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Purpose: To innovatively use the FOCUS‐PDCA quality improvement strategy to establish an external quality assessment (EQA) working group to continuously improve EQA performance, an important indicator of the national tertiary public hospital performance appraisal. Methods: The project was carried out at the National Center for Clinical Laboratories. Using FOCUS‐PDCA, which combines problem‐focused steps (FOCUS) and improvement steps (PDCA), a project team was established to carry out improvement work. Root cause analysis was carried out to analyze the problems in quality control from EQA project application to results analysis and an improvement plan was implemented according to the steps of FOCUS‐PDCA. The project was executed in three cycles from 2019 to 2021 to obtain more satisfactory results. Results: After implementing three cycles of FOCUS‐PDCA, the EQA participation rate increased from 66.5% in 2018 to 100% in 2021, and the EQA pass rate increased from 94.9% in 2018 to 99.3% in 2021. Consequently, the hospital moved into the top 50 in performance assessment for the first time in 2020 and ranked 27th in 2021. Conclusion: The use of the FOCUS‐PDCA quality improvement strategy can improve the EQA performance of national tertiary public hospitals and help them achieve satisfactory results in the national examination. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of FOCUS-PDCA program to reduce the incidence of ventilator-associated pneumonia in ICU patients. Methods The incidence of ventilator-associated pneumonia in ICU patients during 2016 and 2018 were retrospectively analyzed. A FOCUS-PDCA project management team was established to improve the airway management of ICU patients with ventilation. Results A bundle of prevention measures and regulations had been established. The incidence of VAP in ICU patients was decreased form 4. 68‰ to 2. 28‰. Conclusion The Focus-PDCA program is effective to reduce the incidence of ventilator-associated pneumonia in ICU patients (目的 探讨Focus-PDCA管理程序降低重症监护室患者呼吸机相关肺炎的发生率的效果。方法 通过发现重症监护室2016年—2018年呼吸机相关肺炎的发生率逐年递增问题, 2019年及时组建专项管理小组, 利用Focus-PDCA管理工具进行改进。结果 规范重症监护室呼吸机相关性肺炎的预防措施, 呼吸机相关肺炎发生率从4. 68‰下降至2. 28‰。结论 重症医学科实施Focus-PDCA管理能有效降低患者呼吸机相关性肺炎的发生率。)

Objective To investigate the effect of FOCUS-PDCA management mode in standardizing medication of ophthalmic drugs in patients undergoing ambulatory eye surgery, and provide reference for continuous improvement of the nursing quality of ambulatory eye surgery. Methods A non-concurrent control trial was conducted, and patients undergoing ambulatory eye surgery were assigned to the control group (n=146)and the observation group (n=154). The control group received routing nursing management during operation period. The FOCUS-PDCA management mode was adopted in standardizing medication of ophthalmic drugs for patients in the observation group. The rate of qualified self-medication of ophthalmic drugs, awareness and knowledge about ophthalmic drugs and patient satisfaction were measured and compared between groups. Results The rates of proper storage of ophthalmic drugs, proper administration time of ophthalmic drugs and qualified self-medication of ophthalmic drugs in the observation group were higher than those in the control group (P

Background & Aims: Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage. Methods: This study was a mixed‐methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select‐Plan, Do, Check, Act (FOCUS‐PDCA) model in nine steps during 2019−2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered. Results: The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension. Conclusion: The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples. Key points: The most expressed need of the young people on the verge of marriage was weakness in the functional level of reproductive health literacy, mainly in the field of sexual health, due to some existing sexual health education prohibitions to teenagers in schools and most families that is still among the unfulfilled needs of young people.Making changes in the usual marriage education and counseling program based on Find, Organize, Clarify, Understand, Select‐Plan, Do, Check, Act (FOCUS‐PDCA) can improve the quality of health services and increase young people's sexual and reproductive health literacy in various dimensions, particularly for developing areas with limited resources and cultural considerations. [ABSTRACT FROM AUTHOR]

Abstract Background & Aims Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage. Methods This study was a mixed‐methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select‐Plan, Do, Check, Act (FOCUS‐PDCA) model in nine steps during 2019−2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered. Results The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension. Conclusion The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples.

