制作核查标识提高手术患者Time-out核查执行率

目的探讨核查标识提高手术安全核查的效果。方法对照组1 000例患者按常规方法执行Time-out程序实施安全核查,观察组1 000例患者在此基础上在无影灯开关按钮粘贴自制的安全核查标识,提醒手术团队执行Time-out程序。结果麻醉前两组手术患者的安全核查执行率均为100%;手术开始前、患者离开手术间前安全核查执行率观察组显著高于对照组(均P0.01)。结论核查标识可提高手术前及手术结束后手术患者的安全核查执行率。     

多学科集中式术前访视在甲状腺手术患者的应用

目的探讨多学科集中宣教式术前访视模式应用于甲状腺手术患者的效果。方法将173例行甲状腺切除术择期手术患者按照病区分为观察组100例和对照组73例,观察组应用Delphi法确立访视内容,进行多学科集中式术前访视;对照组采取传统一对一访视模式干预。比较两组患者术前准备完善度,疼痛、焦虑评分及患者满意度。结果观察组术前准备完善率及患者满意度显著高于对照组,术后焦虑评分显著低于对照组(P0.05,P0.01)。结论通过实施多学科集中式术前访视,能有效减轻患者负性心理,提高术前准备完善率及患者满意度。     

院前微信无缝隙管理对预住院患者术前准备的影响

目的探讨院前微信无缝隙管理对预住院患者术前准备质量的影响。方法将预住院手术患者按入院时间分为对照组215例和观察组234例。对照组按照常规流程处理,观察组实施院前微信无缝隙管理,包括人员管理、诊疗流程、微信教育、术前准备的无缝隙管理。结果观察组术前准备缺失率显著低于对照组,术前知识掌握程度及患者对预住院的满意度显著高于对照组(均P0.01)。结论院前微信无缝隙管理能有效降低患者术前准备缺失率,提高术前知识知晓率和患者满意度,促进手术顺利实施。     

持续质量改进在术前准备中的应用

目的探讨持续质量改进理论在术前准备中应用的成效。方法将257例患者按时间分为对照组(125例)和观察组(132例)。对照组实施常规术前准备;观察组将持续质量改进理论用于术前准备:分析术前准备存在的问题及原因,以问题为切入点,制定持续质量改进措施,如设计应用术前准备项目核对表,护士4人次分阶段对术前准备完成情况进行核对与跟进,将术前准备列入交接班重点内容等。结果观察组患者术前准备缺陷发生率及手术延误率显著低于对照组(P<0.05,P<0.01);观察组患者术前相关知识知晓及服务满意评分显著高于对照组(均P<0.01)。结论对患者术前准备进行持续质量改进,加强环节质量控制,能显著提高术前准备质量,保障手术的及时性,提高患者满意度。     

iPad访视软件在手术室术前访视中的应用

目的探讨iPad访视软件在手术室择期手术患者中的应用效果。方法选取行择期手术的神经外科患者209例,按随机数字表法分为观察组(n=106)和对照组(n=103),对照组按常规实施术前访视;观察组采用iPad访视软件实施术前访视。比较两组患者术前访视时间、手术相关知识掌握情况、术前准备质量和术前访视满意度。结果观察组术前访视时间显著短于对照组(P0.01),手术相关知识掌握情况、术前准备质量及满意度得分显著高于对照组(均P0.01)。结论iPad访视软件使手术室术前访视内容丰富、形式多样,能够有效缩短术前访视时间,提高择期手术患者手术相关知识知晓情况和术前访视满意度,保障手术顺利进行。     

病房与ICU护士联合术前访视预防颌面部恶性肿瘤患者术后ICU谵妄研究

目的降低颌面部恶性肿瘤患者术后ICU谵妄发生率。方法将325例颌面部恶性肿瘤患者按时间段分为对照组161例、观察组164例;对照组由病区护士于患者术前进行常规手术相关宣教;观察组成立病区ICU护士联合宣教小组,于患者术前共同进行术前宣教与访视。于患者从ICU返回病区第3天及出院当天进行效果评价。结果观察组患者谵妄发生率显著低于对照组,住院满意度显著高于对照组(均P0.01)。结论病房与ICU护士联合术前访视可有效降低颌面部恶性肿瘤手术患者术后ICU谵妄发生率,提高患者满意度。     

多媒体视频应用于神经外科术前集体宣教的效果

目的探讨多媒体视频应用于神经外科术前集体宣教的效果。方法将神经外科手术患者313例,按照入院时间分组,对照组117例接受常规护理宣教,由术前1d值班的责任护士按术前宣教单逐一讲解饮食准备、手术室环境、体位护理、用药护理、疼痛管理等内容。干预组196例在此基础上集中观看科室自制的多媒体视频。结果干预组围手术期相关知识掌握率、适应性训练准确率显著高于对照组(均P0.01)。结论多媒体视频应用于神经外科术前集体宣教有利于患者掌握围手术期相关知识,并能准确进行术后适应性训练。     

术前麻醉评估中心在胸科手术中的效果评价

目的:评价术前麻醉评估中心在胸科手术中的效果,为提高围手术期患者麻醉安全质量提供保障。方法:选取2020年7月1日—2021年2月1日进行胸科手术的患者1 600例,按随机数字表法分为常规访视组（对照组）和术前麻醉评估中心组（观察组）,每组800例。对照组患者于手术前1 d由麻醉医师去病房进行访视和风险评估;观察组于手...     

对日间手术病房患者实施人文关怀的效果探讨

目的 探讨人文关怀措施对日间手术患者焦虑及术后康复的影响,为医护人员实施专业的人文关怀护理服务提供参考。 方法 将接受日间手术的110例腹股沟疝患者随机分为对照组与干预组各55例。对照组给予常规护理,干预组在常规护理的基础上实施人文关怀护理干预。比较两组术前焦虑评分、术后饮食与下床活动时间及护理满意度。 结果 干预组术前焦虑评分显著低于对照组,术后进食时间、下床活动时间显著早于对照组,护理满意度显著高于对照组（均P＜0.01）。 结论 为日间手术病房患者实施人文关怀服务可减轻其心理压力,加速术后康复,提高护理满意度。     

协作式术前访视在妇科手术患者中的应用

目的探讨病房与手术室护士协作完成术前访视在妇科手术患者中应用的效果。方法将200例妇科择期手术患者以抽签法随机分为观察组和对照组各100例。对照组实施传统术前访视方法,观察组术前1 d由病区和手术室护士通过沟通、协调、合作,以团体讨论、互动教育的形式进行术前访视。结果观察组手术相关知识认知、遵医率、满意率显著高于对照组(均P<0.01);观察组焦虑评分显著低于对照组(P<0.01)。结论手术室与病房协作的术前访视满足了患者的术前访视及健康教育需求,保证了术前访视质量。     

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 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.     

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。     

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.     

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.     

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。