FMEA 기법 도입을 통한 병원 급식 품질 개선 사례 연구 -배선서비스 품질 개선 및 환자만족도 중심으로-

김혜진 ( Hye Jin Kim ),홍정임 ( Jeong Im Hong ),허규진 ( Gyu Jin Heo ) 대한영양사협회 2015 대한영양사협회 학술지 Vol.21 No.1

In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.

병원급식 조리구역별 위험도 평가를 통한 안전사고 실태 및 안전인식에 관한 사례연구

김혜진 ( Hye Jin Kim ),홍정임 ( Jeong Im Hong ),허규진 ( Gyu Jin Heo ),박주연 ( Joo Yeon Park ) 대한영양사협회 2016 대한영양사협회 학술지 Vol.22 No.1

This study was carried out to provide a basis for the development of a safety manual for kitchen accident prevention by identifying the safety situation and awareness through risk assessment of kitchen areas. The study was conducted in two phases. First, kitchen accidents and area risk assessment were investigated from February 2014 to September 2014, after which safety awareness of hospital foodservice employees was assessed in a survey. The results of this study were as followes. All of the respondents were women. The evaluation point of kitchen area risk assessment was reduced by 14%. After improvement, an initial score of 108 points decreased to 93 points. The number of accidents was also reduced by 78%; 14 accidents were decreased to three. The most common area of accidents was the kitchen area (58.8%), and burns was the most common accident (35.3%). Most of the employees deemed “enough staff” as the most major factor for good foodservice. “High indoor temperature and poor ventilation in the kitchen area” was chosen as the most common problem in the foodservice workplace. Taken together, our study quantitatively evaluated safety issues in hospital foodservice kitchen areas and provides a basis for the development of a safety manual for kitchen accident prevention.

서울시내 병원의 경장영양식 보험수가에 대한 영양사의 견해 분석

김혜진 ( Hye Jin Kim ),목희정 ( Hee Jung Mok ),홍정임 ( Jeong Im Hong ),허규진 ( Gyn Jin Heo ),이인규 ( In Kyu Lee ) 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Purpose: Enteral nutrition is an efficient method of providing nutrition, which has significant clinical advantages. However, it presents difficulties of ensuring an adequate supply and management because meal wages are insurance- inclusive. By understanding the management status of enteral nutrition in hospitals in Seoul and seeking the opinions of experienced nutritionists on governmentpaid meal wages, we acquired basic data for review of patient meal wages and the insurance system. Methods: Investigation of medical institutions in Seoul was performed through a survey conducted from October 15 to October 31 2012. Twenty-eight questionnaires on the current situation and 103 questionnaires on individual opinions were analyzed. Descriptive analysis, chi-square test, and ANOVA were performed using PASW Statistics 18.0. Results: Regarding satisfaction with enteral nutrition, 93.0% reported that the major complication was diarrhea. Among the list of difficulties in case of complications, lack of diversity was 56.1%. The No. 1 influence in selection of enteral nutrition was ‘Cannot use expensive products because of insufficient medical fees,’ at 45.0%, while No. 2 was ‘Cannot use a variety of products because of insufficient medical fees’ at 26.3%. No. 1 in needs for improvement of enteral nutrition was ‘modifications and complements to insurance fee,’ at 43.0%, No. 2 was ‘pricing by volume`` at 26.0%. More than 98% of respondents answered that systematic development of insurance fees for enteral nutrition according to type of hospital and management was needed. Conclusion: Development of various products and multiple team activities through the Nutrition Support Team are needed for the efficient supply of enteral nutrition. In addition, the revision of cost reimbursement for health insurance by understanding the current status, suggesting an appropriate level of enteral nutrition supply at a government level and providing systematic procedures, including continuous evaluation tools and management, are urgently needed. (J Korean Soc Parenter Enter Nutr 2013;5(3):122-129)

맞춤형 영양교육이 철결핍성 빈혈환자의 임상 지표 및 영양섭취 상태에 미치는 효과

김혜진 ( Hye Jin Kim ),목희정 ( Hee Jung Mok ),홍정임 ( Jeong Im Hong ),남궁신아 ( Sin A Namgung ) 대한영양사협회 2012 대한영양사협회 학술지 Vol.18 No.1

