组织模拟演练,提高应急能力和保障患者安全

目的探讨如何应用《手术室应急手册》组织模拟演练来提高应急能力和保障患者安全。方法麻醉科每间手术室内配备了手术室应急手册,麻醉科成立了模拟教学团队,在手术室内和模拟中心分别开展了"手术室危机事件管理模拟演练"并制作了手术室内危机事件处理的演练视频,经过多学科协作的演练培训,将应急手册整合入临床实践中。在模拟演练中,团队成员扮演不同的角色,通过运用模拟人、呼吸机、监护仪、抢救车及除颤仪等设备,根据模拟病例的实际情况进行操作,并通过导师们的点评和自身汇报总结,发现和改进处理过程中的不足。通过问卷调查评价组织模拟演练的效果。结果 57.96%的答题者同意有能力处理手术室危机;88.46%同意有信心与团队合作来处理手术室危机;61.54%的答题者同意相信有能力带领团队来处理手术室危机。88.46%的答题者同意如果紧急事件发生,一定会用应急手册。65.38%的答题者至少1次处理手术室危机时使用应急手册。结论模拟演练可提高麻醉医生处理手术室危机的信心和团队协作的能力。许多麻醉医生已经成功使用应急手册处理手术室危机。模拟演练可使麻醉医生及时使用应急手册来解除危机,保证患者安全。可以用模拟表演的教育方式来推动基层医院的应急手册模拟演练。     

移动护理系统在优化日间化疗病房用药安全中的应用

目的：探讨移动护理信息系统( PDA )在优化日间化疗病房用药安全中的应用效果。方法从本院护理系统不良事件上报系统中的数据收集2015年4~9月PDA使用前1823例患者中给药差错发生例次与2015年10月至2016年3月PDA使用后1928例患者中给药差错例次进行比较。结果使用PDA后用药差错率明显低于使用PDA前差异有统计学意义( P<0.05);使用PDA后用出院患者的满意度明显高于使用PDA前( P<0.05)。结论 PDA的使用改进了护理工作流程,有效预防用药差错,确保用药安全,提高了护理质量及出院患者满意度。     

医疗失效模式与效应分析在儿科静脉用药调配中的应用

目的 探讨医疗失效模式与效应分析在儿科静脉用药调配中的应用效果。方法 成立医疗失效模式与效应分析小组并绘制儿科静脉药物调配流程图,以风险危机值评估流程中潜在的失效模式,对风险危机值≥8分的项目制定整改措施并实施,比较实施前后儿科静脉用药调配的差错率及失效模式的风险危机值。结果 医疗失效模式与效应分析实施后儿科静脉用药调配差错率由0.120%降为0.026%,差异有统计学意义（P<0.05）;实施后药物与标签不符、调配剂量不准确、溶媒量与标签不符、肠外营养液调配顺序错误、注射器漏液（微量泵专用）、液体内有异物及签字或标识不完整7项失效模式的风险危机值均比实施前下降,差异有统计学意义（P<0.05）;结论 对儿科静脉用药调配工作流程运用医疗失效模式与效应分析,可降低儿科静脉用药调配差错率,值得临床借鉴使用。     

《手术室应急手册》模拟演练的评价

目的通过组织《手术室应急手册》模拟演练比赛的调查来评价其培训教学的价值。方法 2017年5月,组织参照斯坦福麻醉手术室应急手册创作小组《手术室应急手册V2.4》进行现场模拟演练比赛,赛后对7家医院45名医护人员进行问卷调查。结果 45名医护人员全部完成调查,完成率100%。93.33%赞同模拟演练可以促进参加演练的积极性;95.56%赞同模拟演练可以促进了解为什么要使用《手术室应急手册》;97.78%赞同参加模拟演练可以促进医护人员使用《手术室应急手册》;97.78%赞同观摩模拟演练能够受益;97.78%赞同模拟演练极其重要。结论《手术室应急手册》模拟演练是一种有效的教学培训手段,提高了医护人员应用《手术室应急手册》和处理围手术麻醉期危机事件的能力。     

改进信息管理系统在静脉用药调配中心差错防范中的应用

目的:应用信息管理系统,防范静脉用药调配中心差错的发生,防止药品浪费,保证病人用药安全.方法:将2011年9 ～12月配置液体总量232 752袋设为对照组;2012年2～5月配置液体总量350 865袋设为观察组.对照组实施信息管理系统,观察组在分析信息管理系统配置输液总量及发生的差错量基础上增加功能模块.观察两组差错率发生情况.结果:对照组差错发生率为0.089％,观察组差错发生率为0.018％,两组比较差异具有统计学意义(P＜0.01).结论:合理运用信息管理系统,可降低工作中差错发生率,防止药品浪费,提高患者用药的安全性.     

