Abstract
Background:
To explore the application effect of “quality control circle” activity in postoperative nursing of elderly dental implants.
Methods:
From January 2022 to December 2022, a total of 60 elderly patients were selected and divided into an experimental group and a control group, with 30 cases in each group using the random number table method. The elderly patients with dental implants received postoperative care under the supervision of a quality control circle. The control group was treated with conventional nursing methods. The success rate, postoperative complications, and satisfaction of the 2 groups were compared.
Results:
By comparing the postoperative care effect of the 2 groups of patients, the satisfaction of the experimental group and the control group was 93.3% and 73.3%, respectively, showing the satisfaction of the experimental group was higher than the control group (P < .05). The planting success rate of the experimental and control groups were 96.7% and 66.7%, respectively, with the experimental group outperforming the control group (P < .05). The proportion of complications in the experimental was found to be fewer (6.7%) than in the control group (33.3%) (P < .05).
Conclusion:
Quality control circle activities can effectively improve the success rate of dental implants, reduce the occurrence of postoperative complications, improve patient satisfaction, and help medical staff in providing better treatment for patients.
Keywords: dental implant, old age, postoperative care, quality control circle
1. Introduction
For elderly patients, slow response, lack of understanding and memory, weak oral health awareness, and lack of related knowledge are common.[1] The elderly have a significantly higher incidence of the dental defect and loss than other age groups,[2] and elderly patients have low compliance and are prone to other complications.[3] Due to older age, the corresponding decrease in bone density, and other reasons, the operation time of dental implants in elderly patients is longer. The success of a dental implant is closely tied not only to the doctor’s operation and the patient’s condition, but also to the intraoperative cooperation and preoperative and postoperative nursing of specialized nurses.[4]
Isaksson et al[5] proposed implementing long-term and extended care for patients with oral implants. They believed that patients with toothless jaws who received implant prostheses should receive long-term care; that is, daily care for patients should be extended to the family environment, various problems that may occur after implantation should be assessed, and corresponding care should be given. Kimure et al[6] found a weak connection between the daily use of implants and long-term home care in a study of patients receiving long-term care after oral implantation in Osaka, Japan. However, this study only described the relationship between the daily use of dentures and family care after implantation, and the perioperative nursing, as well as nursing mode of implant surgery in the hospital, were not elaborated; hence, this research may be 1-sided.
A quality control circle (QCC) is a form of organization for continuous improvement of quality management. In 1954, American Professor Deming and Professor Juran, respectively, put forward the quality management circle or QCC.[7] According to the available data, there is a statistically significant correlation between implant failure and sex, implant location, periodontal status distribution, and bone enhancement before and during implant placement.[8] Moreover, the implant cycle is long for multiple teeth, and the failure rate of dental implants is greater in elderly patients.
The effect of continuous quality improvement management can be achieved through quality control circle activities in which the circle members will spontaneously clarify the weak links in the work period and adopt effective countermeasures based on the actual situation. All circle members must participate in various specific management work and continuously improve their overall quality management level.[9,10] The quality control circle is increasingly used in nursing, and the results are impressive.[11] In order to improve the success rate of dental implants for elderly patients, reduce the occurrence of postoperative complications and improve satisfaction, the intervention study of quality control circle activities was carried out with dental implants in the hospital. The Medical Ethics Committee of Jiangnan University Affiliated Hospital approved the study. The report is as follows.
2. Data and methods
2.1. General information
From January 2022 to December 2022, 60 elderly patients selected from the stomatology clinic of the Affiliated Hospital of Jiangnan University. Inclusion criteria: Can complete the review on time; All the information is complete; Age ≥ 50 years old. Exclusion criteria: Participating in other research experiments; Unable to communicate normally or have mental illness; Malignant tumor; There are diseases with abnormal coagulation function. According to the principle of randomized control grouping, a random number table was used, with 30 cases in each group. The experimental group was 50 to 70 years old, with an average age of (61.93 ± 5.616) years old. There were 16 males and 14 females. The control group had 15 males and 15 females, who were 50 to 71 years old, with an average age of (61.78 ± 5.858) years. In the general research data, there was no significant difference between the 2 groups (P > .05), indicating comparability (see Tables 1 and 2). All patients were informed of the trial and participated voluntarily.
Table 1.
Comparison of patient gender.
| Group | Number of patients | Gender | |
|---|---|---|---|
| Male | Female | ||
| Experimental group | 30 | 16 | 14 |
| Control group | 30 | 15 | 15 |
| χ2 | .067 | ||
| P value | .796 | ||
χ2 = Chi-square value.