This study examined the effects of custom nutrition education on dietary intakes and clinical parameters in patients diagnosed with iron deficiency anemia. A total of 34 patients visited the anemia clinic of Yeouido St. Mary``s Hospital. Among these, only 16 patients were available for follow-ups. A follow-up was conducted by a clinical dietitian 2 months from the first nutrition education session. Patients were all women. For custom nutrition education, we investigated anthropometric data, dietary assessment (24 hr-recall, FFQ), and self-recognized anemic symptoms. Weight did not show a significant difference but hemoglobin, hematocrit (P <0.01), serum iron, and serum ferritin (P<0.05) were significantly increased after the nutrition education. Serum total iron binding capacity was significantly decreased (P<0.01). Self-recognized symptoms such as dizziness, fatigue (P<0.001), shortness of breath, headache (P<0.01), brittle nails, and sore tongue (P<0.05) were significantly improved. Daily intakes of protein (P<0.05), total iron (P<0.01), and animal iron (P <0.001) were significantly increased. A significantly negative correlation was observed between current serum iron and the intake of carbohydrates, fat, or phosphorus (P<0.05). But current serum ferritin showed a significantly positive correlation with the frequency of intake of meat, poultry, and fish. It could be concluded that the custom nutrition education might be effective on quality of diet as well as iron status and it might also improve the clinical parameters in patients diagnosed with the iron deficiency anemia.

고도비만 환자의 수술적 치료방법에 따른 영양교육 기준 설정에 관한 연구

김혜진 ( Hye Jin Kim ),남궁신아 ( Sin A Nam Gung ),홍정임 ( Jeong Im Hong ),목희정 ( Hee Jung Mok ) 대한영양사협회 2010 대한영양사협회 학술지 Vol.16 No.2

This study examined the effects of postoperative medical nutrition therapy on patients who had undergone bariatric surgery. Eighty seven patients who underwent bariatic-surgery at Yeouido St. Mary`s Hospital from January 2007 to April 2009 were evaluated. The bariatric surgery patients included 42 Laparoscopic Roux-en Y gastric bypass (LRYGB) and 45 Laparoscopic adjustable gastric banding (LAGB) patients. Weight loss was more significant after LRYGB than after LAGB after 9 months (p<0.05). The LRYGB group was more satisfied with the weight loss (LRYGB 4.4/5.0, LAGB 3.0/5.0 p<0.001). The mean albumin, hemoglobin and hematocrit levels were significantly lower in the LRYGB group than in the LAGB group at the time of discharge (p<0.05∼0.001). The GOT/GPT was significantly higher in the LRYGB group at the time of the operation than the LAGB group (p<0.01). The LRYGB group showed significantly lower intakes of total energy, carbohydrates, protein and fat from 1 week after surgery than the LAGB group. Multiple regression showed that the weight change after LRYGB was significantly more associated with the intakes of total energy at 1 week after surgery (p<0.01), SWS (sweets and high-calorie beverages) at 1 and 6 months after surgery (p<0.001), and fat at 3 months after surgery (p<0.01). In addition, LAGB was significantly more associated with the intakes of protein and NLS (non-liquid sweets) at 1 week after surgery (p<0.001, p< 0.01), carbohydrate at 1 months after surgery (p<0.01), total energy at 3 months after surgery (p<0.001), HCL (high-calorie liquids) at 6 months after surgery (p<0.05), and fat at 9 months after surgery (p<0.01). These results suggest that continuous-follow-up medical nutrition therapy is needed according to the types of bariatric surgery, particularly during the weight loss phase (the first 1 week to 12 months).

Clomiphene Citrate와 FSH 또는 Clomiphene Citrate와 hMG의 연속병합에 의한 배란유도주기에서 인공수정 후 임신율의 비교

정구성,홍기언,유승환,이현숙,이종인,허영문,전은숙,윤정임,홍정의,이지삼,Jung, Goo-Sung,Hong, Ki-Eon,You, Seung-Hwan,Lee, Hyeon-Sook,Lee, Jong-In,Hur, Young-Mun,Jeon, Eun-Suk,Yoon, Jeong-Im,Hong, Jeong-Eui,Lee, Ji-Sam 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.3

