Fang Fang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Yuyi Zhang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaogang Zhang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Yabin Ma
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaobo Zhai
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
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Changes in the Quality of Life, Psychological Status, Medication Compliance, and Prognosis of Patients with Acute Myocardial Infarction after PCI by Applying PDCA Cycle Management Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7318653. [PMID: 34712348 PMCID: PMC8548087 DOI: 10.1155/2021/7318653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023]
Abstract
Objective To discuss the changes in the quality of life, psychological status, medication compliance, and prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by applying plan-do-check-action (PDCA) cycle management model. Methods A total of 125 patients with AMI who underwent PCI in our hospital from June 2018 to June 2020 were selected and divided into control group (n = 62) and research group (n = 63) by the random number method. The conventional nursing measures were used in the control group, and the PDCA cycle management model on the basis of the control group was used in the research group. The changes in the quality of life, psychological status, medication compliance, and prognosis were observed. Results After intervention, the Generic Quality of Life Inventory-74 scores and the self-made medication compliance questionnaire score of the research group were higher than the control group (P < 0.05). After intervention, the self-rating anxiety scale score and self-rating depression scale score of the research group were lower than those of the control group (P < 0.05). The total incidence of adverse events in the research group (7.94%) was lower than that in the control group (20.97%) (P < 0.05). Conclusion After the application of PDCA cycle management model, the quality of life, psychological status, medication compliance, and prognosis of AMI patients who underwent PCI were improved.
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