ICU护士预防气管插管非计划性拔管护理知信行调查

目的了解ICU护士预防非计划性拔管护理知信行现状,分析其影响因素。方法采用自行设计的ICU护士预防气管插管非计划性拔管护理的知识、态度、行为问卷对80名护士进行调查分析。结果ICU护士预防非计划性拔管知识、态度、行为得分中位数分别为4.50分、7.50分、5.50分;ICU工作年限、职称和工作年限是认知水平的影响因素,ICU工作年限是态度和信念水平的影响因素,职称和科室是行为水平的影响因素(P0.05,P0.01)。结论ICU护士预防气管插管非计划性拔管护理的态度较为积极,但认知和行为状况不佳。应重点加强低年资、低职称的护士预防非计划性拔管的知识技能培训,以提高ICU护士知识水平和护理质量。     

基于SRK模型的护理人为差错类型分析及管理对策

目的了解护理人为差错的特点及其与不良事件的关系,为减少护理不良事件、保证患者安全提供依据。方法从某三级甲等医院的护士不良事件上报系统收集护理不良事件,根据SRK模型进行人为差错分类。结果共收集护理不良事件806起,其中护理人为差错占74.32%,非人为差错占25.68%;在护理人为差错中,规则型错误所占比例最高(58.43%),其次为技能型疏忽和技能型遗忘(分别为22.37%和11.69%),知识型错误和规则型疏忽占比较少(分别为7.18%和0.33%);不同类型护理人为差错导致的不良事件严重程度比较,差异有统计学意义(P<0.01);知识型错误、规则型错误导致的不良事件严重程度显著高于技能型遗忘和技能型疏忽(均P<0.01)。结论护理人为差错是导致护理不良事件的主要因素,知识型及规则型人为差错引起的护理不良事件后果较严重,需要从组织层面和个人层面防范护理人为差错的发生。     

临床用药护理差错现状的调查

目的了解目前临床用药中护理差错发生的现状及原因,探索相应的对策确保用药安全。方法利用自制问卷,10名调查员根据各自的人际网抽取曾发生用药错误的130名护士,对用药护理差错发生的背景、类型、原因、发现的人员与方式进行调查。结果用药差错多发生于白班(46.1%),且以急诊科(36.9%)和重症监护室(35.4%)高发;个人疏忽(85.4%)、对药物不熟悉(36.2%)、对环境不熟悉(35.4%)和繁重的工作负担(29.2%)是用药差错最常见的原因;同事(61.5%)和双核对(26.1%)是发现用药差错的主要途径;给药剂量错误(36.9%)是用药差错的最常见类型。结论用药差错是多种因素相互作用的结果。护理管理者和临床护士应注意用药差错的高危场所、环节与人群,做好差错的危机管理。     

基于关联规则的住院患者非计划性拔管危险因素分析

目的 挖掘住院患者非计划性拔管数据中有价值的关联规则,为制订院内非计划性拔管预防措施提供参考.方法 回顾性整理172例非计划性拔管事件的数据资料,采用Apriori算法进行数据挖掘并进行关联规则评定.结果 筛选出239条规则,结合专业知识选出具有临床指导意义的关联规则12条,其中男性、年龄60岁以上、意识清醒与自行拔除呈强关联,置管时长1～5 d、意识清醒、自行拔除与再次插管呈强关联,意识清醒的男性与3级导管拔除呈强关联等.结论 在护理工作中应防范患者自行拔除管道,加强对3级管道的保护、重视管道置入初期患者的管理、准确评估拔管时机及时撤除管道,以降低非计划性拔管发生率.     

管路固定指导图谱和实操手册在非计划性拔管专项管理中的应用

目的探讨管路固定指导图谱联合实操手册用于护士非计划性拔管专项管理的效果。方法成立预防非计划性拔管专项管理小组,编制"临床常见管路固定指导图谱",制作"导管固定实操手册",并对全院低年资护士实施预防非计划性拔管的培训和管理,比较实施专项管理前后护士管路固定合格率及患者非计划性拔管率。结果实施专项管理后,患者非计划性拔管率显著降低,护士管道固定合格率显著提高(P0.05,P0.01)。结论管路固定指导图谱联合导管固定实操手册应用于临床护士非计划性拔管的预防管理,能有效提高护士管道固定合格率,降低患者非计划性拔管率,提高临床护理质量。     

