广东省不同等级医院用药错误及管理现状的调查

目的调查广东省不同等级医院用药错误及管理现状,为制定用药错误的护理质量改善指引提供依据。方法采用便利抽样方法随机抽取广东省一、二、三级医院共66所,采用自行设计的"广东省不同等级医院用药错误发生现状调查表"对各医院护理部进行问卷调查。结果各等级医院共上报用药错误494例,护理不良事件4 048例,用药错误占护理不良事件的12.20%;一、二、三级医院护理不良事件及用药错误发生率比较,差异有统计学意义(均P0.01);各等级医院使用条形码识别腕带、电子化医嘱系统、口服药分包系统及药物中心配置方面比较,差异有统计学意义(P0.05、P0.01)。用药错误类型排名前3位的分别是患者错误(24.57%)、药物错误(21.88%)、剂量错误(12.48%)。结论广东省各级医院应建立良性用药安全文化,提高医院自动化和信息化程度,从系统和个人的角度采取减少用药错误的措施;建立完善的用药错误监测和报告系统,制定用药安全质量改进指引,保障患者用药安全。     

眼科护理工作中常见护理差错发生原因及防范措施

在临床护理工作中,护理差错时有发生.它不仅造成病人的身心痛苦,给病人带来额外的经济负担,而且直接影响了护理质量.因此,如何避免和防范护理差错的发生,是我们临床护理人员应予高度重视的问题.现讨论如下: 1常见护理差错发生的原因 1.1未严格执行三查七对制度:最常见的是临床护士在用药期间,未执行"三查"、"七对"制度,而造成差错的发生.     

基于SRK模型的护理人为差错类型分析及管理对策

目的了解护理人为差错的特点及其与不良事件的关系,为减少护理不良事件、保证患者安全提供依据。方法从某三级甲等医院的护士不良事件上报系统收集护理不良事件,根据SRK模型进行人为差错分类。结果共收集护理不良事件806起,其中护理人为差错占74.32%,非人为差错占25.68%;在护理人为差错中,规则型错误所占比例最高(58.43%),其次为技能型疏忽和技能型遗忘(分别为22.37%和11.69%),知识型错误和规则型疏忽占比较少(分别为7.18%和0.33%);不同类型护理人为差错导致的不良事件严重程度比较,差异有统计学意义(P<0.01);知识型错误、规则型错误导致的不良事件严重程度显著高于技能型遗忘和技能型疏忽(均P<0.01)。结论护理人为差错是导致护理不良事件的主要因素,知识型及规则型人为差错引起的护理不良事件后果较严重,需要从组织层面和个人层面防范护理人为差错的发生。     

SHEL模式在急诊静脉用药护理安全管理中的应用

目的 探讨SHEL模式在急诊静脉用药护理安全管理中的应用效果,确保患者用药安全.方法 应用SHEL模式对以往发生的用药护理差错的相关因素进行分析,然后有针对性制订加强安全用药护理管理措施,包括提高护理人员的业务素质.改造工作环境和工作流程,加强管理及时消除安全隐患等.结果 SHEL模式实施后用药护理差错发生率显著降低,护士安全用药知识得分中总分及三查七对的内容和方法等4个条目得分显著提高.护士安全用药行为合格率显著提高(P＜0.05,P＜0.01).结论 应用SHEL模式分析与护士用药有关的差错事故发生原因,制订有针对性的安全用药护理管理措施,可完善护士与用药相关的知识结构,规范护士安全用药行为,降低差错发生率,从而提高护理质量.     

瞒报差错事故护士心理因素分析及管理对策

对23名发生过护理差错事故却被动发现的23名护士进行相关心理因素调查.结果 瞒报护理差错事故的原因:害怕受处分(56.5%)、侥幸心理(47.8%)、惧怕高额赔付(34.8%)和对差错处理方式的恐惧(30.4%).提出瞒报护理差错事故对医疗安全带来极其不利的影响,应从形成非惩罚性护理管理文化氛围、重视系统间的分析和改进、完善差错上报制度和建立有效的医疗责任分担机制等方面改变这一现状.     