Objective To explore the application value of FOCUS-PDCA quality management tool in reducing the incidence of cancer outburst pain (BTCP) in patients with cancer .Methods A total of 60 cancer pain patients admitted to the Department of Oncology before the implementation of PDCA from July to December 2021 were selected as the control group, and routine nursing was implemented. After the implementation of PDCA from January to June 2022,60 cancer pain patients admitted to this department were included in the observation group. On the basis of routine nursing, FOCUS-PDCA quality management was implemented. The degree of BTCP, quality of life and nursing effect of the two groups were compared. Results The accuracy of cancer pain evaluation, the accuracy of cancer pain drug use, the satisfaction of patients with pain control and the follow-up rate of cancer pain in the observation group were higher than those in the control group, and the differences were statistically significant（P＜0.05）.The incidence of cancer burst pain decreased from 53.3% to 13.3%.Conclusion The FOCUS-PDCA quality management tool can effectively reduce the incidence of BTCP in cancer inpatients, improve the accuracy of cancer pain evaluation, the accuracy of cancer pain drug use and the satisfaction of pain control, and increase the follow-up rate of discharged patients. [ABSTRACT FROM AUTHOR]

Background: To optimize the critical value of test items using FOCUS-PDCA (find, organize, clarify, understand, select, plan, do, check and act), and to set the personalized critical value of the test for different departments. Methods: We searched for literature reporting on the critical value and FOCUS-PDCA published over recent 5 years in order to understand the significance and status quo of critical value and FOCUS-PDCA. We also collected and analyzed the critical value data of hospital tests performed in Sichuan province hospitals in 2019, which were later compared to data from 2020 to determine the FOCUSPDCA cycle. Results: The proportion of critical values in the whole hospital decreased from 3.5% before optimization to 2.5% to 3% after optimization. The critical values of ICU, hematology, nephrology, urology, and neonatal departments after optimization significantly decreased compared with those before optimization, while the critical values of cardiac surgery, emergency ICU, cardiology, and neurosurgery ICU showed no significant difference before and after optimization. Contrary, the critical values of the infection department after optimization significantly increased before optimization. Conclusions: FOCUS-PDCA can effectively optimize the critical value of test items, which is beneficial for rational utilization of medical resources.

Abstract Aim To investigate the effect of implementing a model for continuous quality improvement in the nutritional management of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy. Design methods In the intervention group (n = 77), a model for the continuous quality improvement of efforts at nutrition management was implemented. These efforts included the development of a new process for nutrition management, a system to provide nutritional support and the use of targeted intervention plans to improve nutrition. The time from diagnosis to the administration of radiation therapy, the severity of oral mucositis and dietary factors were recorded and considered in the development of targeted nutrition intervention and nutrition education. The control group (n = 71) followed the original procedures for nutrition management. Results The study found that the CQI model can decrease the severity of oral mucositis caused by radiation and improve nutritional status in affected patients.

Background: To optimize the critical value of test items using FOCUS-PDCA (find, organize, clarify, understand, select, plan, do, check and act), and to set the personalized critical value of the test for different departments. Methods: We searched for literature reporting on the critical value and FOCUS-PDCA published over recent 5 years in order to understand the significance and status quo of critical value and FOCUS-PDCA. We also collected and analyzed the critical value data of hospital tests performed in Sichuan province hospitals in 2019, which were later compared to data from 2020 to determine the FOCUS-PDCA cycle. Results: The proportion of critical values in the whole hospital decreased from 3.5% before optimization to 2.5% to 3% after optimization. The critical values of ICU, hematology, nephrology, urology, and neonatal departments after optimization significantly decreased compared with those before optimization, while the critical values of cardiac surgery, emergency ICU, cardiology, and neurosurgery ICU showed no significant difference before and after optimization. Contrary, the critical values of the infection department after optimization significantly increased before optimization. Conclusions: FOCUS-PDCA can effectively optimize the critical value of test items, which is beneficial for rational utilization of medical resources. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of implementing a model for continuous quality improvement in the nutritional management of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy. Design methods: In the intervention group (n = 77), a model for the continuous quality improvement of efforts at nutrition management was implemented. These efforts included the development of a new process for nutrition management, a system to provide nutritional support and the use of targeted intervention plans to improve nutrition. The time from diagnosis to the administration of radiation therapy, the severity of oral mucositis and dietary factors were recorded and considered in the development of targeted nutrition intervention and nutrition education. The control group (n = 71) followed the original procedures for nutrition management. Results: The study found that the CQI model can decrease the severity of oral mucositis caused by radiation and improve nutritional status in affected patients. [ABSTRACT FROM AUTHOR]

