41例院内上报护理不良事件分析

目的探讨提高患者安全管理、降低护理不良事件发生率的方法。方法回顾分析重庆市第三人民医院2012年上报的41例院内护理不良事件的原因与特点,对发生不良事件的患者性别及年龄、时间地点及不良事件的结局和分类进行统计学分析。结果80～89岁和50～59岁患者不良事件发生率最高（53．6％）;护理不良事件分类中,发生率最高的为跌倒、压疮和给药错误;不良事件上报率最高的科室为老年科、神内科、重症监护病房（ICU ）;院内不良事件发生的主要时间段为上午（08：00～12：00）,夜间（00：00～08：00）和晚间（18：00～00：00）;损伤结局中,跌倒是造成患者重度损伤的主要原因。结论医院应完善管理制度、明确岗位职责,合理排班和配置各项资源,提高护理人员的风险意识和护理水平,是减少护理不良事件的根本途径。     

124例护理不良事件的分析与启示

目的：探讨减少护理不良事件发生的对策及相应的防范措施。方法将124例护理不良事件的案例从原因、类型、人群、时间段等方面进行分析。结果发现不良事件易发生的人群是工龄在5年以下的年轻护理人员;易发生的类别是药物治疗尤其是注射药物治疗;不良事件易发生的主要原因是未落实“查对”制度;易发生的时间段主要集中工作日的白班时间段。结论提高护理人员的综合素质和安全意识水平、加强对护理人员安全工作的相关培训与教育、改革排班模式、制定详实的临床护理操作流程、规范护理人员的行为准则是护理工作中减少与杜绝护理不良事件发生的保障。     

210例护理不良事件原因分析及对策

目的通过对210例护理不良事件进行分析,查找不良事件发生的原因和特点,针对其采取防范措施,以期减少不良事件的发生。方法对某三级医院2008--2010年上报的210例护理不良事件进行回顾性研究,分析不良事件发生的原因及特点。结果工作5年内的护士不良事件发生率最高,占54．76％,低职称的护士不良事件发生率高于高职称护士;不良事件发生的类别居前4位的依次为给药错误,占34．8％;非计划性拔管,占18．6％;跌倒／坠床,占15．2％;压疮,占14．8％。不良事件发生的主要原因居前4位的依次为评估不足,占42．4％;查对错误,占29．0％;未执行操作规程,占15．2％;宣教不到位,占8．1％;给药错误、非计划性拔管、跌倒／坠床的发生在一天内不同时间段发生情况,差异有统计学意义（x2分别为25．054,17．833,20．875;P〈0．01）,其中给药错误主要发生在8：00—11：00、14：00—17：00,非计划性拔管主要发生在1：00—5：00,跌倒／坠床主要发生在18：00—22：00;压疮的发生在一天内不同时间段发生情况,差异无统计学意义（P〉0．05）。结论护理管理者要重视对不良事件的分析,树立护理人员的安全意识,合理配备人力,加强重点人群的培训,加强重点时间段的管理,查找根源,制定有效措施,营造安全的工作环境,全面防范护理不良事件的发生。     

应用国际医疗认证联合委员会评审标准分析90起护理不良事件的原因

目的应用国际医疗认证联合委员会评审标准,分析90起护理不良事件发生的类别、原因和时间特点,以制定有效的预防措施,减少护理不良事件的发生。方法依据国际医疗认证联合委员会(Joint Commission International,JCI)对医院安全与规范化管理的相关要求,对2010年1月—2011年9月上报的90起护理不良事件进行回顾分析。结果护理不良事件主要发生在药物管理和使用、员工资格和教育方面;排前3位的不良事件类别依次是输液类、药物类和标本类;交接班时间段是不良事件高发的时间段;低年资护士是护理不良事件的高风险人群。结论需依据JCI相关要求,加强员工的在职教育和培训;完善临床药物派送系统和加强查对制度的落实;尽快改变排班模式,根据需求弹性排班,尽量减少护士交接班次数,并规范护士交接班流程;完善科室常见病种的护理常规及操作指引,尽量从系统的根源避免护理不良事件的发生,提升医院管理品质,推进医院向国际化市场发展。     

56例儿科护理不良事件原因分析及管理对策

目的：基于某院儿科病房上报的56起护理不良事件进行分析,制定护理对策,避免不良事件发生,保证护理安全。方法回顾某院儿科2014年1月至2015年6月上报的56起护理不良事件,对其类型、分级、时间及与护理人员关系等进行分析。结果给药缺陷、坠床、管道滑脱、输液渗漏、跌倒、交接班遗漏、体重测量错误占所有不良事件的80.2%;Ⅲ级发生率为91.1%,08：00~11：59时段发生率为32.1%,≤5年工龄护士的发生率远高于>5年者。结论主要原因是护理人员查对制度不到位、队伍年轻化、责任心不强、评估不足等。应落实查对制度、加强业务学习、增强责任心等,以降低护理不良事件的发生率,从而保证护理安全。     

