导管护理标准化程序的建立及临床应用

目的提升导管护理质量,减少意外拔管,保证患者安全。方法导管小组在对全院各病区带有导管的患者进行横断面调研的基础上,制定29种导管的临床护理操作规范,并完善导管各种规章制度及交接流程、制定转运过程中导管的处理原则。结果导管标准化程序建立后,各种导管非计划拔管发生数由2012年的35例次降至2013年的16例次。2013年导管固定规范率、标识规范使用率,护理人员对意外拔管紧急处理掌握合格率,首次置管护理文件书写记录合格率,患者对导管自护知识知晓合格率显著高于2012年(P0.05,P0.01)。结论导管标准化程序的建立提高了临床护理人员导管护理规范性,提升护理人员护理各种导管的能力和业务水平,减少意外拔管的发生,保证了患者管道护理安全。     

网格化管理联合标准作业程序在导管安全管理中的应用

目的 探讨网格化管理联合标准作业程序在导管固定及质量管理中的应用效果.方法 成立导管固定质控管理小组,制定导管固定标准作业程序,并将全院五大科室38个护理单元设置为网格单元实施培训及网格化管理.结果 2017～2020年全院非计划性拔管率逐年下降;全院五大科室2018～2020年导管质控检查得分显著高于2017年(均P<0.05);因固定不牢致非计划拔管的构成比逐年下降(P<0.01).结论 网格化管理联合导管固定标准作业程序的应用,实现了全院各网格单元导管同质化、规范化的固定及质控管理,降低了非计划性拔管的发生,提高了临床导管管理质量.     

基于单元的综合安全项目对手术室护士髋关节假体产品应用安全的影响

目的 探讨基于单元的综合安全项目的实施对手术室护士人工全髋关节置换术中髋关节假体产品应用安全的影响。方法 将骨科手术间的49名手术室护士按照区域分为对照组24名,试验组25名。对照组实施常规安全管理模式,试验组实施基于单元的综合安全项目对护士髋关节假体产品应用进行安全管理,3个月后对两组护士髋关节假体产品应用知识水平及安全态度得分进行评价,选取两区域各320例患者比较髋关节假体产品应用实际错误/堵漏事件发生率。结果 试验组护士髋关节假体产品应用知识测评成绩与安全态度得分显著高于对照组(均P<0.05),应用髋关节假体产品实际错误/堵漏事件发生率显著低于对照组(P<0.05)。结论 基于单元的综合安全项目的应用能够促进单元内安全文化的建立,提高单元内护士髋关节假体产品应用安全水平。     

三位一体患者安全管理项目的构建与实施

目的 探索患者安全管理新模式，保障患者安全。 方法 构建并实施三位一体患者安全管理项目，采用医院患者安全文化调查表、护理不良事件、护理敏感指标发生情况评价效果。 结果 实施患者安全管理项目后，护士的医院患者安全文化除外组织学习与持续改进、人员配置2个维度，另10个维度得分均呈显著上升（P＜0.05，P＜0.01）；护理不良事件、3项敏感指标发生率从2016年始逐年下降；全院各病区开展综合性安全管理项目28项，安全相关品管圈活动51项，发表安全管理论文45篇。 结论 构建并实施三位一体患者安全管理项目可有效提高护理人员患者安全文化认知水平，降低不良事件发生率，保障患者安全。     

肿瘤患者中心静脉通路装置居家护理平台的研发及应用

目的 研发肿瘤患者中心静脉通路装置居家护理平台微信小程序,并探讨其应用于居家携中心静脉通路装置肿瘤患者的效果。 方法 将677例携中心静脉通路装置肿瘤居家患者随机分为对照组339例和干预组338例,对照组实施常规护理,干预组利用基于微信小程序研发的肿瘤患者中心静脉通路装置居家护理平台进行随访干预。于患者出院后3个月进行效果评价。 结果 干预组自我管理能力、患者满意度显著高于对照组,导管相关性血流感染等并发症、非计划拔管发生率显著低于对照组（P＜0.05,P＜0.01）。 结论 应用肿瘤患者中心静脉通路装置居家护理平台可提高患者的自我管理能力,预防和减少导管相关并发症及非计划拔管的发生,提高患者满意度。     

导道滑脱风险跟踪评估监控流程的设计及应用

目的规范预防导管滑脱管理,降低非计划拔管发生率。方法制定导管滑脱风险评估监控表和导管滑脱风险跟踪评估监控流程,将导管滑脱风险评估监控表和跟踪评估监控流程应用于临床并进行动态管理。结果实施后高危拔管患者非计划拔管发生率显著低于实施前(P0.05)。结论实施导管滑脱风险跟踪评估监控流程,能降低非计划拔管发生率。     