Table 2.
Comparison of patient age.
| Group | Number of patients | Average age (yr) |
|---|---|---|
| Experimental group | 30 | 61.93 ± 5.616 |
| Control group | 30 | 61.78 ± 5.858 |
| Z | −.953 | |
| P value | .340 |
Z = The value of the Wilcoxon statistic.
2.2. Logical requirements
This QCC activity strictly complies with the basic principles of the patient’s knowledge and intention, and they are willing to participate in this QCC activity. All patients have the option to decline participation in this QCC activity. All affected persons and their family members can also withdraw from the QCC. Patients who participated in the study signed a letter of understanding and agreement. The researcher promised that all information and resources would be kept confidential and that they would only be used for academic research.
2.3. Methods
The control group was treated with routine nursing, and the experimental group was treated with tubular nursing.
Accordingly, team members were set up and determined the theme content of this quality control circle. The designed members of this activity had 6 nurses in the department of dental implantology, including 3 supervisors and 3 nurses. Based on the voting of all members, the head of the circle arranged for the head nurse of the dental clinic to be fully responsible for related matters in the circle. The quality control circle was named after the “Care Circle,” and the main purpose was to encourage all circle members to be concerned about the success rate of oral implant surgery for elderly patients and improve patient satisfaction. The inclusion criteria of team members are as follows: The working time of the department is more than 2 years, and they can fully grasp the general routine nursing; They have a bachelor’s degree or above; The participants content for this research. It is confirmed that the “Care Circle” theme will be “improving the success rate of dental implants for elderly patients” from January 2022 to December 2022.
Given the specific problems in postoperative care of elderly dental implant patients, the quality control circle group members used a brainstorming method combined with clinical practice and literature content to systematically summarize and explore the nursing problems of elderly patients at the present stage of the operation, the defects of nursing quality data are summarized Table 3.Plot Plato according to the Quality of care deficiencies cumulative percentages in Table 3 (see Fig. 1).
Table 3.
Statistical data of the defects of nursing quality data.
| Problem | Frequency | Cumulative percentage<?Note To TS: Char=%?> |
|---|---|---|
| Postoperative precautions account is not targeted | 10 | 32.3% |
| The Form of postoperative health Education and guidance is simple | 8 | 58.1% |
| Postoperative instrument disposal was Not in place | 7 | 80.6% |
| The operating room environment was not Properly disposed of | 2 | 87.1% |
| Postoperative adverse reactions were not Tracked enough | 2 | 93.5% |
| Postoperative telephone follow-up was Not fully covered | 2 | 100.0% |
Figure 1.
Quality of care deficiencies in project plato.
Given the problems listed above, the root cause analysis was performed using the fishbone diagram(see Fig. 2), and the discussion was conducted through brainstorming by all members of the circle. The problem was solved by identifying the root causes and developing appropriate countermeasures. The following are the specific implementation countermeasures:
Figure 2.
Fishbone diagram.
2.3.1. Countermeasure 1: Diversified publicity, strengthen health guidance.
Propaganda manuals and oral explanations were combined for patients to carry out propaganda and education. Related contents were uploaded to the WeChat public account, and a science popularization publicity column was added. The contents of propaganda and education were posted in the propaganda column in pictures, which were convenient for patients to view and read.
2.3.2. Countermeasure 2: Standardize the content and process of education.
Formulate health guidance following implant surgery, common symptoms, and treatment methods, and list postoperative care plans for dental implants. Strengthen the theoretical training of nurses, supervise and evaluate the theoretical knowledge of nurses.
2.3.3. Countermeasure 3: Standardize the pretreatment and treatment flow of oral medical instruments.
Strengthen the training of nurses operation skills, organize nurses’ on-site operation demonstration, as well as conduct practice and assessment. The nurses supervise each other, strictly adhere to equipment handling standards, raise the reward and punishment incentive system, and boost their enthusiasm.
2.4. Effect evaluation
Before and after the activity, questionnaires and telephone interviews were used to comprehensively explore patient satisfaction and systematic comparative analysis.
2.5. Statistical analysis
Statistical analysis of the data was performed using SPSS 26.0 software. The counting data is expressed as a percentage and tested by χ2. P < .05 indicated a statistical difference, as shown in Tables 4, 5, and 6.
Table 4.
