Enhancing patient safety: The importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing students

Reid‐Searl K, Moxham L, Happell B. International Journal of Nursing Practice 2010; 16 : 225–232
Enhancing patient safety: The importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing students Medication errors have been the focus of considerable research attention in nursing; however, the extent to which nursing students might contribute to errors has not been researched. Using a grounded theory approach, in‐depth semi‐structured interviews were conducted with undergraduate nursing students based in a university in Queensland to explore their experiences of administering medication in the clinical setting. Almost a third of the participants reported making an actual medication error or a near miss. Where medication errors occurred, participants described not receiving direct and appropriate supervision by a registered nurse. Medication errors by nursing students have the potential to impact significantly on patient safety, quality of health care, and on nursing students' perceptions of their professional competence. Ensuring direct supervision is provided at all times must become an urgent priority for undergraduate nursing education.     

128起给药错误分析

目的:描述给药错误的分类、给患者造成的后果、造成给药错误的原因。方法:对128起给药错误事件进行回顾性分析。结果:护士给药错误占所有给药错误的69.6%,护士转录错误占16.4%。给药错误的分类中,剂量错误占34.5%,其次为药物错误,占19.4%。96.1%的给药错误未对患者造成伤害。造成给药错误的原因中,医护人员个人因素占67.9%,其中违反操作规则,疏忽、粗心,转录错误为主要原因;组织系统因素占17.7%,其中工作频繁被打断、注意力分散、安排没有经验的员工为主要原因。结论:管理者应鼓励医护人员主动上报所有的给药错误,对给药错误的资料进行分析,对组织系统因素进行改善。     

我院精神科护士差错归因分析及管理对策

目的通过对精神科护士差错归因进行分析,以减少差错的发生。方法采用自行设计的精神科护理差错归因调查表,对2003~2005年我院50名精神科护士进行调查。结果50名精神科护士中有22名发生过护理差错,共计52人次。差错的内归因占75.00%,外归因占25.00%。低学历、低年资的年轻护士易发生护理差错。结论在护理管理过程中需加强对护士责任心的培养,督促其严格执行各项规章制度和操作程序。加强专业知识学习,创造优良的工作环境,运用归因理论针对个体差异进行培训。     

护士发生给药错误的特点及原因分析

目的分析护士给药错误发生的特点和原因,探讨如何预防给药错误的发生。方法回顾性分析某三级甲等医院2010年至2012年自愿非惩罚报告系统中上报的给药错误137例,分析护士给药错误的类别、特点及原因。结果给药错误主要发生在综合科室占31.39%,外科占24.82%;患者身份识别错误、药物遗漏、给药技术性错误是给药错误的主要类别;发生给药错误的药物种类,占前2位的分别是抗生素和心血管系统用药;在发生给药错误的原因中,操作过程中没有认真执行查对制度占48.91%。结论护理管理者应根据给药错误的特点制订相应的管理措施,加强护士药物知识的培训,严格执行查对制度,降低给药错误的发生。     

护理差错的分析与启迪

对医院5年来的护理差错进行了调查分析，结果显示：不同班次、不同护龄的护士护理差错发生率有显性差异，不同来源的护士之间也存在差异。针对上述存在问题，提出以下对策：加强护理法规教育，强化护理人员职业道德；转变观念，合理安排护理班次；改善培训模式，重视各类护士的培养管理；改革人员分配制度，建立深层监控系统，通过建立有效的工作系统，保证护士有更多的时间、精力完成高质量的护理工作，确保工作质量。     

Strengthening the nursing and midwifery unit manager role: an interim programme evaluation

clarke e., diers d., kunisch j., duffield c., thoms d., hawes s., stasa h. & fry m. (2012) Journal of Nursing Management 20, 120–129
Strengthening the nursing and midwifery unit manager role: an interim programme evaluation Aims An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health ‘take the lead’ (‘ttl’) programme, an initiative aimed at enhancing nursing/midwifery unit managers’ (N/MUM) skills. Background Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the ‘ttl’ programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Method Semi-structured interviews were conducted with 17 participants who had completed components of the ‘ttl’ programme. The interviews explored participants’ perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. Results The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the ‘ttl’ workshops. Conclusions The results suggest that the studied components of the ‘ttl’ programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Implications for Nursing Management Leadership programmes such as ‘ttl’ may provide an effective tool for improving N/MUM performance and role confidence.     