前馈控制降低ICU气管插管患者非计划性拔管

目的探讨前馈控制降低ICU气管插管患者非计划性拔管的效果。方法对ICU气管插管患者,实施前馈控制干预方案,主要包含成立ICU气管插管患者非计划性拔管的前馈控制管理监督委员会、建立严格的气管插管非计划性拔管风险评估模式(基于SBAR沟通程序的导管交接班流程)、转变护理人员对气管插管非计划性拔管风险管理的理念、加强各能级护理人员相关护理知识及应急技能的培训。结果实施前馈控制后ICU气管插管非计划性拔管发生率由实施前的1.66%降到0.58%;护理人员非计划性拔管相关知识认知、评估技巧(工具)方面及护理对策方面的得分显著高于实施前(均P0.01)。结论前馈控制用于ICU气管插管非计划性拔管管理,能够有效降低气管插管非计划性拔管的发生率,提高ICU医疗护理质量,保障住院患者的医疗护理安全。     

急诊留观患者非计划性拔管预防的护理专案管理

目的 探讨急诊留观患者非计划性拔管预防的护理专案管理效果。 方法 在对前期（2020年4月至2021年4月）收治的急诊留观患者非计划性拔管现状及要因分析的基础上,对2021年5月至2022年5月急诊留观病房收治的患者521例实施非计划性拔管预防的护理专案管理,即细化预防非计划性拔管相关制度及管理策略、强化护士相关培训和考核、优化患者健康教育和反馈、增加护士人力配备、落实持续质量改进等专案管理措施。 结果 实施专案管理后,护士预防非计划性拔管知识、实践得分及患者预防非计划性拔管知识得分显著高于专案管理前,急诊留观患者非计划性拔管发生率显著降低（均P＜0.05）。 结论 对急诊留观患者进行非计划性拔管预防的护理专案管理,可提高护士预防非计划性拔管的知识和实践水平,降低非计划性拔管发生,促进患者安全。     

管道滑脱危险评估表在预防神经外科患者非计划性拔管的应用

目的探讨管道滑脱危险评估表在预防神经外科患者非计划性拔管的应用。方法选取2014年入住神经外科289例置管的患者作为实验组,另选取2013年入住神经外科296例置管的患者作为对照组。对照组按管道护理常规护理管道,实验组在常规的方法上运用管道滑脱危险评估表对置管患者进行评分,根据管道滑脱危险程度采取相应的防范措施,对非计划性拔管的患者进行登记。结果实验组实际发生非计划性拔管3(1.03%)例,与对照组非计划性拔管12(4.3%)例相比,差异有统计学意义(P0.01)。结论运用管道滑脱危险评估表能有效预防神经外科患者非计划性拔管。     

品管圈活动在降低非计划性拔管率中的作用

【摘要】〓目的〓探讨品管圈活动对降低非计划性拔管发生率的作用。方法〓成立品管圈小组,选定活动主题,分析发生非计划性拔管的影响因素,并采取相应的措施,实施质量持续改进。结果〓实施活动后胃管的非计划性拔管率由改善前2.16‰下降至改善中的0.45‰,改善后为1.21‰;锁骨下静脉置管的非计划性拔管率由改善前1.30‰下降至改善中的0.90‰,改善后为1.21‰。结论〓开展品管圈活动促使非计划性拔管率下降,护理人员防拔管意识增强,工作压力减轻,满意度提高;也提高患者导管留置期间的安全性。     

肝胆外科术后脱管风险评估在非计划性拔管预防中的应用

【摘要】 目的 探讨对于肝胆外科术后的患者,导管护理风险评估在非计划性拔管风险控制中的应用效果。方法〓根据标准选择2013年1月~2014年12月就诊于我院肝胆外科并行过手术的85名患者,分为试验组43例和对照组42例,两组患者术后均留置导管。对照组患者(n=42)采用采用常规导管护理,试验组患者(n=43)在对照组的基础上进行留置导管护理风险评估后采用预见性护理干预措施,比较两组患者导管非计划性拔管情况。结果〓试验组患者总的非计划性拔管率低于对照组,其中试验组的胃管、腹腔单腔管、腹腔双套管、中心静脉置管和导尿管的非计划性拔管率均显著低于对照组。试验组的患者在出院时对管道护理相关知识掌握的人数相对比对照组多(P<0.05)。结论〓建立完善管道护理风险评估标准可预防、及时发现和处理意外事故,减少非计划性拔管的发生率。     

Medical manslaughter: Resolving circularity

The legal basis for prosecution and conviction for gross negligence manslaughter has failed to provide prosecutors, judges, and juries with sufficient certainty as to what constitutes the offense in the nineteenth or twentieth centuries. It remains to be seen whether ‘revised guidance’ or a plea for clearer understanding of the elements of the offense of gross negligence manslaughter as set out in the rapid policy review will be a sufficient remedy to allay doctors fears, or whether an entirely new approach is required. If the latter, then founding the charge on the basis of a betrayal of trust between the patient and her doctor may represent a concept that the jury can recognize and empathize with. If a jury can understand a binary decision of betrayal vs nonbetrayal, then the judge's task of direction will be simplified, less ambiguous, providing certainty. At the same time, the Crown Prosecution Service of the UK may find it easier to identify the rare cases of betrayal of trust that merit prosecution.