Comparison of satisfaction between the two groups.
| Group | Number of patients | Satisfied | Not satisfied | Percentage of satisfaction |
|---|---|---|---|---|
| Experimental group | 30 | 28 | 2 | 93.3% |
| Control group | 30 | 22 | 8 | 73.3% |
| χ2 | 4.320 | |||
| P value | .038 | |||
χ2 = Chi-square value.
Table 5.
Comparison of planting success rate between the two groups.
| Group | Number of patients | Effective | Void | Success rate (%) |
|---|---|---|---|---|
| Experimental group | 30 | 29 | 1 | 96.7% |
| Control group | 30 | 20 | 10 | 66.7% |
| χ2 | 9.017 | |||
| P value | .003 | |||
χ2 = Chi-square value.
Table 6.
The proportion of complications in the two groups.
| Group | Number of patients | Number of complications (bleeding, infection, and swelling) | Proportion of complications |
|---|---|---|---|
| Experimental group | 30 | 2 | 6.7% |
| Control group | 30 | 10 | 33.3% |
| χ2 | 6.667 | ||
| P value | .010 | ||
χ2 = Chi-square value.
3. Results
By comparing the 2 groups of patients, the experimental group was more satisfied with the implantation than the control group (P < .05). The experimental group outperformed the control group in terms of planting success rate (P < .05). The proportion of complications was lower in the experimental group than in the control group (P < .05). This indicates that quality control circle activities have positive application effects in perioperative nursing of elderly dental implant patients.
4. Discussion
Due to age factors, bone density decreases; for other physical factors, elderly patients take longer to undergo implantation surgery. Moreover, elderly patients have more damaged teeth, and the multi-tooth implantation cycle is relatively long.[12,13] Although age is not a contraindication for implantation, elderly patients often face systemic diseases, multiple drugs, physical weakness, and long-term oral maintenance issues, which might increase the risk of implantation therapy and eventually lead to treatment failure.[14]
The Cone beam computed tomography technique can provide a more accurate simulation of the shape of the patient’s jaw bone. The detailed surgical process can be effectively analyzed and demonstrated using images, which is conducive to significantly reducing the difficulty and risk of non-flap dental implant surgery.[15,16] Furthermore, patients have expressed a desire for a greater treatment effect where the actual treatment period needs to better play a positive role in nursing. In recent years, hospitals have paid increasing attention to high-quality nursing, which has significantly improved therapeutic and prognostic effects and is conducive to guiding the physical and mental health rehabilitation of patients.[16] In the future, oral implant specialists, professional dental hygienists, dental technicians, and others working in dentistry will need to deepen and expand their understanding of oral care for the elderly, as well as their capacity to manage implants,[17]
Quality control circle means that problems in work can be better solved and nursing efficiency can be improved.[18] Related personnel is organized into a group in a certain work area, and the bar chart is used to rank them from highest to lowest. The fundamental problems can be analyzed with the help of Plato, the core factors involved in the impact of nursing quality can be clarified, the fishbone diagram can carry out in-depth analysis, and effective countermeasures can be formulated on the core problems. Furthermore, brainstorming is used to effectively implement the formulated rectification plan. Quality control circle team members are responsible for the corresponding supervision work and group meetings to ensure weekly implementation. The bar chart compares the nursing work score before and after the rectification. The improvement effect of related nursing problems after implementing the formulated plan is comprehensively observed using the passage chart. For unsolved related problems, Plato clarified that the fishbone diagram further analyzes the specific reasons to ensure that relevant programs are optimized and conducive to the continuous improvement of nursing quality.[18–20]
In summary, the present research proposed a quality management method where quality circle activities can promote team collaboration and continuous improvement. In the perioperative nursing of elderly dental implant patients, introducing quality control circle activities can improve the cooperation and communication of the nursing team, reduce complications, and improve the success rate of surgery and patient satisfaction. Thus, the present study can be widely applied.
Author contributions
Formal analysis: Yannan Cao.
Investigation: Xiangbing Wu.
Supervision: Fangyong Zhu.
Writing – review & editing: Hongxuan Zhao, Meichun Hu.
Abbreviation:
- QCC
- quality control circles
MH, XW, and YC contributed equally to this work.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
This work was supported by the Top Talent Support Program for young and middle-aged people of Wuxi Health Committee (no. HB2023054). Scientific Research Program of Wuxi Health Commission (M202240). Clinical Research and Translational Medicine Research Program, Affiliated Hospital of Jiangnan University (LCYJ202223 and LCYJ202346).
The Medical Ethics Committee of Jiangnan University Affiliated Hospital approved the study.
