急诊患者院内转运存在的安全隐患调查及护理对策

目的分析急诊患者院内转运的风险和利益的关系,为急诊科护士安全转运患者制定护理对策,降低院内转运患者途中的险情发生率。方法对2009-04-2009-09从急诊抢救室转送出的120例患者进行了出科前至接收后全过程的调查。结果患者从抢救室转送出科,进行各项检查、手术、入住监护病房或相应科室,运送过程虽然时间很短,却存在着威胁患者生命或对患者病情及预后有不利影响的隐患,易引起护患纠纷。结论必须重视院内转送患者的工作,采取措施保证患者安全。     

急危重症病人院内转送的安全管理

急危重症病人是大型医院急救中心救治的主要对象,能否对其进行及时的诊断和救治直接影响其救治的成功率,在救治的生命链中院内转送是至关重要的.我院急诊科负责急危重症病人院内的转送,现将其转送过程的护理体会报告如下.     

院内病人转送的安全护理

目的 降低院内转送病人途中的险情发生率。方法 把从急诊科转送住院部及从病房转送ICU的病例作为研究对象。2000年6月～2001年5月转送的病例设为传统转送组，采用传统方法转送。2001年6月-2002年5月转送的病例设为改良转送组。采用改良方法转送。改良转送法主要包括设置合理的转送程序，提高护士对病情综合评估准确度，预先设计途中发生险情时常用的紧急处理预案。结果 院内转送病人险情发生率从0．25％下降至0．03%，抢救成功率上升，险情发生的类别以呼吸系统险情居首位．占62．5％。结论 改良转运法可最大限度地降低院内病人因病情评估不当而引发的转送安全问题。     

全麻病人术后安全转运在手术室的应用

目的：探讨和分析影响全麻病人术后安全转运的因素，完善转运制度和流程，降低院内病人转送途中的险情发生率。方法：随机选择我院手术室全麻术后转送至接收科室的200例病人作为研究对象。2006年6月-2007年5月转送的100例设为传统转送组，2007年6月-2008年5月转送的100例病人设为改良转送组。改良转送法主要包括设置合理的转送流程，提高护士对病情综合评估准确度，以及途中发生险情时的紧急处理能力。结果：院内转送病人险情发生率明显降低，抢救成功率上升。结论：改良转运法可最大限度地降低院内病人因病情评估不当丽引发的转送安全问题。认真执行交接班制度和规范化的流程，有预见的防范措施，是医院护理安全工作中的重要环节，此方法实现了全程无缝隙的转送病人的服务，取得了较好的效果。     

ICU危重病患者院内转运的护理对策

目的通过评估ICU危重病患者院内转运的风险,持续改进ICU患者安全转运的护理对策。方法总结ICU 415例危重病患者院内转运。结果转送成功率为99.3%,出现意外发生率为0.7%。结论对危重病患者进行风险评估和预处理,熟练掌握抢救技术,不断完善转运流程,各种抢救物品处于备用状态,可提高危重病患者院内转运的安全性。     

66例严重多发伤病人院内转送的护理

多发伤是指在同一伤因打击下．人体同时或相继有两个以上的解剖部位或脏器受到严重损伤．即使这些创伤单独存在,也属于较严重。急诊科是多发伤的首诊科室．患者经初步急救、复苏后,被转送到相关科室检查治疗。做好转送途中的护理工作可影响创伤病人后续治疗．现将我们在1999年1月～2000年8月对66例多发伤病人院内转送过程的护理报告如下。     

危重患者院内转送的风险及护理对策

目的 分析危重患者院内转送的风险和利益的关系,为急诊科护士安全转送患者制定护理对策。方法回顾性总结危重患者的院内转送245例次。结果转送成功率为98．76％,出现意外发生率为2．04％,病死率为1．22％。结论对危重患者进行风险评估和预处理,熟练掌握抢救技能,发生险情时冷静、及时、准确地实施急救;不断完善转送流程,对转送工具,抢救器材及药品及时配置、补充并保持完好状态,强化转送记录书写并予以制度保障等,可提高患者院内转送的安全性。     

急诊危重患者院内转送风险与对策

目的分析急诊危重患者院内转送风险，规范院内转送行为，保证医疗安全。方法分析2008年5月658例急诊危重患者的院内转送情况。结果658例患者均安全送至病房，无医疗纠纷发生。结论采取有效措施，规范急诊危重患者院内转送行为，保证医疗安全，提高救治成功率，是减少医疗纠纷的重要措施之一。     

转运治疗急性主动脉夹层的安全性及疗效分析

目的探讨基层医院转运治疗急性主动脉夹层(AD)的安全性及疗效。方法总结2005-2008年住院确诊的AD患者共10例,分析患者入院-转运时间、入院-死亡时间、临床结局情况。结果 10例AD患者转运上级医院6例,均成功、顺利转送上级医院,入院-转运时间1～21 h,转送上级医院耗时2.5～3.5 h;未转运患者4例,均院内死亡,入院-死亡时间5～25 h。结论 AD患者病情危重,及时诊断、转送大型医疗中心行转运治疗安全、可行,是挽救患者生命的最佳措施。     

