IMPROVEMENT OF QUALITY MANAGEMENT SYSTEM IN ANTICOAGULATION OUTPATIENT CLINIC IN GENERAL HOSPITAL CELJE

V magistrski nalogi je prikazana analiza in ocena obstoječega stanja upravljanja antikoagulacijske ambulante v Splošni bolnišnici Celje. V teoretičnem delu je predstavljena dejavnost antikoagulacijske ambulante in pomembnost antikoagulacijskega zdravljenja, potem pa zdravila za preprečevanje strdkov ter indikacije, pri katerih je potrebno uvesti antikoagulacijsko terapijo. Raziskava je pokazala, da prejmejo bolniki v antikoagulacijski ambulanti dovolj informacij, navodil in nasvetov o antikoagulacijskem zdravljenju kljub obremenjenosti zaposlenih in povečanem obsegu ambulantnega dela. Niso pa bolniki dobro seznanjeni z možnimi zapleti antikoagulantne terapije in ukrepi v primeru, da se pojavijo takšni zapleti. Ugotovili smo, da so bolniki zadovoljni s kakovostjo dela zaposlenih v AK ambulanti in z organizacijo dela — procesom dela od vpisa, obiska laboratorija pa do ambulantne obravnave. Kakovost dela in zadovoljstvo uporabnikov zdravstvenih storitev bi izboljšali, ko bi bili možni posveti in razgovori med bolnikom in zdravnikom v antikoagulacijski ambulanti ter krajšim čakalnim časom na prejem končnega izvida antikoagulacijskega zdravljenja. Odnos bolnikov do antikoagulacijskega zdravljenja je pozitiven, zato menimo, da pomeni bolnikom antikoagulantna terapija varno terapijo, saj jih ščiti pred nastankom ali ponovnimi strdki. S spremljanjem kazalnikov kakovosti, to je časov povprečne obravnave bolnika v celotnem procesu pa smo ugotovili, da je obravnava bolnika v antikoagulacijski ambulanti Splošne bolnišnice Celje ob normalnih pogojih dela in v primerjavi z drugo antikoagulacijsko ambulanto zadovoljiva in bistveno hitrejša. Na osnovi rezultatov, dobljenih iz raziskave in notranje presoje, so prikazane prednosti, pomanjkljivosti in možne izboljšave organizacije dela v antikoagulacijski ambulanti. Kot načelo za stalno izboljševanje kakovosti zdravstvenih storitev v antikoagulacijski ambulanti je predstavljen in uporabljen Demingov krog. Z izboljševanjem kakovosti želimo doseči kakovostnejše rezultate zdravljenja pacientov, ki prejemajo antikoagulacijsko zdravilo in izboljšati zadovoljstvo uporabnikov zdravstvenih storitev v antikogulacijski ambulanti. In my dissertation I represent the analysis and assessment of the status quo managment of anticoagulant clinic in General hospital Celje. Teoretical part presents the activity of anticoagulant clinics, the importance of anticoagulant therapy, drugs to prevent clots and the indications for which it is necessary to introduce the anticoagulation therapy. The study shows that patients in anticoagulant clinic are receiving enough informations, instructions and tips on anticoagulant treatment despite the burden on employees and the increased volume of outpatient clinical work. However, the patients have not been aware well enough of the potential complications of anticoagulant therapy and the measures considering the occurance of such complications. We found that patients are mostly satisfied with the work quality of employees in anticoagulant clinic and organization of work - part of the process to entry/registration to inpatient treatment facility. Quality work and satisfaction of users of health services could be improved when there is a possibility of consultations and discussions between patients and physicians in the anticoagulant clinic and above all with shorter period of waiting time to receive the final results of anticoagulant treatment. Patient's attitude towards anticoagulant treatment is positive that's why we assume the anticoagulant therapy is save therapy because it protects against creation and recreation of the clots. By monitoring the indicators of quality, times of the avarage patient treatment throughout the process we found that the treatment of the patient in anticoagulant clinic in General hospital Celje is under normal operating conditions and compared to others satisfactory and considerably much faster. Based on the results obtained from surveys and internal audits there are shown pros and cons, advantages and disadvantages and other possible improvements to the work organization in the anticoagulant clinic. As the principle of continuous improvement of the quality of health services in the anticoagulant clinic the Deming's circle is presented and used, too. By improving the quality we want to achieve better quality of treatment outcomes of patients receiving anticoagulation treatment and we want as well to improve the satisfaction of users of health services in anticoagulant clinic.