SHEL模式在急诊静脉用药护理安全管理中的应用

目的探讨SHEL模式在急诊静脉用药护理安全管理中的应用效果，确保患者用药安全。方法应用SHEL模式对以往发生的用药护理差错的相关因素进行分析，然后有针对性制订加强安全用药护理管理措施，包括提高护理人员的业务素质，改造工作环境和工作流程，加强管理及时消除安全隐患等。结果SHEL模式实施后用药护理差错发生率显著降低，护士安全用药知识得分中总分及三查七对的内容和方法等4个条目得分显著提高，护士安全用药行为合格率显著提高（P〈0．05．P〈0．01）。结论应用SHEL模式分析与护士用药有关的差错事故发生原因，制订有针对性的安全用药护理管理措施，可完善护士与用药相关的知识结构，规范护士安全用药行为，降低差错发生率，从而提高护理质量。     

广西老年肾活检患者临床与病理分析

目的分析广西老年肾活检患者常见的临床和病理类型。 方法本研究纳入了2012年8月至2015年8月在广西医科大学第一附属医院进行肾活检的373例老年患者(年龄≥60岁),收集患者的性别、年龄、民族、临床诊断、肾脏病理诊断等资料,应用SPSS13.0软件回顾性分析了老年肾活检患者的疾病谱分布特点,采用频数和百分比对分类变量进行统计描述。 结果老年肾活检患者最常见的临床综合征是肾病综合征(NS,50.1%),其次是急性肾损伤(AKI,28.7%)和慢性肾炎综合征(15.5%)。在老年肾活检患者中,原发性肾小球疾病占67.8%,继发性肾小球疾病占26.8%。在原发性肾小球疾病中,最常见的病理类型是特发性膜性肾病(IMN,71.9%),其次是微小病变(MCD,9.9%)和局灶节段肾小球硬化症(FSGS,7.9%)。在继发性肾小球疾病中,最常见的是抗中性粒细胞浆抗体(ANCA)相关性血管炎(AAV,31.0%),其次是狼疮肾炎(20.0%)和糖尿病肾病(12%)。老年人NS最常见的病理类型是IMN(75.4%),其次是MCD和FSGS,各占5.3%。老年AKI患者肾活检最常见的病理类型是IMN(26.2%),其次为AAV(24.3%) 。 结论NS是广西老年肾活检患者最常见的临床综合征,IMN是老年人NS和原发性肾小球疾病最常见的病理类型;AAV是继发性肾小球疾病最常见的原因。IMN和AAV分别为老年AKI患者肾活检常见的原发性与继发性病理类型,即该人群发生AKI的主要原因为IMN及AAV。     

预防手术室护理缺陷的对策

<正> 手术是通过侵入性操作为患者解除病痛的治疗手段,手术中发生护理缺陷,轻则给患者带来痛苦,重则可使患者伤残,甚至死亡。故防止上述护理缺陷是保证手术安全的基本要素之一。本文结合我院手术室近年来的经验,对常见护理缺除产生的原因进行分析,以期探计预防的对策。 1 临床资料 我院自1995年7月至2000年7月共进行各类手术5300例,发生护理差错13起,发生率0.25％。 常见护理差错如下:①手品清点不清;②手术器具准备不全;③手术体位不当;④输错液;⑤其它(如患者标本丢失,患者坠床,摔伤,电刀、电凝器使用不当造成灼伤,接错引流瓶等)。 2 讨论 2.1 造成手术室护理缺陷的原因     

护生临床用药安全意识调查及对策

目的了解护生临床用药安全意识情况,为培养护生临床用药安全意识提供参考。方法采用自行设计的问卷对200名护生进行临床用药安全意识调查。结果 60%护生不熟悉《药品管理法》等法律文件,对患者用药时提出的各种疑问能够及时的给予解释者占17.0%,观察患者用药后情况和反应者占28.0%;仅5.0%护生了解新药、特殊药物;50.0%以上的护生未掌握药物的适应证、禁忌证,药物的协同、拮抗作用,药物的通用名、化学名;15.0%不能够做好用药操作前准备工作,49.9%不能遵医嘱用药剂量迅速配制药物。结论护生临床用药安全意识较差,其法律意识不强,药理知识缺乏,用药操作技能方面不熟练。需加强护生的临床用药安全意识教育,以维护患者用药安全。     

护理用药安全手册的制定及应用

目的 加强对临床药品的安全管理,确保患者用药安全.方法 成立用药安全管理组织,针对2011年医院41个护理单元上报用药不良事件及开展的用药安全专项检查存在的问题进行原因分析,确定护理用药安全手册制定的内容及人员分工和职责;用药安全手册内容包括各种用药安全管理组织及制度,收集临床多品多规、看似听似药品并拍成图片进行比对,将临床特殊用药药理知识以表格形式罗列;规范使用药物流程、组织培训与考核等.结果 手册应用后,护士对备用药品管理规范、高危药品管理制度、专科用药知识、药品不良反应上报流程及紧急处理知晓率显著提高(均P＜0.01),临床用药不良事件发生数下降.结论 该手册为护士临床用药安全提供了参照资料,起到临床用药指引作用,可有效提高护理人员用药安全管理能力及自身业务水平,降低工作危机及用药风险,减少用药不良事件,保障患者用药及生命安全.     