新疆某三甲医院护理不良事件发生情况调查分析

目的:调查住院患者护理不良事件发生情况,分析护理不良事件的发生与护理人员的关系。方法:回顾新疆某三甲医院2013年6月~2014年6月护理系统上报的214例次不良事件,对不良事件类型、严重程度、护理人员的相关资料和发生时间进行分析。结果:护理不良事件趋于前3位分别为基础护理事件49例次(22.90%)、导管操作事件41例次(19.16%)和给药错误事件20例次(9.35%);不良事件与护理人员的年龄、工作年限、职称、学历相关,护理不良事件高发时段分别为8∶00~9∶00,10∶00~11∶00和18∶00~19∶00。结论:不良事件的发生与护理人员的年龄、工作年限、职称、学历密切相关;且易发生在工作繁忙的时段。     

精神科护理不良事件原因分析及对策

目的分析精神科发生护理不良事件的原因与特点,并提出相应对策,降低护理不良事件的发生率。方法回顾性调查本院2008年1月～2010年12月发生的139件(共139例患者)护理不良事件,了解其发生原因、分类、损伤结局、发生时间及地点等。结果精神科护理不良事件发生频率前3位依次为跌倒致伤62件(44.6%)、冲动伤人毁物22件(15.8%)及外走10件(7.2%);106件(76.3%)不良事件导致患者不同程度的损伤,排前3位不良事件中跌倒导致患者轻中度损伤发生率最高;不良事件发生率最高两个时间段分别为7:00～10:00时与17:00～18:00时;护理不当是导致不良事件发生的主要原因,其中初级职称护士及低护龄护理人员不良事件发生率最高,护龄在10年及以下的护理人员不良事件发生率为69.8%。结论应加强病房安全管理,规范护理管理流程,合理配置与安排护理人力资源,重视提高低职称、低学历护理人员护理风险防范意识,从而减少护理不良事件的发生。     

55例精神科护理不良事件原因分析及应对策略

目的:分析精神科发生护理不良事件的原因与特点,并提出相应对策,降低精神科护理不良事件的发生率。方法:回顾性调查本院2013年1~12月55例患者发生的护理不良事件,了解其发生原因、分类、损伤结局、发生时间及地点等。结果:精神科护理不良事件发生频率前3位依次为跌倒致伤(包括坠床)9例、患者冲动(包括工作人员粗暴对待患者)6例、外走5例;38例(69.09%)不良事件导致患者不同程度的损伤,排前3位不良事件中跌倒导致患者轻中度损伤发生率最高;不良事件发生率最高两个时间段分别为7∶00~10∶00时与17∶00~18∶00时;护理不当是导致不良事件发生的主要原因,其中初级职称护士及护龄在10年以下护理人员不良事件发生率最高。结论:应加强病房安全管理,规范护理管理流程,合理配置与安排护理人力资源,重视提高低职称、低学历护理人员护理风险防范意识及规范化培训,从而减少护理不良事件的发生。     

从责任护士及病人方面分析护理不良事件发生的原因及其对策

[目的]通过回顾性研究,分析护理不良事件发生与责任护士及病人的关系.[方法]回顾某二级甲等医院2011年-2013年主动上报护理部的234起护理不良事件,对不良事件进行分类,对其涉及病人的住院护理级别、住院时间、责任护士职称等进行分析研究.[结果]234起护理不良事件发生与责任护士班次、职称及病人护理级别、住院时间、年龄有关（P〈0.01）.[结论]护理不良事件高发时间段是N班（21：00至次日08：00）,护师级别的护士值班期间不良事件发生率最高（48.7%）,Ⅰ级护理的住院病人、住院时间≤3d、老年病人更容易发生不良事件.科学合理安排N班护士人力、加强护师级别护士评估能力和风险意识的职业培训、关注Ⅰ级护理住院病人、刚住院病人、老年病人的护理安全管理是消除或减少护理不良事件发生的有效措施.     

139例住院患者跌倒不良事件分析

目的回顾性分析住院患者跌倒不良事件的临床特点,为制定有效的跌倒预防策略提供参考依据。方法通过医院护理管理平台收集2015年1月—2018年12月发生的139例跌倒护理不良事件的临床资料,统计分析相关数据。结果跌倒患者以老年人为主,占64.03%(89/139);发生跌倒次数最多的地点是卫生间,占54.67%(76/139);跌倒高发时间段为清晨(6:00~8:00)和午夜(0:00^-2:00);患者跌倒发生时当班护士以低年资护士为主;患有肿瘤相关疾病、心脑血管疾病及内分泌、代谢疾病的患者跌倒发生率高于其他基础病患者。跌倒评估不够准确/未能识别高危人群、高危患者无防控措施、患者依从性差、护士健康宣教不到位以及环境因素是导致住院患者跌倒的常见根本原因。结论护理管理者及临床护理人员,应关注跌倒不良事件的高危人群、高发地点及时间段等,实施预见性护理,从而预防跌倒的发生。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.