Medication errors associated with the use of ethanol and fomepizole as antidotes for methanol and ethylene glycol poisoning

Introduction. Little is known about medication errors which occur with the antidotes ethanol and fomepizole, used for treatment of methanol and ethylene glycol poisoning. Study objectives were to describe and compare the frequency, type, outcome and underlying causes of medication errors associated with ethanol and fomepizole. Methods. Patients aged ≥13 years were included if they were hospitalized in 1996–2005 for methanol or ethylene glycol poisoning and treated with ethanol or fomepizole. Charts from 10 hospitals were separately reviewed by two abstracters who recorded case details. A consensus panel of clinicians used the abstracted data to identify medication errors and classify error outcome. Fisher's exact test determined significant differences in the proportion of ethanol and fomepizole-treated cases with medication error and univariate logistic regression identified risk factors associated with harmful dosage errors. Results. There were 145 ethanol- and 44 fomepizole-treated cases. There was ≥1 medication error in 113/145 (78%) ethanol- and 20/44 (45%) fomepizole-treated cases (p = 0.0001) with more ethanol-related errors involving excessive dose, inadequate monitoring and inappropriate antidote duration. Harmful errors occurred in 19% of ethanol- and 7% of fomepizole-treated cases (p = 0.06) and were largely due to excessive antidote dose or delayed antidote initiation. Occurrence of harmful dosage error was reduced in cases with Poison Control Centre consultation, odds ratio (95% confidence interval) 0.39 (0.17, 0.91), hemodialysis 0.37 (0.16, 0.88), or fomepizole versus ethanol 0.24 (0.06, 1.04). Conclusion. Fomepizole was less prone to medication error than ethanol. Error-related harm was most commonly due to excessive antidote dose or delayed antidote initiation.     

基层医院开展护理科研难点与对策

目的:调查基层医院护士开展护理科研的难点问题,针对问题采取相应的对策,以提高基层医院护理科研的水平。方法:对2所二级甲等民营医院及2所二级甲等国有基层医院的483名护士进行开展科研的相关问卷调查及追踪访谈。结果:91.30%的护士认为开展护理科研有意义,但专业知识不够及科研知识匮乏是其瓶颈问题,人力和时间资源缺乏以及设备、技术、资料不足是重要问题;民营医院和国有医院之间很想作护理科研的人数有统计学差异。结论:基层医院的绝大多数护士对开展护理科研持积极支持态度,应充分利用继续教育方式,提高护士学历层次;有针对性的科研知识培训和适当的激励机制是提高基层医院护理科研的有效措施;合理地利用时间及适当地增加临床护理人员及提供相关的设备和资料是开展护理科研的前提和保障。     

综合医院护理人员临床教学能力调查分析

[目的]了解护理人员临床教学能力现状,探讨提高护理人员临床教学水平的对策。[方法]采用问卷调查法对我院129名临床护理带教教师进行调查。[结果]临床护理带教教师教学能力尚有差距,66.1%带教教师尚未接受系统临床护理教学师资培训,43.5%教师主持大科或科内的护理教学查房,仅有4.8%的教师发表临床护理教学研究的相关论著。[结论]护理人员临床教学能力不能完全满足临床教学需求,提高临床护理教师教学能力、培养高质量的临床护理教学师资是提高临床护理教学质量的关键。     

高校护理实验室管理与实验教学改革的思考

从实验室管理及实验教学改革的2个方面、5个层次进行阐述,提出了改革实践教学模式、教学体系、教学内容、教学方法、评价体系以及管理理念、管理方法的具体措施,以提高高校护理实验教学质量.     

以护生为主体小讲课教学模式在骨关节专科护理教学中的应用

[目的]探讨以护生为主体小讲课教学模式在骨关节专科护理教学中的应用。[方法]选取在我院骨科实习护生68名,按照不同护理教学要求分为观察组和对照组各34人;观察组实施以护生为主体的小讲课,对照组采用带教老师授课方式,护生自由提问。观察两组护生实习结束后的考核成绩及学习满意率情况。[结果]两组护生各项考核评分均达标,但观察组护生得分高于对照组,观察组护生对学习形式、学习效果及自我评价的满意度高于对照组,观察组护生对小讲课的满意率高达91.2%。[结论]临床骨关节专科护理教学中采用以护生为主体的小讲课模式可有效提高护理教学效果和质量。     

