门诊伤口处理中的风险管理对策与效果

目的探讨门诊伤口处理中风险管理的方法及其效果。方法按入选标准和剔除标准筛选643例在门诊伤口护理中心治疗的急慢性伤口患者，初诊时采用询问、伤口评估、诊断性检查评估其风险因素；在每项伤口处理操作前评估伤口处理难度和所实施操作将来的创伤风险和感染风险。从制度管理、流程和过程管理、环境监控等方面采取对策，观察了各类伤口的治愈率，了解患者对操作、治疗结果、环境的满意度。结果急性伤口和慢性伤口的治愈率分别为99．4％和91.7％，手术后伤口愈合时间为7～12d，无1例发生感染。患者对操作过程满意率为99．9％，对治疗结果满意率为97．8％，对治疗环境满意率为97．7％。2年无纠纷、零投诉。结论伤口处理风险多，从制度入手、强化流程和过程管理、重视环境监控，是确保风险管理有效的方法。

Strategies and Effectiveness of Risk Management for Wound Treatment in the Outpatients

Objective To study the strategies and effectiveness of risk management for wound treatment in the outpatients.Methods According to the inclusion and exclusion criteria,643 patients with acute or chronic wounds treated in the Wound Care Center of the Outpatient Department were enrolled in this stud- y.The actual and potential risk factors of patients were assessed upon their first hospital visit by direct in- quiries,wound condition evaluation,and diagnostic examinations.Before performance of each wound treatment procedure,the difficulty of wound treatment and the risks of additional trauma and infection in association with the procedures to be carried out were estimated.Measures were taken for management of the nursing principles,flowsheet and process as well as environmental surveillance,and the wound healing rate and the patient's satisfaction with the nursing operation,outcomes and the environment were ob- served.Results The acute and chronic wound healing rate was 99.4% and 91.7%,respectively.The heal- ing time of surgical wounds(53 cases)ranged from 7-12 days without any infection episode recorded.The patients had a satisfaction rate of 99.9%with the nursing operation,97.8% with the outcomes and 97.7% with the environment for treatment.No dispute and complaint occurred in two years.Conclusion Wound management is a process open to multiple risk factors.Establishment of the principles,rigorous management of the flowsheet and process,and close environmental surveillance are key factors to ensure successful risk management.