Clinical negligence

Clinical negligence cases are based on the assumption that a doctor owes patients a duty to take reasonable care when treating or advising them. Doctors breach this duty if their treatment falls below the standard expected by a responsible body of medical opinion. The doctor will be held to have acted negligently. A patient may then have a claim for compensation if, and only if, the patient can prove, on the balance of probabilities, that the negligence has caused physical or emotional injury. A claim must be commenced within 3 years of when the injury occurred or it will be time barred.     

Breast cancer evaluation: medical legal issues

Delay in diagnosis of breast cancer is the leading cause for malpractice lawsuits against physicians. Most cases are tried under civil law and, more specifically, the tort of negligence which defines departures from conduct of a reasonable and prudent physician under similar circumstances. The role of both the clinician and imager, separately and in concert, needs to be understood with respect to accomplishing early diagnosis and avoiding potential legal exposure. An understanding of basic legal concepts as they apply to medical practice should provide health care providers a perspective from which to apply their skills and avoid unnecessary legal exposure.     

Medical negligence and informed consent: an overview

The process of informed consent is central to all clinical practice, and particularly to operative surgery. If complications occur, and surgery has been undertaken without adequate information being provided, patients may potentially bring a claim of negligence. Three separate factors must all be present for negligence to have occurred; it must be shown that a duty of care existed, that this duty has been breached, and that the breach caused harm to come to the patient. For consent to be valid, the patient must have capacity to understand, retain and process the information given; this must include the nature of the procedure, alternative treatment options, and serious or frequently occurring risks. Whilst the use of consent forms is not a legal requirement, trusts invariably insist on it. Consent may be obtained by any suitably trained individual, but it remains the surgeon’s responsibility to ensure this has been done before commencing the procedure.     

Tort liability of xenotransplantation centers

BACKGROUND: In the view of future clinical trials, defining possible legal theories under which xenotransplantation center could be held responsible for any adverse effect on public health is becoming increasingly important. METHODS: In order to better define the tort liability of xenotransplantation center, we reviewed the existing cases and statutes on tort and public health law. RESULTS: Xenotransplantation center could be sued under various tort actions, including negligence, public nuisance or strict liability for ultrahazardous activity. Prerequisites for each legal action are discussed and possible scope of tort liability is addressed. CONCLUSION: The promotion of positive public perception and the development of appropriate insurance system could prevent future class actions to succeed in abating the xenotransplantation industry.     

Trends in malpractice litigation in relation to the delivery of breast care in the National Health Service

Malpractice litigation involving the delivery of breast care has been evaluated in the United States of America (USA) but is a relatively new area of study in the United Kingdom (UK). We sought to study and evaluate the emerging trends in litigation claims in relation to breast disease with the National Health Service Litigation Authority (NHSLA) over the last 15 years, up to December 2010.     

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis

Background

As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs.

When Does the ‘Learning Curve’ of Innovative Interventions Become Questionable Practice?

Demand for less invasive surgical intervention has increased in recent years resulting in surgeons occasionally being pressurised into adopting new techniques before evidence of safety and efficacy has been established. Unlike pharmaceutical research, most innovative surgical procedures enter surgical practice without regulatory oversight. This anomaly was recently highlighted in the ‘Bristol Report’ resulting in a recommendation that unproven therapies or surgical techniques be subjected to ethical overview or independent oversight.When a novel technique is introduced, the surgeon will find himself/herself gaining proficiency and experience on suitable patients. Hence the surgeon embarks on a ‘learning curve’. A learning curve can be defined as a graphic representation showing the relationship between experience with a procedure and outcome. Studies demonstrate that learning curves generally ‘flatten out’ as experience increases, resulting in fewer complications and less of a need to convert to the standard procedure.In addition to lack of regulatory oversight, it is this learning curve that gives rise to many ethical and legal dilemmas. This paper considers the ethical issues relating to a surgeon's candour and clinical equipoise, the legal standard of care in a negligence action and the ethical and legal implications regarding risk disclosure during informed consent. The paper concludes by considering a more patient centred approach where new and innovative therapies are being considered in order to ensure good medical practice and avoid litigation for allegations of negligence or breach of human rights.