加强病区高危药品安全管理的实践与效果

目的 加强对病区高危药品的安全管理,确保患者用药安全.方法 2011年针对医院病区高危药品管理中存在的问题进行原因分析,通过建立安全管理组织、健全安全管理制度、规范使用流程、制订管理手册、组织培训与考核等一系列措施,加强病区高危药品的安全管理.结果 与2010年相比,2011年发生高危药品管理缺陷和用药安全隐患的事件明显下降,差异有统计学意义(x2=6.97,P＜0.05).护理人员对高危药品药学知识的掌握程度有显著提高.结论 加强病区高危药品的安全管理,能有效提高护理人员的安全用药能力,保障患者安全.     

西药房高危药品的管理与用药安全分析

目的分析西药房高危药品的管理与用药安全性。方法将2017年8月至2018年7月(常规高危药品管理)、2018年8月至2019年7月(针对性高危药品管理)两个时间段分别设为对照组、观察组,比较两组的高危药品不合理用药情况及药物不良事件发生情况,并调查两个时间段工作人员的高危药品知识知晓程度。结果观察组的不合理用药总发生率、药品不良事件总发生率分别为1.67%、4.00%,低于对照组的8.33%、14.00%,差异具有统计学意义(P<0.05)。观察组工作人员的高危药品知识知晓程度明显优于对照组,差异具有统计学意义(P<0.05)。结论在西药房实施针对性的高危药品管理,可提高用药安全性。     

Joint Commission IDs five high-alert meds

The Joint Commission on Accreditation of Healthcare Organizations has issued a bulletin listing "high-alert" medications that have the highest risk of causing injury when misused. The five high-alert medications are insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, intravenous anticoagulants (heparin), and sodium chloride solutions above 0.9%. The Joint Commission recommends strategies such as a system that confirms the correct drug, dosage, patient, time, and route.     

高危药品说明书中高风险人群儿童用药信息调查

目的 调查北京军区总医院高危药品说明书中高风险人群儿童用药信息的描述情况.方法 以该院在用高危药品品种为研究对象,分别查阅各药品的说明书,对其在儿童用药信息方面的说明情况进行分析.结果 该院在用高危药品共201种,仅78种在儿童用药方面有准确详细的描述,占高危药品总品种数的38.8％.结论 儿童属于高风险用药人群,在高危药品使用中应给予特别关注,但高危药品说明书在儿童用药方面的信息缺失,使儿童在应用高危药品时面临的风险增加,亟需加强说明书中儿童用药信息的补充工作,以保证儿童用药安全.     

对新护士进行高警讯药物知识专题培训的实践

目的研究如何通过培训提高新护士的高警讯药物知识及用药安全意识。方法对进院2年内的新护士进行专题培训20学时,并进行考核。结果新护士高警讯药物理论与操作技能考试成绩显著高于培训前（P〈0．01）,用药差错与护理缺陷明显减少。结论高警讯药物知识专题培训可提高护士的相关药物知识与临床用药安全管理质量。     

高危药品分级管理在临床护理工作中的应用

目的 分析高危药品分级管理在临床护理工作中的应用效果。 方法 制定高危药品分级管理目录,加强对护理人员高危药品知识的培训,规范高危药品的贮存与保管。比较实行高危药品分级管理前后检查情况及护理人员高危药品知识掌握情况。 结果 实行高危药品分级管理后,高危物品分类分级、高危药品标识、高危物品交接登记、高危物品使用登记等方面检查结果好于实行分级管理前。 结论 实行高危药品分级管理,可规范护理人员对高危药品的管理行为。     

Hospital readmission from a transitional care unit

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.     

Increasing the use of 'smart' pump drug libraries by nurses: a continuous quality improvement project

The use of infusion pumps that incorporate "smart" technology (smart pumps) can reduce the risks associated with receiving IV therapies. Smart pump technology incorporates safeguards such as a list of high-alert medications, soft and hard dosage limits, and a drug library that can be tailored to specific patient care areas. Its use can help to improve patient safety and to avoid potentially catastrophic harm associated with medication errors. But when one independent community hospital in Massachusetts switched from older mechanical pumps to smart pumps, it neglected to assign an "owner" to oversee the implementation process. One result was that nurses were using the smart pump library for only 37% of all infusions.To increase pump library usage percentage-thereby reducing the risks associated with infusion and improving patient safety-the hospital undertook a continuous quality improvement project over a four-month period in 2009. With the involvement of direct care nurses, and using quantitative data available from the smart pump software, the nursing quality and pharmacy quality teams identified ways to improve pump and pump library use. A secondary goal was to calculate the hospital's return on investment for the purchase of the smart pumps. Several interventions were developed and, on the first of each month, implemented. By the end of the project, pump library usage had nearly doubled; and the hospital had completely recouped its initial investment.     

Application of the 80/20 rule in safeguarding the use of high-alert medications

Critical care units are busy, complicated settings where the margins of error are narrow and the challenges to patient safety are ever present. Applying the 80/20 rule, front-line nurses can reduce medication errors by focusing on the safe use of "high-alert" medications. There are three primary principles that practitioners can use for safeguarding against medication errors that may result from high-alert drugs. These include: reducing or eliminating the possibility of errors, making errors visible, and minimizing the consequences of errors. These principles constitute a framework of safety that guides the development of proactive error reduction strategies.     

