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1.
目的探讨结肠癌根治术的高危风险以及引起风险的主要原因,提出有效的干预策略。方法应用失效模式与效应分析法对结肠癌根治术进行风险识别研究。结果分析得出结肠癌根治术共计8项流程、26项失效环节,排在前lO位的高危风险分别为:观察患者药物反应失误、设备仪器准备不充分、检查时间过长、术前宣教不佳、麻醉前核对失误、手术时间过长、排药错误、术后注意事项告知有误、护士术后核对失误、手术者术后核对失误。结论FMEA法可以有效地识别高危风险,据此有针对性地制定措施、采取策略,能够最终从源头上避免风险的发生。  相似文献   

2.
目的应用失效模式与效应分析(FMEA)对急诊留观病人转运流程进行改造,降低病人转运意外发生率。方法2010年7月成立FMEA小组,运用失效模式与效应分析法评估急诊留观病人转运流程中容易发生失效的原因和将造成的后果,找出流程中最需要改变的环节,改造转运流程,以预防失效的发生。一年后比较评价改造前后失效风险指数(RPN)。结果一年内急诊留观病人安全转运,影响安全转运的失效模式RPN值明显下降(P〈0.01)。结论应用FMEA模式改造急诊留观病人转运流程,使分析危险因素更全面,流程改造更客观,实施更容易,能有效降低病人转运意外发生率。  相似文献   

3.
陈翔  陈爱  管莉倩 《现代保健》2012,(23):140-142
目的:降低微创手术患者的安全风险,从而减少手术失误,提高手术的安全性。方法:选取2010年1—12月本院微创手术患者为对照组,进行安全风险研究,对微创手术患者进行查对流程的监测,经统计讨论分析,计算事先风险指数(RPN),RPN值高的6个项目是影响手术患者安全的高危因素,选取2011年1—12月本院微创手术患者为实验组,运用失效模式与效应分析(FMEA)高危因素,分析高危环节产生的原因,并提出防范对策。结果:对照组6项高危因素事先风险指数总和1570,均值261.67;实验组6项高危因素事先风险指数总和385,均值64.67,实验组高危因素事先风险指数低于对照组。结论:通过对内镜微创手术患者安全风险进行研究,找出安全风险高的环节,进行失效模式与效应分析,可降低高危因素事先风险指数,有效保障手术安全,降低手术风险,提高手术质量。  相似文献   

4.
通过根本原因分析法,对1例潜在严重后果的手术患者止血药物近似错误案例进行剖析,探讨医嘱管理、相似药品、沟通不良、药物相关知识缺乏、惯性思维等对安全用药的影响。口头指示不清或不明可能导致用药错误,口头医嘱存在较高风险;医护人员用药知识不丰富是医嘱错误常见原因之一;系统不完善可能导致用药差错。确保用药安全需要优化制度流程,加强临床医务工作者的有效沟通与协作,强化医务人员角色功能定位以及完善系统等。  相似文献   

5.
医疗活动中的人为错误及其防范   总被引:5,自引:3,他引:2  
人为错误是与主观愿望相违背的计划错误或执行错误.医疗活动中的人为错误是导致医疗事故的重要原因.常见的有手术部位错误、药物误用、治疗方案错误、医嘱误写误读、设备误接误操作等.防范医疗活动中的人为错误可以结合国内和国外的经验,从人员角度和系统角度着手,加强员工教育,改进操作流程,改善硬件设施.对有风险的技术操作设置多重安全措施,以增加打断事故发生链的概率,如手术部位预先画标记和多部门合作核对,用药前人工核对与计算机条形码匹配相结合,采用规范的临床路径等.管理层和一线员工都要对医疗差错有理性认识,鼓励基层上报差错事故,借以发现问题并进行持续质量改进.  相似文献   

6.
为提高急诊无主病人身份识别的正确率,减少差错率。通过对急诊无主病人差错原因进行分析,并针对主要原因患者信息卡编号进行改造流程,观察差错发生情况。结果发现:通过流程改进,把改进前差错率9.8%降至改进后0差错率,且可操作性强。并认为此新流程能明显减少无主病人在诊疗过程中出现的身份识别错误,减少医疗差错.对医院其它管理流程改造有一定借鉴作用。  相似文献   

7.
失效模式与效应分析在用药流程中的应用   总被引:2,自引:0,他引:2  
运用医疗失效模式与效应分析(HFMEA)评估用药管理流程潜在风险因子,并结合用药流程探讨错误因素,提出改善用药安全的可行性方案,并持续追踪改善成效。  相似文献   