Objective: To evaluate the effectiveness of CC+FSH or CC+hMG in intrauterine insemination (IUI) cycles for the treatment of infertility. Method: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days followed by hMG or FSH. A single IUI was performed at 36 h after hCG. Clinical pregnancy was classified if a gestational sac or fetal cardiac activity was seen on ultrasound. Results: The overall clinical pregnancy rate was 19.1% per cycle (17/89) and 21.5% per patient (17/79). More clinical pregnancies were recorded in CC+FSH (23.1%, 6/26) than CC+ hMG cycles (17.5%, 11/63), but this difference was not statistically significant. No differences were found in age, duration of infertility, follicle size, levels of estradiol ($E_2$) on the day of hCG injection and total motile sperm counts between pregnant and non-pregnant groups. However, more ampules of gonadotropins were used in pregnant group than non-pregnant group (p<0.05). Conclusion: Combination of CC and hMG may economically be more effective to induce ovulation for IUI compared to CC and FSH.

인공수정시술주기에서 내인성 LH, GnRH Agonist 및 hCG를 이용한 배란유발후 임신율의 비교연구

이종인,허영문,전은숙,윤정임,정구성,홍기언,유승환,이현숙,홍정의,이지삼,Lee, Jong-In,Hur, Young-Mun,Jeon, Eun-Suk,Yoon, Jeong-Im,Jung, Goo-Sung,Hong, Ki-Eon,You, Seung-Hwan,Lee, Hyeon-Sook,Hong, Jeong-Eui,Lee, Ji-Sam 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.3

Objective: This study was designed to evaluate the effects of endogenous LH surge, GnRH agonist (GnRH-a) or human chorionic gonadotropin (hCG) as ovulation trigger on pregnancy rate by intrauterine insemination (IUI). Method: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days starting on the third day of the menstrual cycle followed by human menopausal gonadotropin (hMG) for ovulation induction. Follicles larger than >16 mm in diameter were present in the ovary, frequent LH tests in urine were introduced to detect an endogenous LH surge. Final follicular maturation and ovulation were induced by GnRH-a 0.1 mg (s.c.) or hCG $5,000{\sim}10,000$ IU (i.m.) administration except natural ovulation. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. Results: There were no differences in age, duration of infertility and follicle size, but more ampules of hMG were used in GnRH-a group compared to hCG 10,000 IU treated group (p<0.05). Lower level of estradiol ($E_2$) on the day of hCG or GnRH-a injection was observed in hCG 10,000 IU group than other treatment groups (p<0.01). The overall clinical pregnancy rate was 19.8% per cycle (32/162) and 22.2% per patient (32/144). Pregnancy rate was higher in natural-endogenous LH surge group (37.5%, 9/24) than GnRH-a (18.8%) or hCG treated group (20.9% & 13.9%), but this difference was not statistically significant. No patient developed ovarian hyperstimulation. Abortion rate was 22.2% (2/9) in hCG 5,000 IU group. Delivery or ongoing pregnancy rate was 37.5% (9/24), 18.8% (3/16), 16.3% (7/43) and 13.9% (11/79) in endogenous LH surge, GnRH-a, hCG 5,000 IU and hCG 10,000 IU treatment groups, respectively. Conclusion: These results support the concept that use of natural-endogenous LH surge in stimulated cycles may be more effective to obtain pregnancies by IUI than GnRH-a or hCG administration.

제2형 당뇨비만환자의 수술요법 시 임상영양치료 프로토콜 설정

김혜진 ( Hye Jin Kim ),남궁신아 ( Sin A Namgung ),홍정임 ( Jeong Im Hong ),목희정 ( Hee Jung Mok ) 대한영양사협회 2011 대한영양사협회 학술지 Vol.17 No.2

Currently, metabolic surgery (Laparoscopic Roux-en-Y gastric bypass, LRYGB) has an important role and should be recommended as an intervention in the management of obese patients with type 2 diabetes mellitus (T2DM). A successful outcome of surgery requires medical nutrition therapy. Therefore, we performed a retrospective study on 25 patients with T2DM who underwent LRYGB at Yeouido St. Mary`s Hospital from October 2008 to May 2010. The patients were followed up for an average of 6 months after surgery (range: 2∼19 months). Diabetes was resolved in 80% of the patients. Percentage of excess weight loss was (%EWL) was 56.2%. After surgery, fasting blood sugar (FBS) and HbA1c were significantly reduced (123 mg/dl, A1c 6.7%, P<0.001) and triglyceride was also significantly reduced to 107.6 mg/dl (P<0.05). As diets of the patients progressed from liquid to soft to regular diet, energy, carbohydrates, and fat intakes increased significantly (P<0.001). But protein intake did not change significantly. Nutrient intake of the patients after the surgery was significantly lower than the recommended diet for the non-surgery group. Patients experienced side-effects related to the diets after surgery, including hair-loss (76%), smelly gas (52%), vomiting (48%), etc. A significantly positive correlation was observed between vomiting and FBS (P<0.001). There was a significant relationship between side effects and the amount of nutrient intakes. Therefore, guide patients to a diet progression with treatment to minimize side effects, especially vomiting. And monitor their dietary life to be healthy and not to regain weight until remission of T2DM.

