Effects of management by wandering around launched by nursing department

目的 探讨护理部实施走动式管理模式进行全院护理质量控制的效果.方法 护理部坚持每天不定时下病房,跟班巡查,了解临床护理工作的落实和护理人员的需求,并按照护理管理质量标准动态管理.实施1年后评价效果.结果 实施走动式管理后,基础护理、特一级护理、护理文件书写及病区质量管理等8项护理质量质控得分显著高于实施前(均P＜0.01).结论 护理部实施走动式管理,能及时发现工作中的不足并改进,提高护理质量.     

网格化管理联合走动式服务在综合医院门诊的实践

目的探讨网格化管理联合走动式服务在综合医院门诊质量管理的实践效果。方法将医院门急诊工作环境进行网格单元化,同时设置服务岗位及岗位职责,联合走动式服务,门诊和护理部实时进行反馈及效果评价。结果实施网格化管理联合走动式服务后,患者对门诊服务总体满意度及门诊服务质量评分显著优于实施前(均P0.01),门诊医务人员对门诊管理工作的认可率为93.33%~100.00%。结论在门诊实施网格化管理联合走动式服务,持续改进服务,可有效提升门诊服务质量,提高患者及医务人员的满意度。     

设立护理督导组 加强护理质控

我院是一所综合性教学医院，护理实行三级管理．为了进一步优化护理工作管理，1995年下半年护理部成立了专职护理督导小组，协助护理部对护理质量行使职、权、利相结合的控制。实施1年余，对提高护理质量发挥了有益的作用，介绍如下．1护理督导组的组织管理督导组由外科、神经科、感染科的3位科护士长及护理部1名副主任（已办退休手续）共4人组成。3名副主任护师和五名主管护师，在护理部直接领导下，协助护理部对全院护理质量进行检查、评估、督促和指导．2督导组实行护理质控方法护理部将影响护理工作的基本因素，如科室管理、基础护理和…     

应用信息技术加强护理质量管理的方法与效果

目的探讨应用信息技术加强护理质量管理的方法与效果。方法开通中联电子病历系统,实施无纸化办公;通过ftp传输功能,建立护理部质量管理文件夹及各护理单元子文件夹,并在各病区应用护理质量与安全信息反馈表格。结果应用信息技术后,护理管理、护理文书书写、护理安全管理、手术室护理质量有所提升;患者满意度及健康教育覆盖率显著高于应用信息技术前(均P<0.01)。结论应用信息技术可提高护理质量、患者满意度和健康教育覆盖率。     

读书报告会在护理质量改进中的作用

目的提高护士的质量意识,促进其参与科室的质量管理,提升护理质量。方法根据护理部质量反馈意见及科内自查的质量问题拟定需要改进的问题主题,组织护士收集、学习相关文献资料;每月下旬召开读书报告会,针对性制定改进措施,进行跟踪评价。连续1年后评价效果。结果制定护理管理措施、改进工作流程共28项,护理安全、基础护理、护理文书、病房管理、特Ⅰ级护理质量显著上升(均P<0.01),患者满意度由实施前的90.5%上升到96.8%。结论开展读书报告会,护士主动参与护理质量管理的意识增强,能有效促进护理质量的改进。     

基于等级医院复核评审标准的护理质量持续改进

目的探讨基于等级医院复核评审标准对改进护理工作质量的效果。方法组织全院护士理论培训,深入学习新标准,建立完善护理质量与安全管理组织架构、工作职责,护理部依据评审新标准完善护理管理体系,运用个案追踪、PDCA循环、品管圈等质量促进工具与管理方法实施护理质量持续改进。结果等级医院复核评审前后护理质量合格情况、护理工作满意度、不良事件发生率比较,差异有统计学意义(P0.05,P0.01)。结论基于等级医院复核评审为标准的护理质量改进措施有效提升了护理质量,保障了护理安全。     

三级甲等医院实施分级管理效果探讨

目的建立适合大型三级甲等医院的护理管理组织体系,提高护理质量。方法设立16个科护士长岗位,建立护理部主任-总护士长-科护士长-护士长分级管理组织体系,分层管理。实施6个月后选取呼吸专科和骨科评价效果。结果分级护理管理组织体系建立与实施后,呼吸专科7项基础护理质量和6项专项质量评分从89.5~99.5分上升至95.5~100.0分;骨科上述质量评分从96.8~100.0分上升至97.0~100.0分。结论分级护理管理组织体系的实施可提高护理质量及工作效率,适合大型三级甲等医院的发展。     