静脉用药调配中心护理差错事件的影响因素分析

目的 探究静脉用药调配中心护理差错事件发生的影响因素。方法 选择2021年1—12月全市三级甲等综合医院静脉用药调配中心护士共100名为研究对象,采用一般资料问卷、护理差错调查问卷、马氏职业倦怠量表对护士进行调查或评价,统计静脉用药调配中心护理差错事件发生情况,采用单因素分析、多因素Logistic回归分析静脉用药调配中心护理差错事件发生的影响因素。结果 静脉用药调配中心未出现过护理差错事件的护士共85名,出现护理差错事件15名,其中发生1次护理差错的护士9名,2～3次护理差错护士共3名,≥3次护理差错的护士共3名。多因素Logistic回归分析显示,静脉用药调配中心护理差错事件发生的影响因素有工作年限、职称级别、年培训次数、自我学习习惯及护士职业倦怠感量表情感枯竭、去人格化、个人成就感（P<0.05）。结论 静脉用药调配中心护理差错事件的发生是多因素作用结果,护士职业倦怠感与静脉用药调配中心护理差错事件的发生相关,故应强化临床护理管理,积极调节护士职业倦怠,以降低护理差错事件发生率。     

4R危机管理模式对急诊科护理人员危机事件处理能力的提升价值

目的 探讨4R危机管理模式在急诊科中的应用效果。方法 采用便利抽样法,选取2020年4月-2021年3月本院急诊科采取常规管理期间收治的48例患者及同期护理人员28名作为对照组;选取2021年4月-2022年3月本院急诊科采取4R危机管理模式期间收治的48例患者及同期护理人员28名作为观察组。比较两组护理人员危机事件处理能力、患者急诊救治时间、危机事件发生率和患者满意度。结果 观察组护理人员危机事件处理能力评分高于对照组(P<0.05);观察组院前急救反应时间、确诊时间和急诊至手术时间均短于对照组,危机事件发生率低于对照组(P<0.05);观察组患者满意度评分高于对照组(P<0.05)。结论 在急诊科中采取4R危机管理模式,能够提高急诊护理人员危机事件处理能力,有效缩短急诊救治时间,减少危机事件发生,从而提升患者满意度。     

社区老年心血管疾病患者用药差错现状及影响因素分析

目的调查社区老年心血管疾病患者用药差错的现状,并分析其影响因素。方法采取便利抽样法选取郑州市某社区120例老年心血管疾病患者为研究对象,采用一般资料调查表和患者用药差错调查表进行问卷调查。结果 120例老年心血管疾病患者用药差错总分为(22.76±3.35)分。多元逐步回归分析结果显示,患者用药年限、月收入及服药种类是老年心血管疾病患者用药差错的影响因素。结论患者用药差错发生率较高。社区老年心血管疾病患者经济收入越低、服药种类越多、用药年限越长,其用药差错率越高,亟需社区医护人员针对不同人群采取针对性的干预措施,改善其用药差错现状,促进用药安全。     

输血前预防性用药对输血不良反应发生率影响的Meta分析

目的 通过Meta分析系统性评价输血前预防性用药与输血不良反应发生率的相关性。方法 计算机检索Pubmed、Embase、Cochrane Library、CNKI、WanFang Data和VIP数据库,查找关于输血前预防性用药对输血不良反应发生率影响的相关文献。检索时间均为建库至2021年5月9日。由2名研究人员按照纳入和排除标准对文献进行独立筛选,提取相关数据资料,进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果 最终共纳入36篇文献,合计137 996例次患者输血,其中62 581例次患者输血前用药,75 415例次患者输血前未用药。1 742例次患者在输血时发生不良反应。Meta分析结果显示：输血前用药组输血不良反应发生率与未用药组无统计学差异{[RR=0.88, 95%CI(0.76,1.01),P>0.05]},输血前用药组发热反应的发生率低于未用药组{[RR=0.72, 95%CI(0.61,0.86),P<0.05]},2组间过敏反应、溶血反应的发生率均无统计学差异{[RR=0.94, 95%CI(0.77,1.16),P>0.05...     