8.
目的对心血管内科临床工作中的护理风险因素进行分析研究,积极寻找其防范措施,以减少风险事件的发生。方法对心血管内科72例发生风险事件患者的临床资料进行回顾性分析。结果本组72例患者中,共有10例(13.24%)患者发生护理风险事件。风险事件包括:坠床、跌倒、换错液体、标本送检错误、护患纠纷及其它。风险因素包括患者及家属因素(16.67%)、护理人员因素(61.11%)、药物和医疗器械因素(11.11%)及其它(11.11%)。风险防控对策为:①加强健康宣教;②提升护理人员的专业素质;③加强器械及药物安全管理;④加强病区环境管理。结论在心内科临床护理中存在诸多的风险因素,可通过有效的防范及解决措施,提高护理人员的防范意识,降低护理工作中的风险,减少风险事件的发生,提高医疗质量。  相似文献   

9.
临床护理风险事件分析与防范对策   总被引:1,自引:0,他引:1  
目的:探讨更有效地控制护理风险的方法。方法:评估64例临床护理风险事件在种类、发生人员和科室等方面分布的特点,分析发生的可能原因,为临床护理风险事件的预防提供参考依据。结果:临床护理风险事件以直接风险为主,占风险事件总数的81.3%。给药问题、执行医嘱错误问题和意外事件是临床护理中最为常见的护理风险事件,分别占35.9%、20.3%和15.6%。三类风险事件占总数的71.8%。临床护理风险事件的多发区是工作繁忙的输液室、神经内科、呼吸消化内科,其风险事件的发生数占总数的46.9%。另外,3年护龄以下的护士是发生风险事件的高危人群,占81.3%。结论:临床护理风险事件的防范应以给药问题、处理医嘱问题和意外事件为重点,同时加强风险事件高发护士防范意识和培训工作。  相似文献   

10.
目的调查临床医生进出呼吸道传染病病区穿脱防护用品技能掌握情况,了解其进出呼吸道传染病病区职业防护的薄弱环节。方法制定《医务人员进出呼吸道传染病病区穿脱防护用品标准流程》,对临床医生进行培训,并对培训后的临床医生进行现场实际操作考核,记录其错误环节。结果发生率最高的错误环节为摘手套后未进行手消毒,其次是脱防护用品的区域错误,脱防护服或摘手套时手碰到污染面等。结论虽然经过严格的培训,临床医生在进出呼吸道传染病病区的职业防护流程上仍存在薄弱环节,需加强宣教,以降低传染病医院感染的发生风险。  相似文献   

11.
Comparisons of the efficacy of different regimens of medical abortion are difficult because of the widely varying protocols (even for testing identical regimens), divergent definitions of success and failure, and lack of a standard method of analysis. In this article we review the current efficacy literature on medical abortion, highlighting some of the most important differences in the way that efficacy has been analyzed. We then propose a standard conceptual approach and the accompanying statistical methods for analyzing clinical trials of medical abortion and to explain how clinical investigators can implement this approach. Our review reveals that research on the efficacy of medical abortion has closely followed the conceptual model used for analysis of surgical abortion. The problem, however, is that, whereas surgical abortion is a discrete event occurring in the space of a few minutes or less, medical abortion is a process typically lasting from several days to several weeks. In this process, two events may occur that are not possible with surgical abortion. First, the woman can opt out of the process before a fair determination of efficacy can be made. Second, the process of medical abortion allows time for surgical interventions that may be convenient for the clinician but not strictly necessary from a medical perspective. Another difference from surgical abortions is that, for medical abortions, different medical abortion protocols specify different waiting periods, giving the drugs less time to work in some studies than in others before a determination of efficacy is made. We argue that, when analyzing efficacy of medical abortion, researchers should abandon their close reliance on the analogy to surgical abortion. In fact, medical abortion is more appropriately analyzed by life table procedures developed for the study of another fertility regulation technology; contraception. As with medical abortion, a woman initiating use of a contraceptive method can change her mind after some period of exposure and opt out. Also, as with medical abortion, a contraceptive can fail, usually with the risk of failure depending heavily on whether or not the woman follows the protocol for that method precisely. Finally, as with medical abortion, medical conditions may arise that necessitate discontinuing use of the contraceptive method. In both cases, these medical conditions are sometimes open to interpretation or subject to the skill, judgment, or experience of the clinician involved. The appropriate information to collect for a multiple decrement life table analysis of medical abortion includes data on compliance with the protocol, timing of the event of interest (abortion) when it is observable, and, because we argue that these should be regarded as events of interest, a typology of any surgical interventions that are conducted during the woman's participation in the study.  相似文献   

