六西格玛管理法在预防住院患者跌倒管理中的应用

目的:降低住院患者跌倒的发生率,提高患者满意度.方法:2009年11月起采用六西格玛五步法,对住院患者预防跌倒流程中的质量关键点及流程缺陷进行识别.分析2009年1-10月住院患者发生跌倒的原因,跌倒发生率为2％,患者满意度为90％,找出解决方法,制定出相应措施进行改进质量控制,再次收集数据,对比分析应用六西格玛管理法前后乳腺科住院患者跌倒发生率及患者满意度.结果:2010年4月-2011年1月跌倒发生率下降为0.04％,患者满意度提高至96％.结论:通过引入六西格玛管理法,优化了流程,提高了全科护士安全管理的意识,做到了制度及预防措施的有力执行,有效降低了跌倒的发生率,提高了患者满意度.     

临床护士针刺伤调查及职业安全管理探讨

目的了解护士的职业安全意识,以探讨职业安全管理模式.方法采用随机抽样方法对100名临床护士进行针刺伤经历及相关问题的回顾性问卷调查.结果 97.0%被调查护士在工作期间发生过针刺伤,77.3%被针刺伤>1次/年,71.6%在操作和处置中被污染针头所伤,54.6%的针刺伤不能确定感染源;与针刺伤有关的主要操作有清洗、处置注射器、回套针帽、处置临床医疗废物等;在针刺伤发生后40.0%护士不知道报告的程序和处理措施;所有护士都希望获得针刺伤相关的知识及帮助与支持.结论临床护士针刺伤发生率高,防护意识不强,职业安全制度不健全.建议卫生行政管理部门及医疗单位管理部门建立、健全职业安全制度,加强医护人员职业防护培训,以促进医疗职业安全.     

临床护士针刺伤调查及职业安全管理探讨

目的 了解护士的职业安全意识，以探讨职业安全管理模式。方法 采用随机抽样方法对100名临床护士进行针刺伤经历及相关问题的回顾性问卷调查。结果97．0％被调查护士在工作期间发生过针刺伤，77.30／被针刺伤〉1次／年，71．6％在操作和处置中被污染针头所伤，54．6％的针刺伤不能确定感染源；与针刺伤有关的主要操作有清洗、处置注射器、回套针帽、处置临床医疗废物等；在针刺伤发生后40．0％护士不知道报告的程序和处理措施；所有护士都希望获得针刺伤相关的知识及帮助与支持。结论 临床护士针刺伤发生率高．防护意识不强，职业安全制度不健全。建议卫生行政管理部门及医疗单位管理部门建立、健全职业安全制度，加强医护人员职业防护培训，以促进医疗职业安全．     

便携式防针刺伤医疗锐器物回收车的制作与应用

目的降低护士针刺伤发生率,保障职业安全。方法用8根不锈钢圆柱体在不锈钢底板上焊接成长方体框架,设扶手、底架、滑轮、酚醛花泥放置槽及输液卡放置槽,即制成便携式防针刺伤医疗锐器物回收车。使用前将酚醛花泥及双层医疗垃圾回收塑料袋置于回收车内。护士拔针及使用完锐器后将针头插入花泥,其他输液器材置于塑料袋。结果应用回收车后护士针刺伤发生率显著降低(P0.01)。结论便携式防针刺伤医疗锐器物回收车能减少针刺伤的发生。     

六西格玛管理法用于输血流程重组的效果研究

目的降低输血缺陷,保证患者输血安全。方法成立输血质量管理小组,按照六西格玛管理体系的定义、测量、分析、改进和控制5个步骤,对输血关键环节展开调查和分析,以数据为基础,找出流程中的关键问题并进行改进和输血流程重组。结果输血流程重组后,输血各环节双人核对落实率达100%,取血等待时间减少1 267.81s,取血核对时间减少142.57s。合血标本合格率由97.04%提高至99.14%,输血缺陷由0.05%下降到0.01%,六西格玛管理法实施前后合血标本合格率、输血缺陷发生率比较,差异有统计学意义(P<0.05,P<0.01)。结论运用六西格玛管理法重组输血流程能有效减少输血缺陷,提高护理工作效率。     

