手术安全核查制度的解读

目的提高医护人员对安全核查制度及《手术安全核查表》的认知和完成程度。方法建立明确的手术安全核查制度,遵守《手术安全核查表》核查的标准流程,完成手术患者的安全核查。结果通过对手术安全核查制度的解读和有效执行,降低了手术并发症及不良事件的发生率,提高了手术患者的手术安全系数和医护人员的工作质量。结论正确的解读《手术安全核查表》内容并有效的落实到手术患者,能够提高手术医师、麻醉医师和巡回护士对患者核查的准确性,并保障患者的手术安全。     

手术安全核查表存在问题分析及对策

手术安全核查表是执行手术安全核查,防止手术患者、手术部位及术式发生错误的医疗文件,是落实<患者安全目标>中"手术安全核查制度"有效手段,同时在医疗侵权诉讼中,也是医方举证的重要资料[1～3].2010年9～12月,我们于术前、中、后三个环节中采用手术安全核查表,确保手术患者安全.为减少核查表使用中的不足和缺陷,随机抽查325份手术患者病历中的手术安全核查表,对其记录质量进行检查和分析并提出相应对策,取得满意效果.现报告如下.     

数字化视频监控在落实手术安全核查的效果研究

目的 探讨利用中心控制室数字化监控录像在落实手术安全核查管理的效果.方法 首先在多科协作下拍摄既符合国家规范又符合我院实际并以实际操作展示了一个易于学习的《手术安全核查全过程的教学视频》;第二由医院下发文要求外科、麻醉科、手术室组织学习;第三医院制定出各部门监控管理方法和奖惩办法并要求各科室负责人签字并严格执行;最后对比分析严格监控录像监管前后随机抽查100例手术病人查看三步安全核查的落实率.结果 实施监控录像抽查前三步核查落实率分别为(73.0±1.6)％,(81-0.3)％,(67±1.5)％,实施后分别为(98.0±0)％,(98±0)％,(95±1.2)％,结果显示差异有统计学意义(P＜0.01).结论 通过手术室中心监控录像定期和随机抽查安全核查落实情况并及时给予奖惩是科学、高效、公开公平管理模式,提高了安全核查落实率,确保了病人安全.     

手术安全核查标准作业流程的建立与应用

通过分析原有手术安全核查流程存在的缺陷,在查阅文献的基础上,经专题小组讨论,建立手术安全核查标准作业流程,并对医护人员进行系统化培训。手术安全核查标准作业流程包括sign in、time out和sign out 3个关键环节的标准流程,手术团队三方共同合作,分工明确,程序清晰。应用手术安全核查标准作业流程后,手术安全核查规范执行率由62.9%提升至82.3%。手术安全核查标准作业流程可有效促进手术室医护人员规范执行安全核查过程和手术团队内部的交流,是实现患者手术安全的重要保障。     

手术安全核查制度执行状况的质性研究

目的 了解手术安全核查制度在临床的执行状况.方法 采用质性研究中的现象学方法,对33名外科手术人员进行访谈,采用现象学方法进行资料的分析与整理.结果 采用类属分析法升华出5个主题:医务人员对手术安全核查制度的知晓度,手术安全核查制度执行的必要性,手术安全核查制度的可操作性及可行性,手术安全核查制度表的流程及书写,手术安全核查制度对手术安全的执行的有效性.结论 手术人员熟悉手术安全核查制度的内容及意义,对此制度的可操作性及有效性表示肯定.手术安全核查制度的应用对手术安全带来明显成效.     

门诊手术室执行手术安全核查制度存在的问题与对策

目的 探讨门诊手术室执行手术安全核查制度存在的问题与对策,使手术安全核查制度化、规范化,确保门诊手术患者安全.方法 通过调查1 300例门诊手术的安全核查执行情况,认真分析各个环节存在问题和原因,医院各级领导采取了一系列切实可行的整改措施.根据卫生部制定的《手术安全核查制度》,结合医院实际,制定了《门诊手术室手术安全核查制度》,完善并落实了手术安全核查流程.结果 医护人员安全意识增强,对门诊手术患者进行手术安全核查的执行力增加,有效杜绝了手术安全不良事件的发生,保障了患者安全.结论 严格执行门诊手术安全核查制度是保障门诊手术患者手术安全的关键.     