12.
Context: Current efforts to improve the cost‐effectiveness of health care focus on assessing accurately the value of technologically complex, costly medical treatments for individual patients and society. These efforts universally acknowledge that the determination of such value should incorporate information regarding the risks posed by a given treatment for an individual, but they typically overlook the implications for medical decision making that inhere in how notions of risk are understood and used in contemporary medical discourse. To gain perspective on how the hazards of surgery have been defined and redefined in medical thought, we examine changes over time in notions of risk related to operative care. Methods: We reviewed historical writings on risk assessment and patient selection for surgical procedures published between 1957 and 1997 and conducted informal interviews with experts. To examine changes attributable to advances in research on risk assessment, we focused on the period surrounding the 1977 publication of an influential surgical risk‐stratification index. Findings: Writings before 1977 demonstrate a summative, global approach to patients as “good” or “poor” risks, without quantifying the likelihood of specific postoperative events. Beginning in the early 1980s, assessments of operative risk increasingly emphasized quantitative estimates of the probability of dysfunction of a specific organ system after surgery. This new approach to establishing surgical risk was consistent with concurrent trends in other domains of medicine. In particular, it emphasized a more “scientific,” standardized approach to medical decision making over an earlier focus on individual physicians’ judgment and professional authority. Conclusions: Recent writings on operative risk reflect a viewpoint that is more specific and, at the same time, more generic and fragmented than earlier approaches. By permitting the separation of multiple component hazards implicit in surgical interventions, such a viewpoint may encourage a distinct, permissive standard for surgical interventions that conflicts with larger policy efforts to promote cost‐effective decision making by physicians and patients.  相似文献   

13.
Miller DL 《Health physics》2008,95(5):638-644
Interventional fluoroscopy procedures are increasingly important in medical practice. As new procedures are introduced and validated, they tend to replace the equivalent surgical procedure. There is wide variation in patient dose, both among procedures and for a specific procedure. Stochastic risk is present, but interventional fluoroscopy procedures may also present deterministic risk. Radiation risk/benefit analyses are different for interventional fluoroscopy procedures than they are for diagnostic imaging procedures. The radiation risk component of an interventional fluoroscopy procedure is substantially less than the other procedural risks, and there is always clear and measurable benefit to the patient from a successful procedure. Optimizing patient dose will require both improvements in equipment technology and greater attention from regulators, accrediting bodies and medical organizations. Ensuring adequate operator training is essential.  相似文献   

14.
15.
PURPOSE: This paper aims to determine the one-year incidence of, and risk factors for, perioperative adverse events during in-patient and out-patient anesthesia-assisted procedures. DESIGN/METHODOLOGY/APPROACH: A quality assurance database was the primary data source. Outcome variables were death and the occurrence of any adverse event. Risk factors were ASA physical status (PS), age, duration and type of anesthesia care, number of operating rooms running, concurrency level and medical staff. Data were stratified by in-patient or out-patient, surgical (e.g. thoracotomy) or non-surgical (e.g. electroconvulsive therapy), and were analyzed using Chi square, Fisher's exact test and generalized estimating equations. FINDINGS: Of 27,970 procedures, 49.8 percent were out-patient and greater than 80 percent were surgical. For surgical procedures, adverse event rates were higher for in-patient than out-patient procedures (2.11 percent vs. 1.45 percent; p < 0.001). For non-surgical procedures, adverse event rates were similar for in-patients and out-patients (0.54 percent vs. 0.36 percent). The types of adverseevents differed for in-patient and out-patient surgical procedures (p < 0.001), but not for non-surgical procedures. ASA PS, age, duration of anesthesia care, anesthesia type and medical staff assigned to the case were each associated with adverse event rates, but the association depended on the type of procedure. PRACTICAL IMPLICATIONS: In-patient and out-patient surgical procedures differ in the incidence of perioperative adverse events, and in risk factors, suggesting a need to develop separate monitoring strategies. ORIGINALITY/VALUE: The paper is the first to assess perioperative adverse events amongst in-patient and out-patient procedures.  相似文献   

16.
When statistical models are used to predict the values of unobserved random variables, loss functions are often used to quantify the accuracy of a prediction. The expected loss over some specified set of occasions is called the prediction error. This paper considers the estimation of prediction error when regression models are used to predict survival times and discusses the use of these estimates. Extending the previous work, we consider both point and confidence interval estimations of prediction error, and allow for variable selection and model misspecification. Different estimators are compared in a simulation study for an absolute relative error loss function, and results indicate that cross‐validation procedures typically produce reliable point estimates and confidence intervals, whereas model‐based estimates are sensitive to model misspecification. Links between performance measures for point predictors and for predictive distributions of survival times are also discussed. The methodology is illustrated in a medical setting involving survival after treatment for disease. Copyright © 2009 John Wiley & Sons, Ltd.  相似文献   