Reengineering of blood transfusion process by using Six Sigma

目的 降低输血缺陷,保证患者输血安全°方法 成立输血质量管理小组,按照六西格玛管理体系的定义、测量、分析、改进和控制5个步骤,对输血关键环节展开调查和分析,以数据为基础,找出流程中的关键问题并进行改进和输血流程重组.结果 输血流程重组后,输血各环节双人核对落实率达100％,取血等待时间减少1 267.81 s,取血核对时间减少142.57 s.合血标本合格率由97.04％提高至99.14％,输血缺陷由0.05％下降到0.01％,六西格玛管理法实施前后合血标本合格率、输血缺陷发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 运用六西格玛管理法重组输血流程能有效减少输血缺陷,提高护理工作效率.     

便携式防针刺伤医疗锐器物回收车的制作与应用

目的降低护士针刺伤发生率,保障职业安全。方法用8根不锈钢圆柱体在不锈钢底板上焊接成长方体框架,设扶手、底架、滑轮、酚醛花泥放置槽及输液卡放置槽,即制成便携式防针刺伤医疗锐器物回收车。使用前将酚醛花泥及双层医疗垃圾回收塑料袋置于回收车内。护士拔针及使用完锐器后将针头插入花泥,其他输液器材置于塑料袋。结果应用回收车后护士针刺伤发生率显著降低（P〈0.01）。结论便携式防针刺伤医疗锐器物回收车能减少针刺伤的发生。     

应用6 sigma法建立手术室标准化护理常规的实施与成效

目的探讨6sigma质量管理理念与方法对规范手术室护理常规的成效,提高手术室护理质量的实施。方法运用6sigma的定义-测量-分析-改进-控制5个步骤管理模式对手术室标准化护理进行管理,并与实施六西格玛质量管理前进行比较。结果改进措施后护理质量高于改进措施前（P〈0.05）,差异有统计学意义;护士责任意识增强、医生的满意度提升,差异有统计学意义（P〈0.05）。结论运用科学管理提高效率,减少失误,使手术室标准化护理的过程达到最优状态。     

六西格玛管理法提高脑卒中患者早期康复运动依从性的实践

目的探讨六西格玛管理法在提高脑卒中患者早期康复运动依从性中的应用效果。方法将2018年3～6月的86例脑卒中设为对照组,由责任护士完成早期运动评估、制定和实施康复计划、效果评价;将2018年8～12月的86例设为观察组,由六西格玛管理小组寻找脑卒中患者早期运动依从性低的原因,针对原因制定个性化早期运动方案,由个案康复管理师在床旁进行指导和效果评价。比较两组早期运动依从性。结果出院时观察组早期康复运动依从性显著优于对照组(P0.01)。结论运用六西格玛管理法可有效提高脑卒中患者早期运动依从性。     

目标管理对预防住院患者跌倒的作用

目的探讨目标管理对预防住院患者跌倒的可行性并评价其效果。方法遵循目标管理的基本原则及流程,即确定控制目标、制定现场检查追踪内容和评价标准、加强全员培训、追踪督导并及时反馈,对住院患者跌倒发生情况实施目标管理。评价目标管理前后住院患者跌倒发生率和护士对高风险患者管理正确率。结果目标管理后住院患者跌倒发生率为0.15%,显著低于基线值的0.20%(P0.01);护士对高风险患者管理正确率从管理前的33.33%~43.06%上升到管理后的84.72%~93.06%,差异有统计学意义(均P0.01)。结论目标管理能降低住院患者跌倒发生率,但在目标管理过程中,应做到科学设定目标值,定期评价管理效果并及时采取措施改进,达到持续质量改进目的。     

