Dr. Zhu Rong of Children's Nephrology Department was invited to share his experience. Background:
Effective management of instruments and equipment directly affects the timeliness, safety and effectiveness of patients' examination and treatment. There are many kinds of medical instruments and equipment in this department, and it is tedious and time-consuming to count the quantity and register the use of them in paper form, and the instruments and equipment are not placed at fixed points, which increases the time for counting instruments and equipment and may also affect the treatment and rescue of patients in emergency situations. Lean Six Sigma, as a new management tool, can speed up the process and achieve better management results through a long-term continuous improvement process.
Therefore, our department takes the Lean Six Sigma management method as the improvement framework, establishes the informationized instrument management scheme based on QR code, takes optimizing the process of instrument and equipment counting and shortening the time of instrument and equipment counting as the focus of quality improvement, and carries out the related work according to the activity plan.
The department has already registered the use of some instruments and equipment, including cardiac monitors, blood gas analyzers and electrocardiographs, based on the QR code of Questionnaire Star, which has changed the way of filling in the information one by one on paper. In order to realize the sharing of registration information, this project further improves the registration method into a shared document, which is supported and cooperated by the nursing staff of the department. The technology of QR code formed by the shared document is very mature and free of charge, which can provide convenient conditions for this project, such as easy to operate and can be realized.
Second, the method:
Lean Six Sigma (DMAIC) management method of the specific implementation process according to the "Define (Define) - Measure (Measure) - Analysis (Analyze) - Improve (Improve) -Control" (Control) five stages.
Define
This phase aims to establish the overall structure of the project and discuss the optimization goals and expected benefits of the project. The project is carried out in the following 3 steps:
(1) Formation of the team: Based on the Lean Six Sigma management methodology, a trained DMAIC management team was established under the leadership of the nurse manager.
(2) Mobilization and training: All staff members learn about Lean Six Sigma and the DMAIC model; they master the basic theory and methodology of the model and learn the basic statistical methods commonly used in Lean Six Sigma; they learn the specific implementation steps of process transformation.
(3) According to the department's current status of process management to draw a high-level process map, including suppliers (Supplier) - Input (Input) - Process (Process) - Output (Output) - customers (Customer).
(4) Project Objective: Optimize the process of instrument and equipment counting, the goal is to optimize the process to shorten the time of instrument and equipment counting.
Measurement
aims to measure the current process capability and determine the level line.
Through literature review, brainstorming, and combining with the actual situation of the department, we made the “instrument and equipment counting process satisfaction questionnaire” and the “instrument and equipment maintenance related knowledge assessment questionnaire”, and collected the counting time in the “dynamic use register” for one month, and randomly sampled 100 bed units for unpositioned placement as the baseline information before improvement. We also collected the counting time of instruments and equipment in the “Dynamic Use Register” for one month, and randomly sampled 100 bed units for the unpositioned placement of instruments and equipment as the baseline information before improvement.
Calculate the process capacity based on the instrument count times for the key endpoints.
Analysis
to determine the relevant factors and key links affecting the instrument and equipment counting time, and in this way to determine the specific factors that are controllable and have a high degree of impact on the optimization of this process as the main content. Specific implementation methods are as follows:
1, cause analysis using the brainstorming method to derive the fishbone diagram of the factors affecting the instrument and equipment counting time, according to the scoring principles of the key factor evaluation table to analyze the factors affecting the key factors, according to the principle of “80/20”, select all the small causes (a total of 40) × 20% and combined with the sorting, selected the top 8 The top 8 are selected as the important factors.
2、True cause verification circle members after using the checklist to check again, and summarize the checklist to make a Plato, according to the Plato “80/20” principle, to determine the true cause, including ① instrument and equipment registration is complex; ② instrument and equipment inventory is complex; ③ instrument and equipment placed without a unified logo; ④ failure to implement the instrument and equipment management system.
Improvement
1. Countermeasures are formulated to improve the efficiency of instrument and equipment counting Countermeasures are formulated
2. Countermeasures are implemented to set up informatized instrument and equipment use registers and handover books; to divide the functional areas of the instrument room and wards, and to affix signs for the placement of instruments; and to strictly implement the management of instruments and equipment.
Control
The main content is to summarize the results of the process optimization program's stage-by-stage operation, and to compare the capacity of the process of instrument and equipment counting before and after the improvement, so as to formulate measures for the sustainability of process optimization. The main content is to summarize the results of the phase operation of the process optimization program and compare the capacity of the instrument and equipment counting process before and after improvement, so as to formulate measures to ensure the continuity of process optimization.
1. The results of the optimized instrument and equipment counting process can be seen from the capability histogram that all the data are basically within the specification line, compared with the pre-improvement period.
2, control measures to ensure that the optimization process can continue to play a role in the effect of the control measures are as follows: ① process optimization program produced into the departmental work norms, and into the departmental quality management indicators. ② Regulate the nursing staff to register, fill in, return the behavior of instruments and equipment, work under the process guidelines. ③Contact with the equipment section, which has applied for the purchase of an instrument and equipment management information system, which is proposed to be put into use in 2023. ④ Contact the relevant technicians to realize the scanning of instrument positioning, online display and change the status of instrument use.
III. Results
Results
(1) Electronic instrument and equipment management atlas of the Department of Pediatric Nephrology: the atlas contains five QR code scanning diagrams, including instrument and equipment use registration (cardiac monitoring, other instruments), instrument and equipment inventory registration, instrument and equipment maintenance reporting and borrowing registration, and commonly used instrument and equipment operation video, which is equipped with instrument and equipment management positioning function, inventory function, and video teaching function.
(2) Formation of standardized flow chart.
(3) Relevant indicators: improved instrument and equipment inventory process capability