三级甲等医院实施分级管理效果探讨

目的 建立适合大型三级甲等医院的护理管理组织体系,提高护理质量.方法 设立16个科护士长岗位,建立护理部主任-总护士长-科护士长-护士长分级管理组织体系,分层管理.实施6个月后选取呼吸专科和骨科评价效果.结果 分级护理管理组织体系建立与实施后,呼吸专科7项基础护理质量和6项专项质量评分从89.5~99.5分上升至95.5~100.0分;骨科上述质量评分从96.8~100.0分上升至97.0~100.0分.结论 分级护理管理组织体系的实施可提高护理质量及工作效率,适合大型三级甲等医院的发展.     

护理质控体系前移管理效果探讨

目的探讨护理质控体系前移在临床护理管理中的作用。方法前移护理质量三级质控体系,即由病区质控员(一级质控)、护士长(二级质控)、护理部质量控制委员会(三级质控)前移至责任护士(一级质控)、护理组长(二级质控)、护士长(三级质控);培训护理组长,强调预防性质控,完善科室质控上报机制,充分发挥责任护士和护理组长的质控作用。实施1年后评价效果。结果护理质控体系前移实施后基础护理、护理安全、病房管理、消毒隔离、护理文书、急救物品质量评分显著高于实施前(均P0.01)。结论护理质控体系前移可有效提高护理管理质量。     

持续护理质量改进记录本的设计与应用

目的探讨持续护理质量改进记录本在临床护理管理中的应用效果。方法根据卫生部"医疗质量万里行"的要求,护理部自行设计持续护理质量改进记录本,将病区交叉检查,护士长夜查房,病区护士长、组长及责任护士查出的护理问题记录在此本上,并每月召开持续护理质量分析会,对现存的护理问题进行原因分析,列出整改措施并进行效果评价。结果持续质量改进记录本应用后,病区护理质量评分高于应用前,住院患者对护理工作的满意度显著高于应用前(P<0.01)。结论持续质量改进记录本的使用,能激发各层级护士质量管理的潜能,提高护士参与管理的能力,保证护理质量及护理安全。     

Burdened by training not by anaesthesia

Editor—Larsson and colleagues¹ have investigated importantbut often ignored aspects of anaesthetic practice. However,they imply that specialist anaesthetists experience reducedlevels of stress when compared with trainees because they havedeveloped successful coping mechanisms over the years. Thisconclusion cannot be drawn because the specialists' attitudesto work were identified at a particular time and cannot showa progression in learned coping abilities. To demonstrate thedevelopment of these skills, the specialists would have hadto be interviewed     

Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography

Bilateral seminal vesicle puncture and injection of drugs with ultrasound guidance were performed in patients with hemospermia resistant to conservative therapy and with dilated seminal vesicles. Of 7 patients 6 had resolution of hemospermia for 2 to 3 months and then relapse. No side effect was noted.     

Reversal by nalbuphine of respiratory depression caused by fentanyl

In 60 ASA class I or II patients given intravenous fentanyl for elective operations in doses large enough to produce postoperative respiratory depression, the intravenous administration of 20 mg nalbuphine resulted in prompt reversal of respiratory depression without loss of analgesia.     

Tracheal constriction by morphine and by fentanyl in man

The effects of morphine and fentanyl on tracheal smooth muscle tone were studied in 38 patients during induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia was maintained with nitrous oxide, 70 per cent in oxygen, and pancuronium and ventilation was controlled with a respirator. Morphine, 0.5 mg/kg, produced a biphasic response, initially causing tracheal dilatation and then tracheal constriction. Ten minutes after morphine injection, cuff pressure increased to significantly (21 +/- 8 per cent) above control. Morphine-induced tracheal constriction could be completely blocked by the prior administration of atropine, 0.5 mg. Fentanyl, 0.006 mg/kg, also produced significant tracheal constriction, cuff pressures increasing to 44 +/- 11 per cent above control at 10 min. Fentanyl-induced tracheal constriction could be blocked by pretreatment with droperidol, 0.25 mg/kg. At equianalgesic doses, morphine and fentanyl produced similar tracheal constriction.     

Bladder carcinoma treated by preoperative radiotherapy followed by cystectomy

Summary In 1969 a clinical trial was started where patients with bladder carcinoma stage T2 and grade 3 were subjected to preoperative radiotherapy followed by cystectomy. The survival rate in this series was higher than in a previous series of comparable patients who were given full irradiation without cystectomy.     

Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.