Protocols as Quality Assurance Tools (Use by Nurses in Management of Minor Respiratory Illnesses).

摘要

A protocol used by nurses in a health maintenance organization for the management of minor respiratory illnesses is described. The protocol stipulates history, physical examination, and laboratory data to be collected and includes recommendations for appropriate diagnosis, therapy, and disposition on the basis of collected data. A checklist comprises the format of the protocol. One part of the protocol encompassing history and physical examination data is included. Three nurses associated with the Harvard Community Health Plan in Boston, Massachusetts, used the protocol. Two nurses saw patients according to general standing orders without the use of the protocol for comparison purposes. Over a 12-week period between March and June 1972, the safety and efficiency of care given by the three nurses using the protocol was evaluated for 442 patient visits. It was found that detailed auditing of nurse performance was enhanced by the use of the protocol. Nurses using general standing orders ordered antibiotics for viral pharyngitis significantly more often than nurses using the protocol. Nurses managed 70 percent of the patients without physician consultation using the protocol. The average amount of time spent on a protocol encounter was 14 minutes. A list of references is provided.