Objective To enhance the safety management capacity of patients in primary health care institutions, promote the "quality service at the grassroots level" activities, and to achieve the goal of patient safety management. Methods the focus on problem and continuous problem improvement (FOCUS-PDCA) management model was applied to the evaluation and improvement of patient safety management ability in 8 primary health care institutions established according to the standard. Through the establishment of CQI team, according to Organize, Find, Clarify, Understand, Select, Plan, Do, Check and Act nine steps to carry out continuous quality improvement. Results After implementing the FOCUS-PDCA management model, the scores of the checkup system, surgical safety verification system, critical value report management, patient safety risk management and patient participation in medical safety management five items in the primary health care institutions were all higher than those before implementation, and the differences were statistically significant significance (P <0.05). After implementing the FOCUS-PDCA management model, the number of A,B-level compliance items in self-review, district-level expert review and municipal-level expert review were all higher than those before implementation, and the differences were statistically significant (P <0.05), C-level compliance rate was 100.0%. The key quality control indexes of safety management, such as wristband wearing rate, surgical site marking implementation rate, operation tripartite verification implementation rate, critical value report coincidence rate and safety drug consultation rate were significantly improved. Conclusion The application of FOCUS-PDCA management model can effectively improve the patient safety management ability of primary health care institutions, and can be popularized in the later establishment of the standard. [ABSTRACT FROM AUTHOR]

Objectives To identify the intravenous ( IV) medications that are prepared in glass bottles at the institution and establish which of these medications can be prepared in flexible IV bags such as polyvinyl chloride ( PVC) or non- PVC instead of glass bottles. The cost implication of switching from glass bottles to flexible IV bags was calculated. Methods A study using FOCUS- PDCA model to identify IV medications prepared in glass bottles and establish which of these medications could be prepared in IV bags ( PVC or non- PVC). The cost impact of switching from glass bottles to IV plastic bags (including PVC or non- PVC) was calculated. The stability data obtained were used as a reference for updating pharmacy internal IV preparation charts. Key findings A total of 17 IV medications were found to be prepared in IV glass bottles. Of these 17 medications, only 8 (47%) were prepared in IV glass bottles due to incompatibility with PVC bags. For 7 (41%) of the medications, of which 6 were monoclonal antibodies ( MABs), the reason for preparation in glass bottles was unclear as these medications are compatible with either PVC or non- PVC or both. The potential cost savings associated with switching all of the identified medications to IV plastic bags (either non- PVC or PVC) exceeded $200 000. Conclusions The elimination of glass bottles within the institution resulted in a significant cost saving. The use of FOCUS- PDCA model can help healthcare institution achieve significant improvements in process and realize significant cost savings. [ABSTRACT FROM AUTHOR]

Objective: Neonatal meningitis is more common than the other ages and it’s associated with neural complications and high mortality rate. The cerebrospinal fluid test is the most important test in the diagnosis of meningitis. According to several reports, there were some problems in reporting of this test in Amirkola pediatric hospital. Using the CQI model for quality improvement of cerebrospinal fluid reports to decrease processes time taking, complications and increase the satisfaction. Methods: This is a quasi-experimental (Pre and post) study performed by FOCUS-PDCA in Feb-2000 in Amirkola pediatric hospital. The time taking of 25 CSF samples reports were measured randomly, then the improvement program performed and the time were measured again in 25 other CSF samples reports and the results were evaluated. Findings: Not having a regular program to remit the samples was the most important cause of low quality according to numerous vote. The pre-improvement median time took 3:30 hours and the post one took only 40 minutes. Conclusion: According to our results the process time taking decreased 2 hours and 50 minutes after improving program. It caused low complications and high satisfaction. We believe that this first effort can provide a model for the expansion of CQI not only in Babol university of medical sciences but throughout Iran.

This paper presents a quality roadmap of a restructured hospital. Specifically, a case study is showcased to reveal how a FOCUS-PDCA model is applied to the Central Portering Services (CPS) within a restructured hospital, to provide better service to other departments within the hospital who can then in turn value add to the patient care delivery chain. The preliminary results suggest that implementers of quality and service improvement programmes using the FOCUS-PDCA approach should note some of the key implementation difficulties. These difficulties occur at all levels and include issues relevant to change management, process improvement programmes, accessibility to data, communication and judicious execution of the change process. [ABSTRACT FROM PUBLISHER]