手术室护理安全干预机制在安全管理中的应用

目的:探讨手术室护理安全干预机制在安全管理中的应用效果。方法:根据手术室工作中出现的安全隐患,提出护理安全干预措施,分析其在安全管理中的应用效果,比较实施前后医疗差错及患者满意度情况。结果:实施护理安全干预措施后医疗差错明显减少,患者满意度明显提高,实施前后比较差异均有统计学意义(P0.05)。结论:手术室护理安全干预机制应用于安全管理中,可有效提高手术室护理安全质量,降低手术室护理缺陷,提高患者满意度。     

住院患者医疗服务收费差错原因分析与对策

目的探讨减少住院患者医疗服务收费差错的方法。方法抽查2007年10月-2008年9月618份病历，发现收费差错病历170份。针对收费差错的发生原因，采取组织人员培训与收费过程的及时指导；完善项目维护、查对责任到人；改变检查费的收费流程，增加检查科室审核系统；设置检查费套餐收费；落实奖惩制度等方法以减少收费差错的发生。结果采取针对性改进措施后，抽查2008年10月-2009年9月共660份病历，发现收费差错病历125份，差错率（18．9％）较改进前（27．5％）明显降低（P〈0．01）。结论熟悉新的医疗服务价格项目内容，改变收费观念，总物价员对在院病历进行及时检查指导，完善项目维护及查对责任到人，落实奖惩制度，可减少住院患者收费差错的发生。     

基于系统化整体护理方法的护理差错控制探讨

目的探讨系统化整体护理中预防与控制差错的措施。方法通过全员学习参与，提高认识，制订先控措施，实施到位。结果预防措施实施后患者的护理满意度显著提高，护理差错也得到了有效控制。结论在系统化整体护理中，提高预防意识，强化先控措施是确保医疗护理安全，减少差错发生的有效方法。     

医疗美容科护理危机产生的原因及管理对策

目的探讨医疗美容科护理危机产生的原因并制定相应对策,减少危机事件的潜在危害,提高护理质量。方法选择2009年8月至2010年8月就诊患者810例次与实施危机管理措施后2010年9月至2011年8月就诊患者1032例次为研究对象,比较实施护理危机管理措施前后护理缺陷发生率、护患纠纷发生率和患者的满意度。结果实施护理危机管理措施后护理缺陷和护患纠纷发生率分别由4．2％,1．6％下降至2．2％和0．5％,患者满意度由86．9％提高至90．4％,差异均有统计学意义（X2分别为5．866,7．279,5．599;P〈0．05）。结论医疗美容科应用护理危机管理措施能减少危机事件对科室的潜在危害,提高医疗美容护理的抗风险能力,为患者提供安全、优质的护理服务,提高患者满意度。     

门诊药房发药差错分析及防范措施

目的：减少门诊药房发药差错，提高药品调剂的质量。方法：分析差错原因、在此基础上采取相应的干预措施，并对采取措施前后的情况进行比较。结果：采取干预措施后，差错发生率降低了74．6％。结论：通过干预措施有效减少门诊药房发药差错，提高了调剂工作质量。     

实施“医护患三位一体”查房初探

目的 探讨“医护患三位一体”查房在整体护理中的作用。方法 在整体护理模式病房中实施医生、护士、病人三者联合查房,共同讨论疾病的诊疗计划的制订、实施。并通过医院在实施“三位一体”查房前后历次季度检查中的民意测验,对比分析实施前后病人对其疾病知识的知晓率、对其诊疗措施的知晓率、病人对医护满意度及医疗纠纷的发生率情况。结果 实施“三位一体”查房后,病人对其疾病的病程发展及转归的知晓率和对其诊疗措施的知晓率从原来的60.3％上升至90.5％。病人对医护工作的满意度由原来的84.0％上升为97.9％。医患纠纷的发生率由原来2.6％下降至0.3％,均P<0.01,差异具有统计学意义。结论“医护患三位一体”查房能有效地提高病人对其疾病的诊疗措施的知晓率,提高病人的满意度,减少医患纠纷的发生率,降低医疗差错、事故的发生率。     

流程再造管理在门诊输液室中的应用

目的设计合理的工作流程，规范门诊输液管理。方法运用流程管理的思维和方法，对门诊输液室工作流程进行再造。记录实施后半年内护理差错及缺陷的发生情况和患者满意度情况，并与去年同期相应的数据进行比较。结果门诊输液流程再造前后，护理差错及缺陷发生率分别为0．012％、0．002％，患者满意度分别为92．9％、97．9％，流程再造前后比较，均P〈0．05，差异有统计意义。结论输液流程再造有利于减少护理安全隐患，保证护士执业安全和患者的安全。     

护理干预在急诊风险管理中的应用

目的 观察护理干预在急诊风险管理中的应用效果,为其在临床的应用提供理论依据.方法 2010年1～12月我院急诊科在急诊风险管理中引进了护理干预概念并开展相关工作,此期间收治患者1268例,另外选择实施护理干预前2009年1～12月收治的754例患者,将实施护理干预前后的效果进行比较.结果 实施后患者的满意度为98.00％,显著高于实施前的满意度80.00％;实施后出现护理差错或过失1例,实施前出现护理差错或过失10例,实施前后急诊护理人员全年常规理论考核成绩分别为(76.48±12.14)分,(86.44±10.43)分,差异显著.结论 护理干预在急诊风险管理中的应用能提高患者满意度,减少护理差错与过失,提高护理人员的工作能力,有一定的推广应用价值.     