细节管理在消毒供应室中的应用

目的:探讨细节管理在消毒供应室中的应用及临床效果。方法:将消毒供应室的护理人员随机分为观察组和对照组各15名,对照组给予传统管理方式,观察组给予细节管理,观察、比较两组发生差错及临床科室对消毒供应室灭菌质量满意情况。结果:观察组发生差错率为1.20%,明显低于对照组(6.93%),P<0.05;观察组满意度为95%,对照组为85%,两组比较差异有统计学意义(P<0.05)。结论:实施细节管理后,消毒供应室发生差错率明显降低,临床科室对消毒供应室菌质量满意度提高,值得临床推广应用。     

Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration

Background

Compared to fixed-dose single-vial drug administration in adults, pediatric drug dosing and administration requires a series of calculations, all of which are potentially error prone. The purpose of this study is to compare error rates and task completion times for common pediatric medication scenarios using computer program assistance vs conventional methods.

Methods

Two versions of a 4-part paper-based test were developed. Each part consisted of a set of medication administration and/or dosing tasks. Emergency department and pediatric intensive care unit nurse volunteers completed these tasks using both methods (sequence assigned to start with a conventional or a computer-assisted approach). Completion times, errors, and the reason for the error were recorded.

Results

Thirty-eight nurses completed the study. Summing the completion of all 4 parts, the mean conventional total time was 1243 seconds vs the mean computer program total time of 879 seconds (P < .001). The conventional manual method had a mean of 1.8 errors vs the computer program with a mean of 0.7 errors (P < .001). Of the 97 total errors, 36 were due to misreading the drug concentration on the label, 34 were due to calculation errors, and 8 were due to misplaced decimals. Of the 36 label interpretation errors, 18 (50%) occurred with digoxin or insulin.

Conclusions

Computerized assistance reduced errors and the time required for drug administration calculations. A pattern of errors emerged, noting that reading/interpreting certain drug labels were more error prone. Optimizing the layout of drug labels could reduce the error rate for error-prone labels.     

A randomized, controlled trial of the reciprocating procedure device for local anesthesia

The purpose of this study was to determine whether the new reciprocating procedure device (RPD) is superior to the conventional syringe for the administration of local anesthesia. There were 209 local lidocaine anesthesia procedures randomized between the RDP and the conventional syringe. Outcome measures included administration time, anesthesia pain, procedure pain, and operator satisfaction. The RPD significantly reduced anesthesia administration time by 49% (RPD: 0.68 +/- 0.59 min, Syringe: 1.32 +/- 1.01 min, p < 0.001, 95% confidence interval [CI] for % reduction: 36%-60%), reduced anesthesia pain by 27% (RPD visual analog pain scale score: 4.05 +/- 2.64; Syringe: 5.55 +/- 3.00; p < 0.001, 95% CI 14%-38%), reduced significant procedure pain by 74% (p < 0.001, 95% CI 60%-87%), and improved physician satisfaction by 63% (p < 0.001, 95% CI 53%-74%). The RPD markedly reduces the pain associated with lidocaine anesthesia administration, reduces administration time, and maintains the effectiveness of local anesthesia. The RPD is superior to and significantly more effective than the conventional syringe for the administration of local lidocaine anesthesia.     

Reported incidence, causes, and reporting of medication errors in teaching hospitals in Jordan: a comparative study

This research assessed the reported incidence, causes and reporting of medication errors in intensive care units (ICUs) and wards of Jordanian teaching hospitals. There are few studies about medication errors in Jordan. This survey was conducted in 2010 using a convenience sample of 212 nurses from four teaching hospitals. The response rate was 70.6% (212/300). The mean of the reported incidence of medication errors for the whole sample was 35%; 36.4% in ICUs and 33.8% in wards. An inaccurate rate of total parenteral nutrition (TPN) was the scenario most commonly classified as a drug error; for this nurses would notify the physician, and complete an incident report. Poor quality or damaged medication labels were the most commonly reported causes of errors. Nurses failed to report medication errors because they were afraid that they might be subjected to disciplinary actions. There were some significant differences between ICUs and wards in assessment of clinical scenarios, causes of medication errors as well as their reporting. Reporting of medication errors should be encouraged. Immediate interventions should be initiated by all healthcare professionals in all clinical settings, especially in wards.     

