[Improving the Nasogastric Tube Removal Rate in Stroke Patients Using a Quality Control Circle Method].
Post-stroke dysphagia, which affects 40% to 70% of stroke survivors, frequently leads to aspiration pneumonia and diminished quality of life. Despite achieving a 98.8% initial swallowing screening rate, the nasogastric tube removal rate in our unit of 52.7% was below the national benchmark of 57.4%. A quality control circle root cause analysis was conducted, with five critical issues identified. These included a lack of routine in-service education, insufficient interdisciplinary collaboration, inconsistent screening tool versions being used, a deficit in integrated educational resources, and ambiguous re-screening protocols during patient transfers that resulted in a low re-screening rate (60.3%).
This project was implemented to increase the nasogastric tube removal rate in stroke patients from the baseline of 52.7% to a minimum target of 67.8%.
Four key interventions were implemented using quality control circle methodologies. These included: (1) Organizing interdisciplinary workshops to clarify intervention timing and professional roles across disciplines; (2) Integrating a "Three-Stage Swallowing Screening Tool" incorporating pre-procedural oral hygiene protocols and clinical decision-making algorithms; (3) Developing interdisciplinary patient education materials encompassing nursing, traditional Chinese medicine, and speech-language pathology; and (4) Revising standard operating procedures to mandate re-screening during all inter-unit transfers.
Post-intervention, the nasogastric tube removal rate increased from 52.7% to 69.9%, which exceeded the targeted goal. Notably, no re-intubations occurred within the six-month post-discharge follow-up period. In addition, the re-screening rate during inter-unit transfers improved markedly from 60.3% to 97.4%. Ancillary benefits included redirecting approximately 15 minutes of tube maintenance time per nurse daily into high-value individualized patient care,and an estimated savings in annual healthcare costs of NT$24,708 per family.
The process standardization and enhanced interdisciplinary synergy achieved under this project effectively eliminated gaps in care, resulting in substantially improved patient safety and care quality.
This project was implemented to increase the nasogastric tube removal rate in stroke patients from the baseline of 52.7% to a minimum target of 67.8%.
Four key interventions were implemented using quality control circle methodologies. These included: (1) Organizing interdisciplinary workshops to clarify intervention timing and professional roles across disciplines; (2) Integrating a "Three-Stage Swallowing Screening Tool" incorporating pre-procedural oral hygiene protocols and clinical decision-making algorithms; (3) Developing interdisciplinary patient education materials encompassing nursing, traditional Chinese medicine, and speech-language pathology; and (4) Revising standard operating procedures to mandate re-screening during all inter-unit transfers.
Post-intervention, the nasogastric tube removal rate increased from 52.7% to 69.9%, which exceeded the targeted goal. Notably, no re-intubations occurred within the six-month post-discharge follow-up period. In addition, the re-screening rate during inter-unit transfers improved markedly from 60.3% to 97.4%. Ancillary benefits included redirecting approximately 15 minutes of tube maintenance time per nurse daily into high-value individualized patient care,and an estimated savings in annual healthcare costs of NT$24,708 per family.
The process standardization and enhanced interdisciplinary synergy achieved under this project effectively eliminated gaps in care, resulting in substantially improved patient safety and care quality.
Authors
Li Li, Kuo Kuo, Huang Huang, Lo Lo, Tsai Tsai, Chiang Chiang, Wu Wu, Huang Huang, Lai Lai, Ho Ho, Huang Huang
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