风险核查评估对院内危重患者安全转运的应用分析

目的分析和探讨实施风险核查评估在院内危重患者安全转运中的应用效果。方法选取395例院内危重转运患者为研究对象,其中222例患者为观察组,在转运前实施风险核查评估流程,其余患者为对照组,实施院内患者转运流程。比较两组转运前急救措施落实率、转运过程中意外事件发生率。结果在转运前实施风险核查评估流程,患者转运前急救措施落实率明显提高,转运过程中意外事件的发生率明显下降,差异有统计学意义(P0.05)。结论对院内危重患者实施转运前风险核查评估流程,能有效落实转运前急救措施,降低了转运过程中意外事件的发生率,保证院内危重患者的安全转运。     

提升医护人员执行手术安全核查制度的有效性

目的 探讨手术安全核查制度执行力差的原因,提升其有效性.方法 采取随机跟踪调查手术过程、自制问卷调查我院88名手术科室医护人员,分析其原因,提出改进对策,建立手术安全核查“四步曲”程序.结果 患者佩戴标识腕带率由78.18％提升至100％,患者手术部位标识率由48.18％提升至83.6％,手术安全核查制度执行率由不足20％提升至95％以上.结论 提高思想认识,修订并细化管理流程,持续改进安全管理措施,明确责任,可提升医护人员执行手术安全核查制度的有效性.     

手术患者接送及术前核对表的设计及应用评价

<患者安全目标>是中国医院协会公布的.在<2008年患者安全目标>中的"目标五"明确指出:医院在进行外科治疗的活动中要严格防止手术患者、手术部位及手术方式错误.为认真贯彻落实这一目标,我院参照了该目标中的"手术安全核对表"与"手术风险评估表",结合我院实际工作,自行设计了"手术患者接送及术前核对表",于2009年1月-12月开始使用,细化了工作流程,杜绝了差错事故的发生,降低了手术风险,保障了手术患者的安全,取得了满意效果.现报道如下.     

手术安全核查表的应用与效果

目的:探讨手术安全核查表的应用效果。方法:构建手术安全核查表,组织医务人员培训,组织督导人员现场督促检查,比较应用手术安全核查表前后手术核查正确率、准时率、护理缺陷发生率的差异情况。结果:应用手术安全核查表后,手术室接患者、麻醉开始、手术开始准时率分别为100%,99%,96%,均高于实施前的90%,85%,80%;手术医师、麻醉医师、手术室护士核查的正确执行率分别为98.46%,95.00%,98.00%,均高于实施前的70.00%,65.00%,84.00%;护理缺陷的发生率均低于实施前,除患者皮肤、患者管道、病理标本及非注册护士签名外,其余各项差异均有统计学意义(P<0.05)。结论:手术安全核查表应用后,有效提高了手术人员安全核查的依从性,护理缺陷率下降,确保手术患者安全。     

加拿大医疗风险监测预警机制的循证评价——整合全国卫生资源,建立病人安全体系

目的循证评价加拿大医疗风险监测预警机制的现状及其防范措施，为我国医疗风险监测预警机制的制定提供决策依据。 方法根据本课题组统一制定的检索策略，检索国内外相关数据库和官方网站等，全面收集有关加拿大医疗风险管理、医疗差错和病人安全等方面的文献，并将文献分类分级统计和进行描述性分析。 结果共纳入文献15篇，其中官方文献10篇（占2／3），有确切研究方法文献5篇（占1／3），主要涉及医疗风险管理和评估、医疗差错和病人安全等内容。加拿大于2001年成立国家病人安全指导委员会，提出要求整合全国卫生保健资源，建立病人安全系统，创建病人安全协会以改善病人安全的建议。依托医疗相关机构如医疗保健协会和卫生事业监督委员会等，通过建立和改善病人安全管理制度，收集和发布相关信息、制定具体措施、与医疗组织和机构进行沟通、交流，分享最佳病人安全医疗行为和模式，加强继续教育培训卫生专业人员，完善法律法规程序，增强公民医疗差错意识等途径在医疗风险防范、病人安全保障和医疗质量提高方面，取得了一定的成绩。 结论加拿大医疗风险防范体系较为完善，所采取的措施及其成功经验，对我国整合全国有限的卫生资源、建立科学高效的病人安全系统、增强全民病人安全意识、降低医疗差错都具有重要借鉴意义。     