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children

Background: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy?, allows for rapid determination of critical drug doses without performing calculations. Objective: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. Methods: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape? (Broselow) and Handtevy LBT? (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1-year-old and 5-year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. Results: We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8%) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. Conclusion: In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.     

High-visibility warning labels on paracetamol-containing products do not prevent supratherapeutic ingestion in a simulated scenario

Context: In Australia, legislation requires medication containing paracetamol display warning of co-administration with other paracetamol products, and safe maximum daily dosing (4 g). Labelling style, size and visibility differ, potentially leading possible supratherapeutic misadventure. Objective: We studied the likelihood of participants exceeding the recommended dose of paracetamol using products with standard packaging versus products labelled with one of two additional warning labels. Methods: This was a pilot prospective, observational study, conducted from May 2013 to July 2014. Participants undertook a structured interview to create a simulated 24-h scenario in which they chose from a range of labelled lone paracetamol- and compound paracetamol-containing medications to treat dental pain on six occasions. Participants were randomized to choose from one of three groups of analgesic medications with different package labelling: (1) standard packaging alone, (2) standard packaging?+?a pre-existing warning label and (3) standard packaging?+?large customized warning label. The primary outcome was to determine if participants would administer >4 g in 24 h, exceeding the recommended daily dose. Results: One hundred eighteen surveys were completed (response rate 100%, 56% females). Forty-one (35% of total) participants took >4 g within the 24-h scenario period. About 24% (10/42) of the standard packaging group, 37% (13/35) of the standard packaging?+?pre-existing warning label group and 48% (19/40) of the SP?+?large customized warning label group ingested >4?g of paracetamol. There were no significant differences between the three groups (p?>?0.05). Conclusion: In this small, simulated dental pain scenario, use of customized warning labels did not reduce the likelihood of supratherapeutic misadventure.     

The impact of type of manual medication cart filling method on the frequency of medication administration errors: a prospective before and after study

Background

The medication cart can be filled using an automated system or a manual method and when using a manual method the medication can be arranged either by round time or by medication name. For the manual methods, it is hypothesized that the latter method would result in a lower frequency of medication administration errors because nurses are forced to read the medication labels, but evidence for this hypothesis is lacking.

Objectives

The aim of this study was to compare the frequency of medication administration errors of two different manual medication cart filling methods, namely arranging medication by round time or by medication name.

Design

A prospective, observational study with a before-after design.

Participants and settings

Eighty-six patients who stayed on an orthopaedic ward in one university medical centre in the Netherlands were included.

Methods

Disguised observation was used to detect medication administration errors. The medication cart filling method in usual care was to fill the cart with medication arranged by round time. The intervention was the implementation of the second medication cart filling method, where the medication cart was filled by arranging medicines by their names. The primary outcome was the frequency of medication administrations with one or more error(s) after the intervention compared with before the intervention. The secondary outcome was the frequency of subtypes of medication administration errors.

Results

After the intervention 170 of 740 (23.0%) medication administrations with one or more medication administration error(s) were observed compared to 114 of 589 (19.4%) before the intervention (odds ratio 1.24 [95% confidence interval 0.95-1.62]). The distribution of subtypes of medication administration errors before and after the intervention was statistically significantly different (p < 0.001). Analysis of subtypes revealed more omissions and wrong time errors after the intervention than before the intervention. Unauthorized medication errors were detected more frequently before the intervention than after the intervention.

Conclusion

The frequency of medication administration errors with the medication cart filling method where the medication is arranged by name was not statistically significantly different compared to the medication cart filling method where the medication is arranged by round time.     

Frequency of pediatric medication administration errors and contributing factors

This study examined the frequency of pediatric medication administration errors and contributing factors. This research used the undisguised observation method and Critical Incident Technique. Errors and contributing factors were classified through the Organizational Accident Model. Errors were made in 36.5% of the 2344 doses that were observed. The most frequent errors were those associated with administration at the wrong time. According to the results of this study, errors arise from problems within the system.