大面积烧伤伤员长途转送须注意的问题

目的:探讨大面积烧伤长途转送中存在的问题,以提高救治成功率.方法:对106例大面积烧伤休克期长途转送入院患者的临床资料进行回顾性分析.结果:106例烧伤面积15%～80%.烧伤后转送时间为6小时内39例,6～12小时30例;13～24例小时25例,25～36小时12例.转送前及转送途中给予补液、切开气管、抗感染等相应处理.本组死亡31例,其中转送途中死亡10例,入院后治疗过程中死亡21例.结论:立足当地,就地治疗,因地制宜,早期补液,保持气道通畅是基层医院早期救治大面积烧伤的关键,而不应强调长途转送.普及专科知识,建立烧伤急救网是当务之急.     

作业流程重组在住院患者院内检查护送流程中的应用研究

目的 探讨作业流程重组在住院患者院内检查护送过程中应用的临床价值.方法 采用作业流程重组理论中"系统性重新整合"的方法,对住院患者院内检查的护送流程和服务环节进行重组,应用重组后的流程护送住院患者进行院内检查,分别随机选取心电图检查患者126例,X线片检查患者130例,头颅CT检查患者128例为观察组,以护送检查所需时限、患者满意率为研究监测指标,并分别与流程重组前的112例心电图检查、112例X线片检查和120例CT检查患者进行对照比较.结果 流程重组后,心电图检查、X线片检查、头颅cT检查所需时限明显缩短,患者满意率明显提高,与对照组比较,差异均有统计学意义(U值分别为14.55、12.26、13.57,X2值分别为17.37、14.65、10.75,P＜0.01).结论 作业流程重组在住院患者院内检查护送过程中具有非常重要的应用价值,可达到缩短护送检查所需时间,提高患者满意率的目的,对提高效益及医院竞争能力具有重要的现实意义.     

急诊危重患者院内安全转运管理进展

文章阐述了急诊危重患者院内安全转运过程中存在的不良事件及并发症,分析了急诊危重患者转运的病情、转运、人员、药物及设备、沟通等相关危险因素,提出制订转运及相关护理文书规范、加强转运的沟通与交接、完善转运前准备、加强转运中的监测与护理等安全措施,为提高急诊危重患者院内转运的安全性提供参考。     

Deficiencies in Patients' Comprehension of Implantable Cardioverter Defibrillator Therapy

Background: Patients receive education before implantable cardioverter defibrillator (ICD) implantation. Patients' understanding of ICD therapy requires investigation. Methods: A retrospective cohort study was carried out at two implant centers where patients are educated during a consenting process pre-ICD implantation. Questionnaires examining understanding of ICD therapy were completed during telephone interviews of patients with ICDs. Results: Of 75 patients interviewed, 62 (83%) were male. The median age at time of ICD implantation was 64 years (standard deviation [SD] = 9.4; range: 29-82 years). The median interval from implantation to interview was 3 years (SD = 1.9; range: 0.1-9.0 years). Despite 83% (62 of 75) claiming to understand the reason for ICD implantation, no patient suggested arrhythmia termination when describing the indication. Of shock recipients, 60% (12 of 20) felt poorly prepared for shock therapy. Of patients who experienced a device-related complication, 83% (10 of 12) reported feeling inadequately forewarned of complications. Excluding patients with cardiac resynchronization therapy defibrillators (n = 6), 65% (45 of 69), 52% (36 of 69), 50% (35 of 69), and 61% (42 of 69) believe their ICD reduces risk of heart attack and improves breathing, exercise capacity, and heart function, respectively. Ninety-three percent (70 of 75) are satisfied with their decision to accept ICD therapy. Only 12% (9 of 75) believe they will want to inactivate therapies in setting of terminal illness. Conclusions: Despite preimplantation education, patient comprehension of the risks and benefits of ICD therapy is poor. Patients' expectations of ICD therapy may be inappropriate. Education strategies before and after implantation require improvement. (PACE 2012; 35:1097-1102).     

Profiles in Patient Safety: A "Perfect Storm" in the Emergency Department

Correct and rapid diagnosis is pivotal to the practice of emergency medicine, yet the chaotic and ill-structured emergency department environment is fertile ground for the commission of diagnostic error. Errors may result from specific error-producing conditions (EPCs) or, more frequently, from an interaction between such conditions. These EPCs are often expedient and serve to shorten the decision making process in a high-pressure environment. Recognizing that they will inevitably exist, it is important for clinicians to understand and manage their dangers. The authors present a case of delayed diagnosis resulting from the interaction of a number of EPCs that produced a "perfect" situation to produce a missed or delayed diagnosis. They offer practical suggestions whereby clinicians may decrease their chances of becoming victims of these influences.     