17.
A survey was conducted in the largest hospital in Albania to estimate the prevalence and risk factors for nosocomial infections (NIs). A one-day prevalence survey was carried out between October and November 2003 in medical, surgical and intensive care wards. Centers for Disease Control and Prevention definitions were used. Study variables included patient and hospital characteristics, surgical procedures, invasive devices, antibiotic treatment, microbiological and radiological examinations, infection signs and symptoms. Risk factors were determined using logistic regression. In all, 185 NIs were found in 163 of 968 enrolled patients. Urinary tract infections (33.0%), surgical site infections (24.3%), pneumonia (13.0%) and venous infections (9.2%) were the most frequent NIs. The prevalence of NIs was higher in intensive care units (31.6%) than in surgical (22.0%) and medical wards (10.3%). Overall, 132 NIs (71.4%) were confirmed by microbiological examination; the single most frequently isolated micro-organism was Staphylococcus aureus (18.2%). By means of logistic regression, the following independent risk factors were identified: age >40 years, length of hospital stay, 'trauma' diagnosis at admission, and invasive devices. Even though comparisons must be made with great caution, the prevalence of NIs was higher than in western European countries and in some developing countries.  相似文献   

18.
In this paper we consider classical and robust methods of estimation and diagnostics for the multiple linear regression model when some of the errors are correlated. This work was motivated by the analysis of a medical data set, from an observational study aimed at identifying factors affecting the outcome of a surgical method for the correction of scoliosis (abnormal lateral spinal curvature). There are 392 observations but some of them are on the same patient (double curves). It seems adequate to consider a multiple linear regression model but, since it is not desirable to discard the double curves, the assumption of non-correlated errors is clearly violated, and this is indeed confirmed by related diagnostics on the residuals (Durbin-Watson test). A more appropriate model retains the linear structure but allows for non-null correlation between the errors on the same patient. We propose two different procedures for the estimation of the parameters of the linear model and the correlation parameters: maximum likelihood assuming normal errors and a robustified version obtained by plugging-in results from robust linear regression. The latter procedure is designed to be resistant to outlying observations or error distributions with heavy tails and has produced the most satisfactory results for the analysed data set.  相似文献   

19.
How many diagnostic errors occur? How often do errors cause harm, and how serious is that harm? Do we understand the major causes of diagnostic errors? Really, we don't know how to answer these questions! This article seeks to define a challenge facing all healthcare risk managers, whose usual methods of identifying and analyzing errors have not, and cannot, supply this missing information. What should risk managers do about diagnostic error? Our medical literature acknowledges the existence of a problem, but offers few practical solutions. This article will review some promising theories from the literature regarding how to identify and remediate diagnostic errors, and identify some tools and resources available to risk managers.  相似文献   

20.
OBJECTIVE: To develop prognostic models for improved risk adjustment in surgical site infection surveillance for 5 surgical procedures and to compare these models with the National Nosocomial Infection Surveillance system (NNIS) risk index. DESIGN: In a multicenter cohort study, prospective assessment of surgical site infection and risk factors was performed from 1996 to 2000. In addition, risk factors abstracted from patient files, available in a national medical register, were used. The c-index was used to measure the ability of procedure-specific logistic regression models to predict surgical site infection and to compare these models with models based on the NNIS risk index. A c-index of 0.5 indicates no predictive power, and 1.0 indicates perfect predictive power. SETTING: Sixty-two acute care hospitals in the Dutch national surveillance network for nosocomial infections. PARTICIPANTS: Patients who underwent 1 of 5 procedures for which the predictive ability of the NNIS risk index was moderate: reconstruction of the aorta (n=875), femoropopliteal or femorotibial bypass (n=641), colectomy (n=1,142), primary total hip prosthesis (n=13,770), and cesarean section (n=2,962). RESULTS: The predictive power of the new model versus the NNIS index was 0.75 versus 0.62 for reconstruction of the aorta (P<.01), 0.78 versus 0.58 for femoropopliteal or femorotibial bypass (P<.001), 0.69 versus 0.62 for colectomy (P<.001), 0.64 versus 0.56 for primary total hip prosthesis arthroplasty (P<.001), and 0.70 versus 0.54 for cesarean section (P<.001). CONCLUSION: Data available from hospital information systems can be used to develop models that are better at predicting the risk of surgical site infection than the NNIS risk index. Additional data collection may be indicated for certain procedures--for example, total hip prosthesis arthroplasty.  相似文献   

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