门诊输液环境改造对提高护理安全的作用

目的:研究提高门诊输液环境对提高护理安全的作用。方法:通过改善门诊输液室的硬件设施、优化诊疗及输液流程、创造优质的输液条件等措施以实现优质护理服务,从而提高门诊护理安全,并采用自制门诊输液满意度调查表评价输液环境改造前后病人满意度。结果:输液环境改造前共统计输液病人86 432例,发生护理差错40例;输液环境改造后共统计输液病人79 361例,其中发生护理差错15例,环境改造前后护理差错发生率、病人满意度比较有统计学意义。结论:在软硬件方面改造门诊输液环境,采用临床护理路径实施优质护理服务,有助于减少护理差错的发生,提高病人护理安全及满意度。     

基层医院门诊注射室纠纷与差错预防措施探讨

目的探讨预防纠纷与差错发生的方法，以减少基层医院门诊注射室差错纠纷的发生。方法通过全员学习参与、提高认识、制订先控措施、监督实施、定期总结考评。结果预防措施实施一年后纠纷与差错发生率显著降低。结论提高预防意识，强化先控措施是确保医疗安全，减少纠纷与差错发生的有效方法。     

Always having to say you're sorry: an ethical response to making mistakes in professional practice

Efforts to decrease errors in health care are directed at prevention rather than at managing a situation when a mistake has occurred. Consequently, nurses and other health care providers may not know how to respond properly and may lack sufficient support to make a healthy recovery from the mental anguish and emotional suffering that often accompany making mistakes. This article explores the conceptualization of mistakes and the ethical response to making a mistake. There are three parts to an ethical response to error: disclosure, apology and amends. Honesty and humility are discussed as important virtues that facilitate coping and personal growth for the health care provider who is involved in mistakes. In conclusion, a healthy view of nursing practice and mistake making is one that prevents error but, when prevention is not possible, accepts fallibility as part of the human condition and achieves the best possible outcome for all.     

2型糖尿病患者饮食治疗存在的误区及护理干预

目的 探讨糖尿病患者饮食治疗存在的误区及护理干预效果。方法 采用自行设计的饮食治疗知识调查表,评价100例住院2型糖尿病患者饮食治疗存在的误区,并实施饮食护理教育、评价教育干预效果。结果 有40％左右的患者对糖尿病综合治疗中的作用、每日机体所需的七大营养要素、甜味剂的使用、膳食纤维的食用、当舍并糖尿病肾病时蛋白质的撮入量、每日盐的食用量、水果的食用、花生、瓜子的食用及对食品交换表的认识均存在不同程度的认识不足及错误。糖尿病教育明显提高患者的饮食治疗知识水平（P〈0．01）。结论 糖尿病患者饮食治疗存在较多误区,饮食教育千预使患者走出误区,明显提高患者的饮食治疗知识水平。     

Finding blunders in thyroid testing: experience in newborns

We evaluated thyroxin (T4) and thyroid‐stimulating hormone (TSH) data along with clinical information from 600,000 newborns. We looked for certain combinations of tests and clinical data that were questionable and possibly mistaken. Our approach suggests that certain combinations of test results, especially the presence of missing results deserved further evaluation for possible blunders. We found that missing tests were frequently the result of oversight. The laboratory used the well‐known standard blood‐spot‐on‐filter paper methods for TSH and T4. For quantitation of TSH and T4, we used the time‐resolved fluoroimmunoassay available from Perkin Elmer. We found 56 babies with confirmed primary congenital hypothyroidism (PCH) in a total of 600,000 patients. We also found 18 sets of results in the same 600,000 babies that gave inconsistent findings, had missing values, and (or) possible misinterpretations of the clinical and (or) laboratory data. What is an acceptable mistake rate? All mistakes are unacceptable, but there is likely some irreducible mistake rate, and efforts to reduce the mistake or blunder rate still further may not be cost‐effective. What can be done is to study the mistake rate per 600,000 babies from year to year; the mistake rate should be decreasing or not changing. This assumes a stable cohort of babies; an assumption that may be acceptable. We applied a form of pattern recognition to identify cases of possible blunders and missing values in either the laboratory or clinical data. What is clear is that we apparently identified some blunders. The 18 mistakes per 600,000 babies may be “very low” and acceptable. We recommend that seeking ever decreasing mistakes is the way to go, and the level of monitoring the data should be very intense given the serious consequences of mis‐diagnosed thyroid disorders. J. Clin. Lab. Anal. 22:254–256, 2008. © 2008 Wiley‐Liss, Inc.     

