糖尿病学组在三甲医院非内分泌专科同质化管理的作用

目的探讨糖尿病学组在三甲医院非内分泌专科同质化管理中的应用效果。方法采取前瞻性非同期对照设计,将2016年9月从全院81个护理单元抽取的79例糖尿病患者作为实施前组,实施常规护理。在护理部组织下成立医院糖尿病学组,从各科室招募81名联络护士,建立“糖尿病学组质控组-临床科室质控组-科室联络员”三级院内血糖管理模式,对全院实行同质化管理。实施2年后(2018年9月)再次抽取80例糖尿病患者为实施后组,比较实施前后联络护士和患者糖尿病知识水平及患者出院前空腹血糖水平。结果糖尿病学组建立后,联络护士的糖尿病知识及技能操作成绩显著优于实施前(均P<0.01);实施后组患者糖尿病知识知晓率显著高于实施前组,出院前空腹血糖显著低于实施前组(均P<0.01)。结论糖尿病学组的建立在三甲医院非内分泌专科糖尿病同质化管理方面有积极作用,可提升非内分泌科室护士的糖尿病知识及技能水平,提高患者糖尿病知识水平,有效降低空腹血糖水平。     

年轻护士长护理风险识别能力的培训与管理

目的 提高护士长护理风险管控能力,提高护理安全性.方法 对31名年轻护士长进行针对性风险管理培训,聘任护理风险导师、实施现场指导与示范,建立不良事件上报奖励机制等.实施1年后评价效果.结果 Ⅱ级、Ⅲ级不良事件发生数由干预前(2018年、2019年)的145、143起,164、165起减少至干预后(2020年)的61、93起,Ⅳ级护理不良事件上报率从1.3％&、3.2％增加至98.3％(P＜0.01).结论 多措并举的风险培训与管理措施可有效提高年轻护士长护理风险识别与管理能力,从而提高护理质量与患者安全.     

新护士长培训路径表的设计与应用

目的探索新护士长培训路径及效果。方法开展新护士长培训需求调查,制定新护士长培训路径表对竞聘上岗的17名新护士长从上岗前1个月到上岗后1年进行规范化培训,观察新护士长理论知识、操作技能、综合素质,科室不良事件、投诉发生率等指标。结果培训后新护士长的理论水平、操作技能、综合素质测评成绩提高,所管理科室的不良事件发生率、护理投诉下降,护士对护士长满意度提高(均P0.01)。结论应用新护士长培训路径表实施规范化培训,有效提高了新护士长的管理水平。     

新护士长培训路径表的设计与应用

目的探索新护士长培训路径及效果。方法开展新护士长培训需求调查,制定新护士长培训路径表对竞聘上岗的17名新护士长从上岗前1个月到上岗后1年进行规范化培训,观察新护士长理论知识、操作技能、综合素质,科室不良事件、投诉发生率等指标。结果培训后新护士长的理论水平、操作技能、综合素质测评成绩提高,所管理科室的不良事件发生率、护理投诉下降,护士对护士长满意度提高（均P〈0．01）。结论应用新护士长培训路径表实施规范化培训,有效提高了新护士长的管理水平。     

晨会提问在护士培训中的应用

目的 探讨晨会提问在护士培训中的应用效果.方法 在全院各护理单元,护士长根据科室护理工作的特点,对本专科护理工作中存在的知识薄弱点及工作重点(包括护理常规、管理规范、操作流程、护理工作制度、护理服务礼仪规范、卫生法律法规等),提前1 d设计好提问的题目,利用晨会时间提问,时间5 min左右.结果 实施后护士综合素质及护理质量显著优于实施前(P＜0.05,P＜0.01).结论 开展每天晨会提问是护士培训的较好补充手段,能促进护士理论联系实际,提高护理专科理论,从而提高护理质量.     

危险预知训练在手术室新护士培训中的应用

目的 探讨危险预知训练在手术室新护士培训中的应用效果.方法 根据新护士入科时间,将2018年8月入手术室的新护士23名作为对照组,使用常规培训方法进行带教;将2019年8月入手术室的24名新护士作为观察组,在常规培训基础上,实施危险预知训练.培训6个月后比较两组新护士评判性思维能力、安全态度及护理不良事件发生率.结果 培训后观察组评判性思维能力各维度得分及总分、安全态度评分显著高于对照组(均P＜0.01),工作1年内不良事件发生率低于对照组.结论 对手术室新护士开展危险预知训练,能提高其评判性思维能力及安全态度,减少护理不良事件的发生,保障手术室护理安全.     

关键事件分析法在手术室护理安全培训中的应用

目的通过关键事件分析法对手术室护理人员进行安全培训,提高护理人员辨别、处理风险的能力。方法收集近5年来发生在国内外及本科室的典型不良事件,由护士长和安全质控小组成员进行筛选,确定本科室的关键事件,制定关键事件专题培训计划,每个季度选择一个关键事件主题,采用头脑风暴法各抒己见,找出科室的薄弱环节,提出改进措施。结果护理人员接受安全培训后,降低了科室的不良事件发生率、护理安全质量有较大的提高(P0.05,P0.01),护士主动上报安全隐患的事例增加。结论关键事件分析法能降低手术室不良事件的发生,保障手术患者安全,提高手术室护理质量。     

分享式护理管理方法在手术室管理中的应用

目的探讨分享式护理管理在手术室的应用方法和效果.方法在手术室成立9个专科组,通过实施科护士长-护士长-专科组长-专科组员4级管理,使护士直接参与手术室日常管理工作.结果实施分享式护理管理后(2004年)医生和患者对手术室的满意率分别为92.8%、95.6%,与实施前(2001年)比较,差异有显著性意义(P＜0.05,P＜0.01).结论运用分享式管理,有利于发掘护士的潜力,发挥其创造性,增强主动服务的意识,提高手术室护理工作满意度.     