154例护理差错的原因分析及应对措施

目的：通过对护理差错原因进行分析，查找差错高发的原因，寻求有效的应对措施。方法：对6年的护理差错进行统计和分析。结果：护士职称人员、上午时间段 、外科病区发生护理差错的比例高。而护理差错的类型以输液类占第一位。结论：只有通过加强年轻护士规范化培训，根据不同时间段合理配备人员及强化查对意识，严格执行查对制度，增强安全意识，才能有效地降低护理差错的发生，保证患者的安全。     

护理给药错误事件的危险因素分析及预测模型的构建

目的快速筛查护理给药风险事件,提出全面而有针对性的防范措施,以期指导临床护理工作,确保患者用药安全,提升护理质量,为药物护理质量管理体系提供较为可靠的理论框架和依据。方法采用回顾性病例对照研究设计,选取2016年1月—2018年12月某三甲医院上报的688例护理给药错误事件作为病例组,以病例组例数的2倍数在同时期药物执行数据库中进行随机抽样,抽样1376例未发生给药错误的护理给药事件作为对照组。对给药错误事件发生的相关客观因素及人为因素进行单因素及多因素Logistic回归分析,探讨护理给药错误事件的潜在危险因素,构建护理给药错误事件的风险预测模型。结果单因素分析显示,护士职称、护龄、患者性别、患者文化程度、患者年龄、给药班次、交接班时段、工作时长、给药途径、药物执行的科室是护理给药错误事件的影响因素(P<0.05)。通过多因素Logistic回归分析将护龄、科室、给药途径、患者年龄、是否处于交接班时段纳入最终的护理给药错误事件风险预测模型(P<0.05)。绘制并计算ROC下面积(AUC)=0.765,AUC>0.7,显示该模型有较好的临床预测能力。结论护理给药错误预测模型的构建可为临床药物护理提供理论依据,对于保障医院药物护理管理体系更具针对性及实用性,能够保证护理安全。     

基层医院护士对护理科研认知的调查分析

[目的]了解基层医院护士对护理科研的认知情况,分析基层医院开展护理科研的困难及需求,为针时性地实施科研指导提供依据.[方法]对某市6所镇级医院492名护士进行护理科研认知情况的问卷调查.[结果]基层医院护士开展护理科研的意识及能力普遍较差.[结论]需要积极引导基层医院护士进行科研,提高护士科研意识及能力.     

Determinants of tenure in allied health and nursing education

AIM: This paper presents a prospective cross-sectional study that investigated the tenure rate and the primary criterion use in granting tenure in nursing and allied health education in the United States of America. BACKGROUND: Given the recent trend by highly skilled professionals to seek employment in other countries, a clear understanding of the conditions of service in higher education is important to educators contemplating the relocating to another country. The preponderance of the published literature on academic tenure is from the United States of America, where educators continue to debate the value of the tenure system and the criteria to be used in tenure decisions. METHOD: We surveyed the deans of National League for Nursing accredited programmes (n = 187) and deans of allied health programmes belonging to the association of schools of allied health professions (n = 75) in the United States of America. The questionnaire sought demographic and institution-related information, tenure rate and weightings attached to teaching, scholarship and service in tenure decision. The data were collected in 2002. FINDINGS: Allied health and nursing educators had 47% and 35% tenure rates, respectively. The overwhelming majority of the deans in our study, 77%, ranked teaching as the primary criterion used in tenure decisions in their institutions. On the other hand, fewer than 25% rated scholarship and fewer than 5% rated service as the most important criterion used for tenure in their institution. The responses of the deans were modulated by the type and ownership of the institution in which they were employed and the characteristics of the educators. CONCLUSION: The implications for preparing future educators in the United States of America for long-term careers in allied health and nursing professions are that: (1) teaching is less highly valued in research-oriented universities; and (2) heavy teaching workloads may be detrimental to the chances of obtaining tenure. Replication of the study in other countries would have the potential to facilitate the employment mobility and educator exchange.     

我院护理给药差错管理办法的实施与效果

目的有效控制护理给药差错的漏报率，提高住院病人的安全。方法成立护理给药差错评定小组，强化护理人员的安全意识，扩充有效的给药差错报告渠道，细化奖惩细则及评价标准。结果实施护理给药差错管理办法后，给药差错漏报率有明显降低，差异具有统计学意义（P〈0．01）。结论合理的护理给药差错管理办法能激励当事人和科室管理者主动上报差错的发生情况，使护理给药差错管理纳人良性循环。     

护士给药错误管理研究现状

医院不良事件中用药错误的发生率较高。从护理专业角度,对国内外给药错误的基本概念、后果、现状分析、量化管理、发生因素及预防措施进行综述,为护士给药错误的管理提供依据,以保障和促进病人安全。     

住院病人静脉药物治疗给药错误环节分析与对策

目的分析住院病人静脉药物治疗过程中发生给药错误的环节,为制订改进措施提供依据。方法回顾性分析某三级甲等医院过去5年护理非惩罚性主动上报静脉药物治疗给药错误环节、给药错误类型及发生给药错误原因。结果静脉药物治疗发生给药错误的环节由高到低依次为：护士给药操作、护士医嘱处理、护士配药、医生开具医嘱、药房配药发药、病人依从性差;发生给药错误涉及护士、医生、药师、病人;给药错误类型为：药物错误、遗漏给药、发错病人等,操作不规范和流程设计不合理是发生给药错误的主要原因。结论由护士失误引起的给药错误所占比例最高,特别是由护士个人完成的环节,给药错误发生率最高;整体理念是研究预防给药错误发生对策的关键,提高护理管理水平,减少给药错误的发生要从多方面考虑。