조혈모세포이식 시 조기생착에 영향을 주는 요인 분석 -경구섭취 저해인자 및 영양지원 시기를 중심으로-

김혜진 ( Hye Jin Kim ),노민영 ( Min Young Noh ),정명지 ( Myeong Ji Jung ),홍정임 ( Jeong Im Hong ),정연선 ( Yeon Sun Jung ) 대한영양사협회 2009 대한영양사협회 학술지 Vol.15 No.2

Hematopoietic stem cell transplantation is being widely used in an attempt to treat many hematological diseases such as leukemia, anemia, and lymphoma. To evaluate the success of hematopoietic stem cell transplantation, it is very important to determine how rapidly engraftment occurs. Therefore, this retrospective study was conducted to determine which factors affected the term of engraftment during hematopoietic stem cell transplantation, while focusing on the oral intake status. To accomplish this, 416 patients who underwent transplant operations at St. Mary`s hospital from May 2006 to April 2008 were evaluated. The long-term engraftment group was characterized as having longer fasting days and more frequent vomiting, diarrhea, and oral mucositis incidences than the short-term engraftment group. In addition, the inhibitors of oral intake such as vomiting, diarrhea, and oral mucositis developed frequently between the pre-transplantation and 2 weeks after transplantation. A significantly negative correlation was observed between the oral intake volume and the duration of the oral intake inhibitors. A multiple regression analysis revealed that the frequency of vomiting and oral mucositis during hematopoietic stem cell transplantation, the length of hospitalization, and the hematocrit level in the 2 weeks after hematopoietic stem cell transplantation were significant predictors of engraftment. The results of this study could be used to establish a guideline for nutritional assessment, nutritional goals, and nutritional support for patients during hematopoietic stem cell transplantation.

영양지원팀의 임상적 적용 방법

김은영 ( Eun Young Kim ),김주미 ( Ju Mee Kim ),김미형 ( Mi Hyung Kim ),권택수 ( Taek Su Kwon ),이혜승 ( Hye Seung Lee ),목희정 ( Hee Jung Mok ),홍정임 ( Jeong Im Hong ),김혜진 ( Hye Jin Kim ),김현경 ( Hyun Kyung Kim ),정성진 ( Sun 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Purpose: Most hospitals have been reply to the consultation if the needed departments consult with the Nutritional Support Team (NST) for patient evaluation and management. However, as a common occurrence, some people requiring treatment cannot receive care due to lack of cognition of nutritional support and lack of resources for assessment of nutritional status. Methods: We provide an indication for screening of patients and for active nutritional support. Indications include symptoms that reflect the conditions of increasing nutritional requirement and decreasing nutritional supply. Two surgical wards and surgical intensive care unit were included and nursing teams recommended patients to the NST by interviewing inpatients if they met the indications. Results: We included 60 patients referred to the NST before applying for screening, from January 2005 to January 2009 and 44 patients selected for only five months by the NST after applying for screening. The number of consultations showed a slow decrease, 27 in 2005, 23 in 2006 to 10 in 2007, before applying for screening, but increased significantly to 44 for only five months after applying for screening. While the number of departments applying to the NST was five departments in 2005, six departments in 2006, and two departments in 2007, it increased significantly to eight departments. After applying for screening, the most common cause was ‘artificial nutrition longer than five days’ in 48.1%; the second cause was ‘poor nutrition status’ in 13.5%, and the third was ‘significant weight loss’ or ‘gastrointestinal function change’ in 8%. Moderate risk patients showed improvement and shifted to minor risk patients and normal patients. The rate of improvement was approximately 47.7%. Conclusion: The screening tools should be simple, as well as easy to use. Therefore, using this tool, we must actively select patients with poor nutrition and apply the screening tools rapidly. (J Korean Soc Parenter Enter Nutr 2013;5(3):117-121)