体外膜肺氧合患者安全院际转运方案的构建及实施

目的 构建体外膜肺氧合(ECMO)支持患者安全院际转运方案,并探讨其临床应用效果.方法 将2018年7月至2019年7月行ECMO院际转运患者30例设为对照组,按照常规转运流程实施转运;2019年10月至2020年10月的30例患者设为观察组,在常规院际转运流程基础上,基于循证构建并应用ECMO安全院际转运方案进行转运.比较安全院际转运方案实施前后重症医学科医护人员ECMO院际转运知识知晓得分、院际转运效率、院际转运相关不良事件发生率.结果 实施后重症医学科医护人员对ECMO院际转运知识得分显著高于实施前,观察组管路预充时间与置管时间显著低于对照组(P＜0.05,P＜0.01),院际转运相关不良事件发生率低于对照组,但差异无统计学意义.结论 安全院际转运方案可提高医护人员院际转运知识掌握程度,提高院际转运效率,减少院际转运相关不良事件的发生率.     

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.     

The risks of using samovars as the main tea-preparing facility in some Eastern countries

Samovars are the main tea-making devices in some Eastern countries. In part of a joint Iran–Sweden research project on epidemiology and prevention of burns, 265 households in a rural area were entered into a cross-sectional study in which safety status of samovars used and unsafe behaviours in using them were assessed.Samovars were the main device used to boil water for making tea in 75% of the households; 55.2% of samovars were placed in the kitchen, 20% in the living room and the remainder elsewhere. The device was placed where the floor surface was uneven in 15.1% of the houses. It was placed in traffic areas in at least 20.7% and where it was accessible to preschool children in 60%. Only 11.5% of the 194 kerosene samovars examined had a national standard maintenance mark. Mean volume capacity of samovars was 6.9 l (6.4–7.4 l). A tap problem was observed in 17.4% of samovars, an unstable base in 7.7%, an unstable teapot in 13.4%, unstable handles in 7.2%, broken handles in 5.7%, an unstable water container in 13.4% and an unstable container lid in 5.1%. With most of the samovars there were technical problems making them unsafe. Behaviours in using samovars were also unsafe.     

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.     

The dynamic interplay of physical and psychosocial safety climates in frontline healthcare

Little is known about how safety climates concerning physical safety and psychosocial safety interact in the prediction of working conditions and subsequent worker health. Frontline healthcare was selected as the setting for this study on the dynamic interplay between physical and psychosocial safety climates because of a recent call for attention to working conditions in this industry. Poor safety climates for healthcare workers spill over into adverse outcomes for worker health, and when workers are compromised, then so too is their provision of quality patient care. We developed an integrated model of the relationships between psychosocial and physical safety climates, working conditions, and health and safety outcomes. A multilevel model was tested (N = 463 workers nested within n = 60 teams), and lagged analysis was conducted across four time points, each 6 months apart. The combination of safety climates significantly predict objective outcomes from hospital safety system records on staff accidents, absence, and patient incidents (quality of care), suggesting a dynamic interplay in the prediction of impacts on the worker, organization, and end‐user. Integrated physical and psychosocial safety climate measures can be incorporated into hospital occupational health and safety reporting and response systems as effective lead indicators and key performance metrics for work health and safety.     

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。     

Complications of laser dermatologic surgery

BACKGROUND AND OBJECTIVE: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. METHODS: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. RESULTS: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. CONCLUSION: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.     

Using system analysis to build a safety culture: improving the reliability of epidural analgesia

BACKGROUND: A potentially dangerous situation was revealed by an incident report describing the use of an inappropriate device to administer post-operative epidural analgesia to a patient on a surgical ward. The incident occurred in a 1200-bed university affiliated tertiary hospital (Geneva University Hospitals, HUG) and involved three clinical departments: anaesthesiology, the surgical intensive care unit and urology. METHODS: A multidisciplinary system analysis was carried out to identify care-delivery problems and contributory factors. Corrective actions were devised on the basis of their ability to prevent and absorb unsafe situations. RESULTS: The system analysis identified three care-delivery problems in relation to the management of epidural analgesia. It enabled medical and nursing managers to adopt an interdepartmental set of corrective actions: a common protocol for post-operative epidural analgesia, leading to the exclusive use of patient-controlled epidural analgesia (PCEA) pumps; greater availability of the patient-controlled pumps; the dissemination of guidelines; permanent proactive training of nurses by the acute-pain team; the clarification of medical responsibilities; and a common help-line phone number for all surgical departments. DISCUSSION: The analysis provided a convincing exposure of various care-delivery problems and their corresponding contributory factors, as well as an opportunity to address a systemic issue in a multidisciplinary way. By thus facilitating decisions and corrective actions, the analysis was instrumental in strengthening our safety culture.     

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。