Application of medical record supervision based on PDCA cycle in residents
Nie Shuping
Zhang Bingbing
Liu Zhenhua
Zhang Yuankai
Zhao Dongxiu
Zhang Lifeng
Abstract：Objective To explore the application effect of PDCA cycle based medical record supervision on improving the quality of medical record writing for residents.Methods A total of 1434 residents from January 2022 to March 2023 were selected,and the medical records written by them were checked by the medical record supervisors based on the plan,do,check and act(PDCA)cycle once a month.Results After PDCA cycle,the submission rate,completion rate and correction rate of medical record writing continued to increase,while the notification rate continued to decrease.With the progress of medical record supervision,the scores of medical record writing showed an increasing trend,with a statistically significant difference(P<0.05).Conclusion The medical record supervision based on PDCA cycle can play a good role in improving the quality of medical record writing of residents.
Keywords：residentsmedical record writingPDCA cyclemedical record supervision
Publication Date：2024-09-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 659-661,669 )