门诊患者的药物素养现状调查

目的对门诊患者的药物素养进行调查,分析影响药物素养的因素。方法抽取446例在长沙市6所医院门诊就诊患者,采用中文版药物素养评估量表进行问卷调查。结果门诊患者药物素养得分7.49±3.47,12.1%药物素养差,57.4%中等,30.5%好。不同性别、年龄、职业、文化程度、婚姻状况、月平均收入、疾病总数、服药数量的门诊患者的药物素养得分比较,差异有统计学意义(均P0.01)。多元逐步回归分析显示,年龄、文化程度、婚姻状况、职业是影响门诊非住院患者药物素养水平的主要因素(R~2=0.446)。结论门诊患者的药物素养处于中等水平,其中高龄、低文化程度、非在职及无配偶患者药物素养相对较差,应采取针对性措施提高该类人群的药物素养水平,促进安全用药。     

Outcomes of a Failure Mode and Effects Analysis for medication errors in pediatric anesthesia

The Institute of Medicine has called for development of strategies to prevent medication errors, which are one important cause of preventable harm. Although the field of anesthesiology is considered a leader in patient safety, recent data suggest high medication error rates in anesthesia practice. Unfortunately, few error prevention strategies for anesthesia providers have been implemented. Using Toyota Production System quality improvement methodology, a multidisciplinary team observed 133 h of medication practice in the operating room at a tertiary care freestanding children's hospital. A failure mode and effects analysis was conducted to systematically deconstruct and evaluate each medication handling process step and score possible failure modes to quantify areas of risk. A bundle of five targeted countermeasures were identified and implemented over 12 months. Improvements in syringe labeling (73 to 96%), standardization of medication organization in the anesthesia workspace (0 to 100%), and two‐provider infusion checks (23 to 59%) were observed. Medication error reporting improved during the project and was subsequently maintained. After intervention, the median medication error rate decreased from 1.56 to 0.95 per 1000 anesthetics. The frequency of medication error harm events reaching the patient also decreased. Systematic evaluation and standardization of medication handling processes by anesthesia providers in the operating room can decrease medication errors and improve patient safety.     

社区老年人用药安全认知、态度及自我效能调查分析

目的对社区老年人用药安全认知、态度及自我效能进行现况调查,为制定社区老年人用药安全健康教育干预提供参考。方法采用方便抽样,对泰安市某小区216名老年人实施问卷调查。结果调查对象用药安全认知、态度及自我效能得分率分别为56.00%、62.51%、61.91%。年龄、文化程度、参与用药安全讲座是老年人用药安全认知、态度及自我效能的影响因素(均P0.01)。结论社区老年人用药安全认知属于低等水平,用药安全态度及用药安全自我效能属于中等水平。年龄、文化程度、参与用药安全讲座为用药安全认知、态度及自我效能的预测因子,建议在后期制定健康教育干预方案时考虑到不同年龄和文化程度老年人的接受情况,给予针对性的健康教育指导。     

Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients

Russell C, Conn V, Ashbaugh C, Madsen R, Wakefield M, Webb A, Coffey D, Peace L. Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients.
Clin Transplant 2011: 25: 864–870. © 2010 John Wiley & Sons A/S. Abstract: Background: Immunosuppressive medication non‐adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area. Methods: Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non‐adherence using electronic monitoring. Fifteen non‐adherent participants were randomized to receive either a continuous self‐improvement intervention or attention control management. The six‐month continuous self‐improvement intervention involved the participant and clinical nurse specialist collaboratively identifying the person’s life routines, important people, and possible solutions to enhance medication taking. The participant then received individual monthly medication taking feedback delivered via a graphic printout of daily medication taking generated from electronic monitoring. Results: The mean medication adherence score for the continuous self‐improvement intervention group (n = 8) was statistically significantly higher than the attention control group’s (n = 5) mean medication adherence score (p = 0.03). The continuous self‐improvement intervention effect size (Cohen’s d) was large at 1.4. Participants’ perceptions of the intervention were highly favorable. Conclusions: The continuous self‐improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients. A fully‐powered study with a diverse sample is needed to confirm these preliminary findings.     