改良PBL结合微格教学法在基层医院临床护理带教技能培训中的应用

目的采用改良PBL结合微格教学法对临床带教老师进行带教技能培训,探索其教学效果以及在教学过程中具体的实施步骤和方法。方法2017年1月至2018年12月,选取如东县人民医院26个护理单元,经护理部考核合格的科带教老师50人为研究对象,随机分为观察组和对照组。观察组采取改良PBL结合微格教学法实施带教技能的培训,对照组采取传统教学方法进行培训,培训结束后对科带教老师的教学技能、教学培训效果、教学能力进行测评。结果培训结束后,观察组带教老师的教学技能评分明显高于培训前(P<0.05);观察组带教老师的教学培训效果、教学能力评价也明显高于对照组(P<0.05)。结论在基层医院临床护理带教技能培训中,应用改良PBL结合微格教学法能够提高临床带教老师的带教技能,增强教学自信心和教学技巧等,对促进护理带教能力的培养具有积极作用。     

医院感染监控护理带教体会

目的　通过医院感染监控护理带教,使护生增强预防医院感染的知识和参与管理、开展科研的能力。方法　制订教学大纲、安排带教计划、探索带教模式、实施带教、评价教学效果。结果　学生医院感染知识得到巩固,管理和科研意识初见端倪。结论　带教过程中注重教书育人,确立护理专业思想;认真完成带教任务,培养医院感染控制实用人才;学习管理和科研基本知识,教与学相得益彰     

Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American nurses

This study describes how the potential sources of errors and error prevention in operating room (OR) teams are experienced by Finnish, American and British nurses. The data were collected by interviews and analysed using a qualitative content analysis. Results consisted of categories demanding teamwork practice, shared responsibility in teams and organized teamwork. The demanding practice category included fear of errors, turnover in teams, overtime work and emotional distress as potential factors leading to errors in OR teamwork. Shared responsibility emphasized how the familiar teams, safety control and formal documentation of errors prevented errors. At the organizational level, the prevention of errors required scheduling of work, good management, competency and a reasonable physical environment. In order to improve safety in OR teams, recognition should be given to the balance of error-making and learning from them. More effective ways in reporting incidents should be adopted and overall reporting systems should be developed in Finnish OR teams.     

某医院毕业实习护生对临床护理带教工作满意度现状与思考

目的：了解我院毕业实习护生对临床护理带教工作的满意度状况,以发现临床带教工作中的现存问题,改进临床护理教学工作。方法：采用自行编制的问卷,对在我院进行毕业实习的332名护生进行临床护理带教工作满意度调查,内容涉及带教老师自身素养、带教老师带教态度、病房带教安排、护生实习收获四个方面。结果：实习护生对临床护理带教工作整体满意度得分为3.74±0.53;专科护生满意度得分为3.87±0.30,本科护生满意度的得分为3.66±0.48;护生对带教老师自身素养满意度得分最高,为3.79±0.48;护生对病房的带教安排和护生实习收获满意度得分最低,分别为3.71±0.57和3.71±0.54。结论：实习护生对我院临床护理带教工作整体满意度评价较高,特别是在评价带教老师自身素养方面。同时,专科护生较本科护生对临床带教满意度高。而护生在班次安排、带教计划、实习期间职业情感的培养、带教老师愿意主动教护生、带教护生采用的方式等方面满意度相对低,提示在今后的临床护理教学中应进一步关注上述问题。     

Prevalence and treatment of pain in adults admitted to Italian hospitals.

BACKGROUND: Very few studies have been conducted on the presence and control of pain in Italian hospitals. AIMS: The present study estimates pain prevalence and therapy in Italian hospitalised patients. METHODS: In the autumn of 2000, a survey was taken on 4523 inpatients throughout Italy. All eligible patients were given a questionnaire with two Numerical Rating Scales (NRS) concerning their pain intensity at interview and over the previous 24 h. Nurses were given a second questionnaire asking for information on analgesic treatment and another NRS about the pain they supposed the patient felt. RESULTS: At interview, 91.2% (95%CI: 90.3-92.1%) of the patients reported pain; 46.6% reported severe pain. The prevalence of severe pain was significantly lower in women and was double in general medicine wards compared to surgical wards. The degree of agreement between the pain reported by the patient and the pain scores given by the nurse was poor (Cohen K=0.318). Only 28.5% of the inpatients had taken analgesics in the past 24 h and the probability of receiving analgesic treatment was higher for women (adjusted OR=1.33, 95%CI: 1.14-1.54) and lower for general medicine compared to surgical wards (adjusted OR=0.55, 95%CI: 0.45-0.64), while it was unrelated both to the patient's self-reported pain and to level of pain assessed by the nurse. CONCLUSIONS: Pain affects an impressively high percentage of inpatients and is largely untreated and unrecognised in Italian wards. Educational intervention is required to improve the knowledge and attitudes of health professionals towards the approach and handling of patients in pain.