SHEL模式在外科护理差错防范中的应用

护理差错的发生是多因素的。在外科护理管理过程中,应用SHEL(S-soft:软件部分,H-hard:硬件部分,E-environm ent:临床环境,L-litigant:当事人及他人)模式加强护理差错防范,从提高护士综合素质,改善工作环境,加强关键人员、工作制度、重点工作时段控制以及对重点病人的护理管理,制定行之有效的防范措施。经过2年的实践,使13个外科科室护理差错发生率明显下降,病人对护理工作的满意度提高。     

Toward a Theory of Self-Reconciliation Following Mistakes in Nursing Practice

PURPOSE: To explore nurses' responses to making mistakes in hospital-based practice in the US. METHODS: A grounded theory approach was used to explore the process that occurs after nurses perceive that they have made mistakes in practice. Theoretical sampling was used and data were collected until saturation occurred. Ten participants, who were registered nurses, described 17 personal mistakes. The mistakes they described occurred in hospitals. All participants were practicing nursing either in hospitals or in other work settings. FINDINGS: A process of "Self-Reconciliation After Making Mistakes in Hospital Practice" was identified, with four distinct categories: reality hitting, weighing in, acting, and reconciling. The core category was reconciliation of the self, personally and professionally. CONCLUSIONS: This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested.     

临床护理教学中预防护生发生差错事故的做法与体会

目的预防护生发生差错事故。方法抓好护生临床实习每个阶段的教育和技术培训,即:岗前防范教育、岗前技术培训、在岗教育、实习末期教育。结果增强了护生法律意识和安全意识,提高了护生自身素质和各项技术操作水平,以零差错事故率完成临床实习任务。结论抓好护生实习每个阶段的教育和技术培训,是防止护生差错事故发生的有效对策。     

The three most common errors in family nursing: how to avoid or sidestep

In this article, the authors offer what they believe to be the three most common errors or mistakes in relational family nursing practice. Each error is described, followed by practical suggestions on how the mistake or error can be avoided. A clinical case vignette for each error is also given, with useful ideas of how the mistakes could have been avoided or sidestepped. By sidestepping and avoiding the most prevalent mistakes, nurses can not only sustain but also improve their nursing care of families and thus prevent unnecessary anguish and suffering of family members and possible shame, guilt, or embarrassment on the part of the nurse.     

Learning by mistake. The status of error in the initial education of nurses

This study shows the diversity of the mistakes made by the nursing students. The evolution of the mistake status in the framework of the training evaluation remains limited. Even though the mistakes are sometimes comparable between the I.F.S.I (nursing schools) and the care services, they are not dealt with in the same way. In the service, the professionals avoid the incidents, thanks to their very strong vigilance. Mistake is not used as a learning tool, people rather tend to eliminate and punish it. In the I.F.S.I there is a lack of thorough research related to the understanding and the usefulness of mistake. Mistake anticipation must rely on the student's experiences and on the information he has at his disposal; it comes within the framework of risk anticipation so that the student avoids being involved in a procedure dangerous for the patient. Mistake training can bear its fruit in a training period only if there is a transfer; therefore, it is integrated in the process of corrective anticipation. This study opens new ways for research because mistake anticipation leads to the development of a risk policy based on everybody mobilization.     

住院日清单致医患纠纷原因分析及对策

当前住院费用“日清单”导致的医患纠纷日趋增多．而且处理难度大．成为护理人员的工作难点之一。作分析了导致纠纷的原因：日清单设计欠完善；患对医疗收费陌生引起误会；对现行医疗保险体制不适应；微机医嘱出错以及护士缺乏处理由医疗费用引起纠纷的经验。提出了管理对策：完善日清单；加强微机医嘱的管理；提高护士处理医疗费用纠纷能力以及为病人提供高效、低耗、优质服务。     

护理事故差错原因的“冰山角”模型分析

目的 对护理事故差错原因进行表面原因、过渡原因和根本原因的分类,便于提出对策.方法 采用文献查询法和头脑风暴法,提出护理事故差错的原因,合并雷同原因,使用“冰山角”模型进行分类分析.结果 责任心不强、工作负荷大、职业作风不严谨、监督机制欠缺、护理人员配置不足为根本原因,医疗缺陷为表面原因,其余为过渡原因.结论解决护理事故差错的关键是加强责任心的培养,形成严谨的职业作风;配置充足的护理人员,减轻护理人员工作负荷;完善监督机制,加强监督.