Medication management in dialysis: Barriers and strategies

People with end-stage kidney disease (ESKD) who require chronic dialysis are often reliant on complicated medication regimens to manage their health conditions. Due to the complexities of the advanced kidney disease, underlying comorbidities, and special instructions, medication regimens for patients on dialysis put patients at high risk for medication therapy problems related to safety, effectiveness, appropriateness, and adherence. This article explores the factors that affect optimal medication use for people on dialysis, including the broader drug use system, and offers recommendations around medication reconciliation, medication review, deprescribing, and considering social determinants of health to improve medication management among patients with ESKD.     

Incidence,characteristics, and predictive factors for medication errors in paediatric anaesthesia: a prospective incident monitoring study

Background

Medication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric hospital, and to identify their characteristics and potential predictive factors.

Medication errors--new approaches to prevention

Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. Errors include those involving the automatic system of cognition and those involving the reflective system. Errors and violations are distinct, but violations often predispose to error. The system of medication administration is complex, and many aspects of it are conducive to error. Evidence-based practices to reduce the risk of medication error in general include those encompassed by the following recommendations: systematic countermeasures should be used to decrease the number of drug administration errors in anesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimized according to agreed standards; syringes should always be labeled; formal organization of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered. Dosage errors are particularly common in pediatric patients. Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system-wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies and of individual practitioners to engage in them.     

Medication safety in pediatric anesthesia: An educational review and a call to action

Children presenting for anesthesia are at high risk for medication error during their care. In this educational review, we address the rates of medication error in pediatric patients undergoing anesthesia, why they are at higher risk than adults, and why reporting chronically underestimates the number of medication errors incurred during the anesthetic care of children. We also introduce the Anesthesia Patient Safety Foundation and Wake Up Safe, two safety organizations that have led the call to decrease medication errors. We discuss various tools to increase medication safety, as championed by Anesthesia Patient Safety Foundation and Wake Up Safe, including human factors research and highlight a few studies that have evaluated and addressed medication safety in the anesthesia environment.     

Medication Errors: An Important Component of Nonadherence to Medication in an Outpatient Population of Lung Transplant Recipients

Data about medication errors in outpatients are limited. Medication errors, defined as discordance between the most recent flow-sheet version, the patient's diary card or the contents of the pill container were assessed systematically after announcement in an outpatient setting of lung transplant recipients by a direct observation approach. A total of 101 patients took a median of 15 (13-17) different drugs and 31 (26-38) pills daily. A total of 2253 doses of drugs were further analyzed. A total of 152 errors were identified resulting in 303 incorrect doses. Lack of keeping a diary card was the only factor significantly associated with a higher rate of incorrect doses (regression coefficient 0.24, p = 0.02). Furthermore, a significant correlation of medication errors with clinical adverse events could be demonstrated. This study shows that medication errors are frequent in a population which has to comply with a complex drug regimen. The need for error control as a basic requirement for drug adherence must be accentuated. Mostly, medication errors seem to occur system-based. Therefore, redundant error control mechanisms and alertness of both the patient and the care-giver should be initiated systematically.     

Impact of clinical pharmacy services on renal transplant patients'' compliance with immunosuppressive medications

BACKGROUND: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-transplant care. This randomized, controlled trial evaluates the impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive agents. METHODS: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the intervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histories and review of patients' medications with an emphasis on optimizing medication therapy to achieve desired outcomes and minimizing adverse medication events. The clinical pharmacist also provided recommendations to the nephrologists with the goal of achieving desired outcomes. To promote medication compliance by using compliance enhancement strategies, the clinical pharmacist counseled patients concerning their medication therapy and instructed them how to properly take their medications. Patients in the control group received the same routine clinic services as the intervention group except that they did not have any clinical pharmacist interaction. Compliance rate (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month, and the mean time patients were compliant were compared between groups. Whether there was a difference in the frequency of patients achieving 'target' immunosuppressive levels in the control and study groups was evaluated. RESULTS: The mean CR for patients who had clinical pharmacist intervention (n=12) was statistically higher than the control group's (n=12) mean CR (p<0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients in the control group (p<0.05). Additionally, patients who had clinical pharmacy services had a greater achievement of 'target' levels than patients who did not receive these services (p<0.05). CONCLUSIONS: Patients who received clinical pharmacy services with traditional patient care services had better compliance with immunosuppressants than patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharmacist as part of the care for post-transplant patients is beneficial for enhancing medication compliance.