226名护士发生职业暴露的监测分析及防护管理

目的探讨传染病医院护士职业暴露的发生情况、原因及预后,提出防护管理对策和暴露发生后的处理措施。以降低职业暴露的发生率及其影响。方法回顾性分析本院2009年4月至2012年12月226名护士职业暴露发生的情况,对护士职业暴露的科室分布、暴露方式、受伤部位、暴露地点,暴露源种类、暴露后处理情况及随访结局进行分析,所有资料均采用Excel软件进行数据录入和SPSS 16.0软件进行统计学分析。本研究主要采用描述性统计分析方法,计量资料以x±s描述,计数资料采用构成比描述。结果护士发生职业暴露共226人次,其中针刺伤183人次（81.0%）,体液溅入37人次（16.3%）,被患者抓咬伤6人次（2.7%）。发生频率最高的科室为妇科、中西一科、ICU和手术室。暴露源以HBV最为常见,其次为HCV和HIV。职业暴露后伤口均及时得到正确处理,暴露者均未感染。结论通过提高意识、加强管理、规范操作、及时处理等,严格执行标准预防,正确使用个人防护用品,规范伤口处理及发生暴露后的上报及随访体系,就能有效地防止职业暴露的发生。     

Infektionsprophylaxe nach Nadelstichverletzung

Background

Needle stick injuries are associated with a risk of infection. The aim of this study was to collate the reasons for the failure to carry out prophylactic measures from the perspective of those affected.

Methods

An anonymous internet questionnaire was designed to record the experiences of health care workers at the University Hospital Rostock with secondary infection prophylaxis after needle stick injuries.

Results

During the investigation period 106 questionnaires were returned. There were deficiencies in the acceptance of prophylactic measures due to job-associated lack of time and social pressure.

Conclusion

The study suggests reorganization of work-flows and additional educational measures about the necessity of prophylactic procedures after needle stick injuries.     

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.     

Risk to surgeons: a survey of accidental injuries during operations

A survey was conducted with the participation of eight consultant general surgeons, two consultant urologists, four consultant orthopaedic surgeons and four surgical residents to find the incidence of accidental injuries to surgeons and their assistants during operations. Of the total of 2016 operations over a one year period there were 112 reported accidental injuries. These included 107 needle stick injuries, 4 knife cuts and 1 diathermy burn. We found that accidental injuries to surgeons during operations were inevitable.     

Epidemiology of exposure to blood borne pathogens on a surgical service

BACKGROUND: The goal of this study was to analyze the type and mechanism of blood exposure injuries on the surgical service in order to develop appropriate preventative strategies. METHODS: A retrospective review of all exposure injuries affecting members of the operative care line at a single teaching institution between December 2002 and December 2005 was performed. RESULTS: Of 98 exposure injuries on the surgical service, only 17 (17%) were inflicted by hollow-bore needles. Seventy-four (76%) of these reported injuries occurred in the operating room (OR) and 24 (24%) occurred in other clinical areas. Sharps injuries accounted for 69 (93%) of OR injuries and were inflicted by suture needles (n = 37, 50%), hollow-bore needles (n = 7, 9%), and sharp instruments (n = 25, 34%). Mucocutaneous contamination accounted for 5 (7%) of the OR exposures. Professionals most frequently injured were residents (n = 43, 44%), followed by nurses (n = 28, 29%), students (n = 17, 17%) and other healthcare workers (n = 10, 10%). CONCLUSIONS: Blood exposure prevention strategies should be directed at safety within the surgical field and focused beyond hollow-bore needle stick injuries to include education, mentoring, and competency training.     

临床护理人员锐器伤发生环节与受伤部位探讨

目的了解临床护理人员锐器伤发生的环节与受伤部位,为进一步制定职业防护措施提供实证依据。方法采用分层整群抽样的方法,抽取临床一线护理人员458名,填写自行设计的护士锐器伤调查问卷。结果458名护理人员中发生锐器伤1 286人次。41.70%护士经常双手回套针帽,5.68%经常徒手拾取破碎玻璃,30.13%操作时从不戴手套。在锐器伤发生的主要环节中,44.48%的锐器伤发生在操作准备过程,操作中占39.04%,操作后整理用物为8.86%。94.79%的锐器伤发生在双手,其中双手手指占89.42%,右手示指以37.48%的高发率位居首位,其次是右手中指16.33%,左手示指13.53%。结论护理人员锐器伤发生环节主要是掰安瓿,输液/注射/采血/拔针,拔针帽;锐器伤害发生的主要部位是双手,右手多于左手。医院管理者应定期开展锐器伤相关培训教育,使用高效安全的护理用具,制定安全规范的护理操作程序,实施标准预防,减少护理人员潜在的针刺伤危险。     

