基于PDCA循环的门诊注射室护理质量持续改进效果评价

Evaluation of the Effectiveness of Continuous Quality Improvement in Outpatient Injection Room Based on the PDCA Cycle

摘要: 目的：评价基于PDCA (计划–实施–检查–处理)循环的护理质量持续改进对门诊注射室静脉穿刺一次性成功率及患者输液等候时间的改善效果。方法：采用前后对照研究设计。于2026年4月1日至6月30日开展质量改进，其中基线期(PDCA实施前)为4月1~15日、巩固期(PDCA实施后)为6月15~30日，各纳入门诊注射室输液患者50例，按病例特征配对。主要结局指标为静脉穿刺一次性成功率与输液等候时间，次要结局为穿刺总耗时。配对McNemar检验评价二分类结局；连续变量均不服从正态分布(Shapiro-Wilk检验，P < 0.05)，采用配对Wilcoxon符号秩检验；检验水准α = 0.05 (双侧)。结果：一次性穿刺成功率由54.0% (27/50, 95%CI: 40.4%~67.0%)升至84.0% (42/50, 95%CI: 71.5%~91.7%)，绝对提升30个百分点；输液等候时间中位数由11.0 (10.0, 13.0) min降至7.0 (6.0, 7.0) min，平均缩短4.84 min (降幅42.2%，P < 0.001)；穿刺总耗时中位数由5.0 (4.0, 6.0) min降至3.0 (2.0, 3.0) min (P < 0.001)。亚组分析显示，血管条件较差患者的一次性成功率提升最显著(13.6% → 68.2%, +54.5个百分点)。结论：基于PDCA循环的改进显著提升了门诊注射室的技术质量与流程效率，且困难血管患者获益最大，具有较高的临床推广价值。

Abstract: Objective: To evaluate the effect of a PDCA (Plan-Do-Check-Act) cycle-based continuous nursing quality improvement on the first-attempt success rate of venipuncture and patient infusion waiting time in an outpatient injection room. Methods: A pre-post self-controlled study was conducted. Fifty outpatients from the outpatient injection room were enrolled before (baseline) and after (consolidation) PDCA implementation, with the baseline phase (pre-implementation) from April 1 to 15 and the consolidation phase (post-implementation) from June 15 to 30, 2026, matched by case profile. The primary outcomes were first-attempt venipuncture success rate and infusion waiting time; puncture duration was a secondary outcome. The paired McNemar test was used for the binary outcome and the paired Wilcoxon signed-rank test for continuous outcomes (differences non-normally distributed by Shapiro-Wilk test, P < 0.05); two-sided α = 0.05. Results: First-attempt success rose from 54.0% (27/50, 95%CI: 40.4%~67.0%) to 84.0% (42/50, 95%CI: 71.5%~91.7%), an absolute increase of 30.0 percentage points. Waiting time decreased from a median of 11.0 (IQR 10.0, 13.0) min to 7.0 (IQR 6.0, 7.0) min, with a mean reduction of 4.84 min (a decrease of 42.2%, P < 0.001). Puncture duration decreased from a median of 5.0 (IQR 4.0, 6.0) min to 3.0 (IQR 2.0, 3.0) min (P < 0.001). Subgroup analysis showed the most significant improvement in first-attempt success rate in patients with poor vessels (13.6% → 68.2%). Conclusion: The PDCA cycle-based intervention significantly improved both technical quality and process efficiency in the outpatient injection room, with the greatest benefit in patients with difficult venous access, having high clinical promotion value.