QUEST: Questionnaire relating to patients’ Understanding and Expectations of their Symptoms and Treatment

Objectives : To survey patients’ perceptions of illness and their expectations of the emergency department visit in a major tertiary‐referral teaching hospital and to compare these responses with the doctors’ assessment in a major tertiary‐referral teaching hospital. Method : A two‐part survey was conducted. Patient questions focused on patient perception of illness severity, and expectation of process and outcome. Doctor questions focused on the severity of illness and the advice given. Results : Pre‐consultation: Of 141 patients, 94 (67%) were concerned that they were suffering from something serious or dangerous. Eighty‐three of 145 patients (57%) expected an explanation and/or reassurance. Eighty‐four of 145 patients (58%) expected investigation. Twenty‐seven of 135 patients (20%) expected admission to hospital. Post‐consultation: 119/126 patients (94%) who were given an explanation stated that they understood their illness. One hundred and thirteen of 122 patients (93%) felt reassured on departure. Conclusions : In this group of patients, fear of a dangerous or life‐threatening condition not borne out in the doctors’ assessment is common. Present clinical practice, including explanation and reassurance based on clinical and investigation findings, appears sufficient to meet patient expectations.     

Emergency department patient preferences for waiting for a bed

Objective: Many EDs have difficulty transferring admitted patients to inpatient beds in a timely manner because of access block. We assessed ED patient preferences for waiting location. Method: Admitted ED patients at Royal Perth Hospital, Perth, Western Australia, Australia were surveyed over a 4 week period. Patients were questioned about their preferences for waiting location (ED cubicle, ED corridor, ward corridor, no preference). Patients were also asked what they felt was the maximum acceptable time for waiting for a ward bed. We also assessed if patient expectations were met with regards to their waiting times. Results: A total of 400 patients were surveyed. Of all, 121 patients (30.2%) had no preference for waiting location and 215 patients (53.8%) preferred ED cubicles. If the waiting location option was between EDs and ward corridors, 185 patients (46.2%) had no preference. Of the 215 patients who had a preference, 72.1% preferred to wait in a ward corridor (95% CI 65.5–77.8%) and 27.9% preferred the ED corridor (95% CI 22.1–34.5%). Fifty‐seven per cent of patients expected to get to their ward bed within 6 h. Seventy‐two point one per cent (95% CI 66.3%–77.2%) of patients did not have their expectations met for bed waiting times. Conclusions: Patients would prefer to wait in ward corridors for their ward bed if there was no ED cubicle available. Waiting in the ED corridor is their least preferred option. Patients usually expect to get to their ward bed within 3 h. However, with high levels of access block, patient expectations for waiting times for a bed are usually not met. These findings could be used to drive system changes that are more patient‐focussed.     

病房病人转交接本的应用与体会

目的保障病房病人在转交接过程中的护理安全。方法自2008年起使用我院护理部自行设计的病房病人转交接本,以规范临床病人转交接工作。结果使用后未发生科室间及护患间的纠纷,分数化管理提高了转交接本使用合格率(P0.01)。结论病房病人转交接本有效规范了转交接流程,保障了病人在转交接过程中的护理安全。     

后腹腔镜下肾上腺切除术的手术配合

总结11例后腹腔镜下肾上腺切除术的手术配合,包括术前做好心理护理,掌握解剖结构及手术过程,术中严格执行查对制度、保持手术无菌状态,器械的传递做到轻、准、稳、快,与手术医生密切配合,密切观察生命体征尤其是血压及心电图的变化等.结果手术均顺利完成,住院10 d～14 d康复出院.出院后随访2年,11例病人血压均恢复正常.     

医院急诊患者院内转运过程的管理

本文介绍了在急诊患者转运过程中,检伤分类与转运交接记录单在本院的实施流程,重点介绍了急诊患者转运的护送标准,人员、设备的配备;转运途中的观察重点,阐述了检伤分类在整个运送过程中的作用;简单说明了转运交接记录单在转运中的有效作用,最后总结了本院在运用了检伤分类与转运交接单,转运过程的效果。     

风险管理在护理流程再造中的应用

笔者报道风险管理在护理流程再造中的应用方法:成立风险管理、护理流程再造小组;建立风险事件呈报制度;培训全院护士风险防范意识和对流程再造内涵及意义的认识;风险管理、护理流程再造小组分析风险信息及不安全隐患报告。认为建立风险管理护理流程再造组织,以风险管理理念重新审视各项护理工作流程,进行流程再造,可使各项护理工作流程得到进一步的完善,使护理工作更规范、更有序,更好地保障病人的安全,有效降低护理风险的发生,提高护理质量。