The Safety Organizing Scale: development and validation of a behavioral measure of safety culture in hospital nursing units

BACKGROUND: Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a "safety culture" is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is positively related to patient safety. OBJECTIVE: We sought to develop and test a self-report measure of safety organizing that captures the behaviors theorized to underlie a safety culture and demonstrates use for potentially improving patient safety as evidenced by fewer reported medication errors and patient falls. SUBJECTS: A total of 1685 registered nurses from 125 nursing units in 13 hospitals in California, Indiana, Iowa, Maryland, Michigan, and Ohio completed questionnaires between December 2003 and June 2004. RESEARCH DESIGN: The authors conducted a cross-sectional assessment of factor structure, dimensionality, and construct validity. RESULTS: The Safety Organizing Scale (SOS), a 9-item unidimensional measure of self-reported behaviors enabling a safety culture, was found to have high internal reliability and reflect theoretically derived and empirically observed content domains. The measure was shown to discriminate between related concepts like organizational commitment and trust, vary significantly within hospitals, and was negatively associated with reported medication errors and patient falls in the subsequent 6-month period. CONCLUSIONS: The SOS not only provides meaningful, behavioral insight into the enactment of a safety culture, but because of the association between SOS scores and reported medication errors and patient falls, it also provides information that may be useful to registered nurses, nurse managers, hospital administrators, and governmental agencies.     

Proposed regulations for enforcement of the Patient Safety and Quality Improvement Act of 2005

The Patient Safety and Quality Improvement "proposed rule" (2008) was published in the Federal Register on February 12, 2008. This "proposed rule," with a comment period extending to April 14, 2008, was created for the purpose of implementing specific facets of the Patient Safety and Quality Improvement Act of 2005; those dealing with the establishment of Patient Safety Organizations (PSOs), confidentiality protection for patient safety activities, and patient safety work product, and reporting by the Secretary of the Department of Health and Human Services (HHS) to Congress regarding successful strategies that have reduced medical errors and have thereby increased patient safety.     

安全教育对改善婴儿照顾者伤害知识和行为的影响

目的探讨安全教育对改善婴儿照顾者伤害知识和行为的影响。方法采取方便抽样的方法,抽取广州市某社区中心92名婴儿照顾者,进行关于婴儿期伤害知识、态度、行为的调查,然后采用安全手册及电话咨询教育的方式对其进行安全教育。比较安全教育前后婴儿照顾者伤害知识、态度和行为得分情况。结果安全教育后婴儿照顾者对伤害知识的认识及态度和行为改善程度优于安全教育前,安全教育前后比较,差异具有统计学意义（均P〈0.001）。结论安全教育可提高婴儿照顾者安全知识,改善其伤害态度及行为,从而为婴儿营造一个安全和谐的环境,有效减少婴儿伤害的发生。     

Leadership and support for safety

This is the second in a series of seven articles on the National Patient Safety Agency's Seven Steps to Patient Safety (NPSA 2004a). Leadership and support for staff can be achieved by ensuring that patient safety has a clear focus throughout the organisation. This article considers the context in which nurses work and provides examples of what can be done at organisational, directorate and team levels to ensure patient safety.     

Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education

BackgroundSince the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.AimTag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.MethodsInformed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.ConclusionTag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.     

Safe intrahospital transport of non-ICU patients

The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.     

Promoting safer home environments for persons with Alzheimer's disease. The Home Safety/Injury Model

This article describes a Home Safety/Injury Model derived from Social Cognitive Theory. The model's three components are safety platform, the person with dementia, and risky behaviors. The person with dementia is in the center, located on the safety platform composed of the physical environment and caregiver competence. The interaction between the underlying dementia and indicators of frailty can lead to the person with dementia performing risky behaviors that can overcome the safety platform's resources and lead to an accident or injury, and result in negative consequences. Through education and research, the model guides proactive actions to prevent risky behaviors of individuals with dementia by promoting safer home environments and increased caregiver competence.     

Violence Prevention Training for ED Staff

The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors. Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.     

The safe use of negative-pressure wound therapy

The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors. Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.