The authors have no conflicts of interest to disclose.
How to cite this article: Zhao H, Hu M, Cao Y, Wu X, Zhu F. Study on the application of quality control circle activity in postoperative nursing of elderly dental implants. Medicine 2024;103:2(e36894).
Contributor Information
Hongxuan Zhao, Email: 443987739@qq.com.
Meichun Hu, Email: 1549460426@qq.com.
Yannan Cao, Email: cyn525@163.com.
Xiangbing Wu, Email: wuxiangbing2007@163.com.
References
- [1].Xiaolin W, Xiao Z, Bei W, et al. Application of targeted oral health education in elderly patients with dental implant surgery. Chin J Geriatr Stomatol. 2020;1:35–42. [Google Scholar]
- [2].Oishi MM, Momany ET, Collins RJ, et al. Dental care in programs of all-inclusive care for the elderly: organizational structures and protocls. J Am Med Dir Assoc. 2012;22:1194–8. [DOI] [PubMed] [Google Scholar]
- [3].Yun L, Yanqiu L. Application of continuous care in elderly patients with out-patient implantation surgery. Chin J Endemic Dis Control. 2017;11:1252–4. [Google Scholar]
- [4].Jian L, Haiou X, Shoumei J. A qualitative study on the evaluation of nursing practice by nursing managers in Shanghai. J Nurs Adm. 2012;12:506–7. [Google Scholar]
- [5].Isaksson R, Becktor JP, Brown A, et al. Oral health and oral implant status inedentuious patients with imlant-suppored dental prostheses who are receivinglong-term nursing care. Gerodonology. 2009;26:245–9. [DOI] [PubMed] [Google Scholar]
- [6].Kimura T, Wada M, Suqanami T, et al. Dental implant-status of patients receiving long-term nursing care in Japan. Clin Implant Dent Relat Res. 2015;17:163–9. [DOI] [PubMed] [Google Scholar]
- [7].Lin-Run W, Yang W, Xiang-Yi Z, et al. Application value of quality control circle management in medical institutions. Med Rev. 2012;31:23–6. [Google Scholar]
- [8].Compton SM, Clark D, Chan S. Considerations for dental implant in the elderly. The Korean Journal of Clinical Geriatrics. 2017;23:1–8. [Google Scholar]
- [9].Huiqin W. Nursing culture in quality management. Chin J Nurs. 2010;45:3. [Google Scholar]
- [10].Linfeng L, Yi Z, Haiying L. Application of quality control circle in nursing quality control. J Nurs Manag. 2013;13:800–1. [Google Scholar]
- [11].Minghui L, Tingfang L, Siping D. Application of quality control circle in continuous improvement of medical quality. Chin Hosp Manage. 2012;32:37–9. [Google Scholar]
- [12].Wenjuan Z, Xia X, Weijing C. Effect of immediate and delayed implantation in patients with premaxillary single tooth restoration. Hainan Med. 2017;28:647–9. [Google Scholar]
- [13].Jianhua Q, Yanxia Z, Changchun D, et al. Application of CBCT in minimally invasive maxillary sinus lift in elderly patients with osteoporosis. J Aerosp Med. 2019;1:42–4. [Google Scholar]
- [14].Yuan Q. Dental implant treatment in medically compromised patients. Cham: Springer International Publishing; 2020. [Google Scholar]
- [15].Jia C, Zhihong Z, Honghong L, et al. Clinical evaluation of bone mass measurement by curved body slice and conical beam CT. J Anhui Med Univ. 2015;50:393–5. [Google Scholar]
- [16].Mingzhen L, Minhua L, Xiumei C. Application progress of quality control circle in nursing quality management. Int Med Rev. 2015;21:3546–8. [Google Scholar]
- [17].Ohkubo C, Ikumi N, Sato Y, et al. Maintenance issues of elderly patients requiring nursing care with implant treatments in dental visiting: position paper. Int J Implant Dent. 2022;8:63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Xiaoying Z, Hui Z, Xianming N, et al. Analysis of related factors and preventive measures of periodontitis. China Mod Doct. 2015;53:67–69, 73. [Google Scholar]
- [19].Yunyun G, Fucai S, Wanzhen Y, et al. Correlation analysis of periodontal plaque microbial infection and periodontitis. Chin J Nosocomial Esr. 2015;25:2570–2. [Google Scholar]
- [20].Xiyan P, Xiangying O, Lu H. Study on the definition of periodontitis. J Dent Pulp Periodontol. 2015;25:45–51. [Google Scholar]