前馈控制降低ICU气管插管患者非计划性拔管

目的探讨前馈控制降低ICU气管插管患者非计划性拔管的效果。方法对ICU气管插管患者,实施前馈控制干预方案,主要包含成立ICU气管插管患者非计划性拔管的前馈控制管理监督委员会、建立严格的气管插管非计划性拔管风险评估模式(基于SBAR沟通程序的导管交接班流程)、转变护理人员对气管插管非计划性拔管风险管理的理念、加强各能级护理人员相关护理知识及应急技能的培训。结果实施前馈控制后ICU气管插管非计划性拔管发生率由实施前的1.66%降到0.58%;护理人员非计划性拔管相关知识认知、评估技巧(工具)方面及护理对策方面的得分显著高于实施前(均P0.01)。结论前馈控制用于ICU气管插管非计划性拔管管理,能够有效降低气管插管非计划性拔管的发生率,提高ICU医疗护理质量,保障住院患者的医疗护理安全。     

气管插管患者非计划性拔管的预见性护理

目的探讨气管插管非计划性拔管的管理方法。方法将120例神经外科气管插管患者随机分为干预组和对照组,干预组选择有效的固定方法,建立管道标示及评估记录要求,正确书写护理诊断,规范护理操作等预见性的护理措施,对照组按常规进行护理。比较2组非计划性拔管的发生率。结果干预组和对照组非计划性拔管的发生比较,干预组比对照组明显减少,差异有统计学意义(P﹤0.05)。结论通过实施预见性护理措施,气管插管患者非计划性拔管的发生率明显降低,有力保障了导管护理安全。     

老年住院患者管道风险预控体系的构建及应用

目的构建科学的管道护理体系,提高住院患者安全。方法基于风险预控原理,采用访谈法及客观资料收集法收集资料,构建住院患者管道风险预控体系,建立有价值的风险评估指标,制定基于扎根理论的住院患者管道安全风险评估表和住院患者管道安全风险护理措施记录表,应用于40例老年患者(观察组),并与40例(对照组)进行对照。结果观察组老年带管患者的非计划拔管率显著低于对照组,其满意度显著高于对照组(P0.05,P0.01)。结论住院患者管道风险预控体系的构建,提高了临床护理人员管道安全意识,能够降低住院患者导管相关不良事件的发生,提高住院患者住院期间的管道安全。     

病区备用药品的安全管理

目的对病区备用药品进行有效的安全管理,堵塞药品管理漏洞,防范用药错误发生,保证患者用药安全。方法健全病区备用药品管理制度;加强药品安全管理知识培训;标识醒目并分类管理病区备用药品等。结果病区药品管理不良事件发生率较实施前显著下降（P〈0.05,P〈0.01）。结论加强病区备用药品的安全管理,能提升病区药品管理水平,降低药品不安全隐患,保障患者用药安全。     

Ultrasound guided vascular access: efficacy and safety

In the United Kingdom and United States, US guidance for internal jugular central venous catheterisation is recommended. Despite reluctance to adopt these guidelines, there is sufficient evidence to support routine use, as even proceduralists skilled in landmark techniques commonly encounter complications. Serious morbidity and mortality may result, which arguably is avoidable, if ultrasonography was used. Real-time 2D US demonstrates patient anatomy and anatomical variability in a manner not previously possible for anaesthetists. Unencumbered by reliance on surface landmarks, the needle path and tip can be visually directed into the target vessel lumen. This potent ability improves successful cannulation and first-attempt success, reduces the number of needle attempts and decreases mechanical complications associated with vascular access procedures.

Conflict of interest

AC has received honoraria from SonoSite and AstraZeneca as a workshop tutor for teaching ultrasound-guided procedures.     

整形美容与麻醉安全

医学整形美容行业在我国已经相当流行,然而,近年来我国连续发生了多起涉及美容麻醉医疗安全的事件,其主要原因是美容行业忽视了麻醉安全问题,为此,笔者从麻醉学的角度就＂整形美容与麻醉安全＂这一问题作一初步分析及讨论。     

Parallels in safety between aviation and healthcare

Aviation and healthcare are complex industries and share many similarities: the cockpit and the operating theater, the captain and the surgeon. While North American commercial aviation currently enjoys a tremendous safety record, it was not always this way. A spike of accidents in 1973 caused 3214 aviation-related fatalities. Over the past 20 years, the rate of fatal accidents per million flights fell by a factor of five, while air traffic increased by more than 86%. There have been no fatalities on a U.S. carrier for over 12 years. Last year, there were 251,454 deaths in the United States owing to medical error. Pilots pioneered ways to address risks through crew resource management (CRM), and threat and error management (TEM). Both strategies, which are aimed at minimizing risk and optimizing safety, are applicable to surgery and the healthcare industry. These strategies as well as the Swiss Cheese Model, Checklists and the Normalization of Deviance will be reviewed in this article.     