护理人员操作中被针头刺伤情况的调查分析

目的：了解护理人员在操作中被针头刺伤的情况，以采取相应的防护措施。方法：采用问卷调查法调查404名护理人员在半年内被针头刺伤的情况及采取的预防措施。结果：未被针头刺伤者仅占5．94％（24／404），刺伤≥7次者占11．14％，易导致针头刺伤的操作环节主要是拔取针头（37．37％），将针头折弯，毁型（22．89％），抽血和输液时不戴手套者分别占91．58％，68．07％，未注射乙肝疫苗者为31．68％，。结论：护理人员自身防护意识淡薄，应加强理论教育，提高其自我防护意识，预防针刺，减少经血液传播疾病的发生。     

Incidence of a needle stick injury occurring in a needleless intravenous system

A needle stick injury occurred with a needleless intravenous system. When a nurse picked up a disposable glove left on the floor of an operating room to discard it, there was an intravenous needle left under the glove and caused a needle stick injury to the nurse. Although the needle was designed as a needleless intravenous system, we found after a close observation that there is a potential hazard for a needle stick injury regarding the needle. The incidence happened due to the negligence of standard precaution by another health care provider (a doctor); leaving the contaminated needle on the floor. Unfortunately, the disposable glove fell on the needle for some reason and concealed it. Should the doctor follow the standard precaution properly, i.e. discard it in a puncture-resistant sharps container immediately, this incidence might not have happened. Any safety device may not prevent incidence 100%, we have to always heed and follow a standard precaution.     

Latrogenic lesion of the inferior vena cava during laparoscopic cholecystectomy: case report and review of the literature

Retroperitoneal great vessel injuries are a rare but dramatic complication of any minimally invasive procedure. We report a case of laceration of the anterior aspect of the inferior vena cava following insertion of the Verress needle during a laparoscopic cholecystectomy. A 32-year-old man was operated on for acute cholecystitis. During the insertion of the Verress needle, a laceration of the anterior aspect of the inferior vena cava occurred. Immediate conversion and suture of the vessel were performed. The patient did well and was discharged after 24 days because of postoperative pancreatitis, managed with medical therapy. Major vascular injuries during laparoscopic procedures are rare but catastrophic complications which may endanger the patient's life. Over 75% of these lesions occur during insertion of the Verress needle or the Hasson trocar. Prompt diagnosis and immediate conversion are mandatory for correct management of these injuries so as to minimise morbidity and mortality.     

Novice performance of ultrasound-guided needle advancement: standard 38-mm transducer vs 25-mm hockey stick transducer

The optimal method to develop expertise in ultrasound-guided regional anaesthesia is unknown. Studies of laryngoscopic expertise in novices demonstrate that the choice of laryngoscope affects performance. In this study, we aimed to compare the effect of two different linear array transducers (38-mm standard vs 25-mm hockey stick) on novice performance of ultrasound-guided needle advancement. Following randomisation, participants watched a video model of expert performance of ultrasound-guided needle advancement. Recruits performed the modelled task on a turkey breast model. The median (IQR [range]) composite error score was statistically significantly larger for participants in the hockey stick transducer group compared with the standard transducer group; 10.0 (7.3-14.3 [2.5-29.0]) vs 7.5 (4.5-10.0 [2.0-28.0]) respectively, (p = 0.01). This study has demonstrated that performance of ultrasound-guided needle advancement by novice operators after simple video instruction is better (as assessed using a composite error score) with a standard 38-mm transducer than with a 25-mm hockey stick transducer.