基于QFD改善高危孕产妇围孕期安全
发布人：yaot 发布时间：2023/10/18 9:42:53 浏览次数：1159次
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】——王 佳 潘秀红 祝立群 陈丽 吴奎
【摘要】目的 准确识别高危孕产妇围孕期需求，构建围孕期安全管理模式，确保围孕期安全。方法 对高危孕产妇围孕期安全需求进行问卷调查，运用质量功能展开对需求进行分析，运用 Kano 模型识别魅力需求，运用独立配点法计算质量特性重要度，设计并执行高危孕产妇围孕期安全管理模式，包括院前卡扣式产检流程、院中快速救治方案、交互式信息化智慧诊疗等。结果 高危孕产妇识别准确率提高至100%，筛查干预建档率提高至100%，组织抢救时间缩短至10 min，紧急用血时间缩短至25 min，标准化上报完整率提高至100%，信息联动率提高至100%。结论 基于质量功能展开的创新型品管圈活动，能够以高危孕产妇围孕期安全需求为中心，多措并举确保高危孕产妇围孕期安全。
【关键词】质量功能展开；品管圈；QFD创新型品管圈；高危孕产妇；围孕期安全
中图分类号：R197.323 文献标识码：B
Improving Perinatal Safety of High-Risk Pregnant Women Based on QFD/WANG Jia,PAN Xiuhong,ZHU Liqun,et al.//Chinese Health Quality Management，2023,30(9):67-73
Abstract Objective To accurately identify the needs of high-risk pregnant women during perinatal period, construct a safe management model to ensure safety during pergnancy. Methods A questionnaire survey was conducted on the safety needs of high-risk pregnant women during pregnancy, the needs were analyzed by quality function development, the attractiveness needs were identified by the Kano model, the importance of quality characteristics was calculated by the independent matching point method, and the management model was designed and implemented, including a pre-hospital buckle obstetric examination process, rapid treatment plan in the hospital,and an interactive information intelligent diagnosic and treatment system.Results The accuracy of identification an in-hospital rapid treatment plan of high-risk pregnant women increased to 100%, the filing rate of screening intervention increased to 100%, the time of organized rescue was shortened to 10 min, the time of emergency blood use was shortened to 25 min, the rate of standardized reporting integrity was increased to 100%, and the rate of information linkage was increased to 100%. Conclusion The innovative quality control circle activities based on quality function can focus on the safety needs of high-risk pregnant women during perinatal pregnancy and take multiple measures to ensure the safety of high-risk pregnant women during pregnancy.
Key words Quality Function Development; Quality Control Circle; QFD Innovative Quality Control Circle; High-Risk Pregnant Women; Perinatal Safety
Firstauthor's address Shanghai Pudong Hospital, Shanghai,201399, China
1主题选定
全体圈员召开头脑风暴会议，结合科室现状，提出多个备选主题，并从领导重视程度、重要性、迫切性、圈能力4个维度以评价法进行主题评价，票选分数“5分最高、3分普通、1分最低”，最终选定得分最高的“基于QFD改善高危孕产妇围孕期安全”为本次活动主题。经QC-Story判定，本期活动主题为QFD创新型品管圈。?/div>
名词定义：高危孕产妇即具有高危妊娠因素的孕产妇，而高危妊娠是指在妊娠期有某种并发症、合并症或致病因素，可能危害孕妇、胎儿及新生儿或导致难产［1］。
选题背景：近年来，高龄孕产妇比例逐年增长，且多出现危及生命的产科并发症、合并症［2］。早筛查、早干预是确保高危孕产妇安全的关键［3-4］。产检是筛查与干预的前提，接受规范的产前检查，对保障母婴围产期健康具有重要意义［5］。据统计，上海市浦东医院2021年接收高危孕产妇1 775人，占全部孕产妇的78.71%，其中：未建档52人，产检不全220人；新生儿死亡2例，死胎1例，均未做过产检。如何督促高危孕产妇及时产检，多措并举确保高危孕产妇围孕期安全，是亟待解决的问题。
2活动计划拟定
在计划活动时间内，圈员严格按照PDCA循环理念制订活动计划安排，其中：P阶段时长占总时长的29.4%，D阶段时长占总时长的52.9%，C阶段时长占总时长的11.8%，A阶段时长占总时长的5.9%。
3质量规划与课题明确化
3.1需求挖掘
首先，圈员基于预约时间、产检时、异常报告时、个性化产检档案、紧急意外情况时、宣教时、分娩前、分娩时、分娩后等场景需求，对孕产妇及相关方进行现场访谈，收集需求。其次，将需求规范化，删除与活动主题不相符的需求，运用KJ法进行归纳整理，使质量需求更加具体。最后，通过头脑风暴会议，将质量需求整理为安全、效率、服务3大类共16条。
3.2 需求重要度判定
采用李克特5级评分法（“非常同意、同意、不一定、不同意、非常不同意”分别记为“5分、4分、3分、2分、1分”）对需求进行重要度判定，并通过评估重要度进行需求筛选，得到质量需求重要度。见表1。
3.3质量水平提升分析
选择两家具有代表性的医院（A为专科医院，B为综合医院）进行对比，通过对本院进行走访，结合两家医院现状与本院实际设定本课题要达成的目标水平，计算水平提高率。见表1。
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