Laser safety

Safety has always been an important aspect of any laser application in surgery and medicine. In any review of the laser surgery literature, several issues continue to dominate. These issues include: wearing eye protectors, dealing with the plume of vaporized tissue, and controlling potential fire hazards. No one denies that lasers can pose a serious hazard to the eye, but the decision to wear eye protectors in all procedures has been frequently questioned. The degree of effort needed to minimize the very serious risk from chronic breathing of vaporized tissue also requires judgment. Aside from a few eye injuries from a laser beam exposure, most serious accidental injuries (and even deaths) reported to date from the laser beam itself can be traced to the ignition of surgical drapes and airway tubes. © 1995 Wiley-Liss, Inc.     

Enhancing surgical safety using digital multimedia technology

Background

The purpose of this study was to examine whether incorporating digital and video multimedia components improved surgical time-out performance of a surgical safety checklist.

Methods

A prospective pilot study was designed for implementation of a multimedia time-out, including a patient video. Perceptions of the staff participants were surveyed before and after intervention (Likert scale: 1, strongly disagree to 5, strongly agree).

Results

Employee satisfaction was high for both time-out procedures. However, employees appreciated improved clarity of patient identification (P < .05) and operative laterality (P < .05) with the digital method. About 87% of the respondents preferred the digital version to the standard time-out (75% anesthesia, 89% surgeons, 93% nursing). Although the duration of time-outs increased (49 and 79 seconds for standard and digital time-outs, respectively, P > .001), there was significant improvement in performance of key safety elements.

Conclusion

The multimedia time-out allows improved participation by the surgical team and is preferred to a standard time-out process.     

安全训练观察程序在实习护生行为安全管理中的应用

目的探讨实习护生行为安全管理方法,以提高临床实践中的识险避险能力。方法按实习时间将2011年7月至2013年4月的实习护生587名作为对照组,采用传统教学法;2013年7月至2015年4月的实习护生533名作为实验组,在常规教学基础上实施安全训练观察程序。结果实验组不良事件发生率及锐器伤发生率显著低于对照组(均P0.01),手卫生认知、手卫生依从性率及技术操作规范合格率显著高于对照组(均P0.01)。结论将安全训练观察程序应用于护生临床实践环节中,有助于规范实习护生安全行为和技术操作,提高临床教学质量。     

Campaigning for safety

There are four challenges to practicing evidence-based medicine: obtaining the evidence; evaluating the evidence; promulgating the evidence; and persuading practitioners to adopt the evidence and practice according to the evidence. The Perfusion Down Under (PDU) Collaboration addresses the first three. The fourth is more difficult, and it typically takes many years for new evidence to be adopted into widespread practice. In the case of innovations related to patient safety, evidence from randomized controlled trials is often very expensive to obtain. Other methods of evaluation may be more appropriate, but these do need to be robust and to take account of the constructs underlying the innovations and the context in which they are to be implemented. In the United States, The Institute for Healthcare Improvement (IHI) aims (among other things) to promote the adoption of best practices and effective innovations. The IHI has articulated a useful framework for doing this. Measurement is fundamental to quality improvement, and sustainable change is likely to be more readily achieved if claims are supported by credible, measurable, and clinically relevant outcome data. The PDU is well placed to support quality improvement in perfusion by providing such data.     

British Association of Urological Surgeons' suprapubic catheter practice guidelines

What’s known on the subject? and What does the study add? The suprapubic catheter (SPC) is a useful and widely used tool in urological practice. However, complications can arise from its insertion or ongoing care. Currently there are no guidelines relating to SPC usage. This study has reviewed the available clinical evidence relating to SPC usage. Where this is lacking, expert opinion has been sought. Guidelines are suggested to help maximise safety and ensure best practice in relation to SPC usage.

OBJECTIVE

To report the British Association of Urological Surgeons’ guidelines on the indications for, safe insertion of, and subsequent care for suprapubic catheters.

METHODS

A comprehensive literature search was conducted to identify the evidence base. This was reviewed by a guideline development group (GDG), who then drew up the recommendations. Where there was no supporting evidence expert opinion of the GDG and a wider body of consultees was used.

RESULTS

Suprapubic catheterisation is widely used, and generally considered a safe procedure. There is however a small risk of serious complications. Whilst the evidence base is small, the GDG has produced a consensus statement on SPC use with the aim of minimising risks and establishing best practice ( Table 1 ). It should be of relevance to all those involved in the insertion and care of suprapubic catheters. Given the paucity of evidence, areas for future research and development are also highlighted. This review has been commissioned and approved by BAUS and the Section of Female, Neurological and Urodynamic Urology.

Table 1. Summary of recommendations for suprapubic catheters (SPCs) practice