Transitioning the practical nursing student into practice: outcomes of a geriatric initiative

Schools of nursing for practical nursing students typically follow the traditional model of acute care facilities. The purpose of this pilot study was to evaluate an initiative project examining the use of a skilled nursing facility as a final clinical site in a practical nursing program. The pilot study proved to generate a successful academic and practice partnership between the school of nursing and skilled nursing facility, provide opportunities for students to gain confidence and practice in caring for older adults, and meet the goals and outcomes of the clinical practicum. Clinical experiences offered in a skilled nursing facility prepare practical nursing students to care for older adults and transition from student to graduate.     

Lessons learned from a mentored graduate program in gerontological nursing.

An educational training grant provided the funding for a 3-year project to recruit candidates into a mentored and redesigned gerontological advanced practice nursing program. The project goal was to design and implement a part-time program in advanced practice gerontological nursing that allowed nurses currently working in a long-term care (LTC) facility to maintain their full-time employment. Most of the students recruited worked at a partner LTC facility. The cohort was ethnically diverse. The outcome objective is board certification in gerontological advanced practice nursing. The mentored model offered a high level of support, including tutoring, professional role development activities, writing support, regular meetings, and workshops. Project faculty learned valuable lessons from this project relating to mentoring, tutoring, course scheduling, learning styles and preferences, and writing support. The part-time curriculum should also be reviewed critically.     

Polypharmacy in nursing home residents in the United States: Results of the 2004 National Nursing Home Survey

Background: Despite the need for and benefits of medications, polypharmacy (defined here as concurrent use of ≥9 medications) in nursing home residents is a concern. As the number of medications taken increases, so does the risk for adverse events. Monitoring polypharmacy in this population is important and can improve the quality of nursing home care.Objectives: The aims of this article were to estimate the use of polypharmacy in residents of nursing homes in the United States, to examine the associations between select resident and facility characteristics and polypharmacy, and to determine the leading therapeutic subclasses included in the polypharmacy received by these nursing home residents.Methods: This was a retrospective, cross-sectional study of a nationally representative sample of US nursing home residents in 2004; the outcome was use of polypharmacy. The 2004 National Nursing Home Survey was used to collect medication data and other resident and facility information. Resident characteristics included age, sex, race, primary payment source, number of comorbidities, number of activities of daily living (ADLs) for which the resident required assistance, and length of stay (LOS) since admission. Facility characteristics included ownership and size (number of beds).Results: Of 13,507 nursing home residents who received care, 13,403 had valid responses for all 9 independent variables in the analyses. The prevalence of polypharmacy among nursing home residents in 2004 was ~40%. A multiple regression model controlling for resident and facility factors revealed that the odds of receiving polypharmacy were higher for residents who were female (odds ratio [OR] = 1.10; 95% CI, 1.00–1.20), were white, had Medicaid as a primary payer, had >3 comorbidities (OR = 1.57–5.18; 95% CI, 1.36–6.15), needed assistance with <4 ADLs, had an LOS since admission of 3 to <6 months (OR = 1.25; 95% CI, 1.04–1.50), and received care in a small, not- for-profit facility (data not shown for reference levels [OR = 1.00]). The most frequently reported medications for residents who received polypharmacy included gastrointestinal agents (laxatives, 47.5%; agents for acid/peptic disorders, 43.3%), drugs that affect the central nervous system (antidepressants, 46.3%; antipsychotics or antimanics, 25.9%), and pain relievers (nonnarcotic analgesics, 43.6%; antipyretics, 41.2%; antiarthritics, 31.2%).Conclusions: Despite awareness of polypharmacy and its potential consequences in older patients, results of our analysis suggest that polypharmacy remains widespread in US nursing homes. Although complex medication regimens are often necessary for nursing home residents, monitoring polypharmacy and its consequences may improve the quality of nursing home care and reduce unnecessary health care spending related to adverse events.     

老年高危冠心病患者介入术围手术期的护理

目的评价个体化的围手术期护理干预方案对老年高危冠心病(CAD)介入术的效果。方法对385例老年高危冠心病(高危组)行介入术患者术前作好护理评估,制订术后相应的护理措施,根据术中病情变化及手术结果修改护理措施,提供出院后康复指导,并随访康复结果,并就上述各项指标与老年普通病人(普通组)进行比较。结果老年高危组手术成功率、并发症、围术期病死率和随访期主要心脏不良事件发生率方面与老年组比较均无显著差异(P>0.05),效果满意。结论个体化的围手术期护理干预方案对提高老年高危CAD病人介入治疗成功率,降低并发症和MACE发生率以及病死率具有重要临床意义。     

Collaboration: Integrating Practice and Research in Public Health Nursing

The need to integrate clinical practice and research has been stressed for many years in both public health and nursing. This article describes such a collaborative project between two rural upper Midwest public health nursing agencies and public health nursing faculty from a small, liberal arts, baccalaureate nursing program. The high-risk prenatal research project provided an opportunity for nursing staff and faculty research consultants to work together on a clinical study. A model for collaborative research is illustrated, and advantages and disadvantages for practice, administration, and research are discussed.     

An intravenous medication safety system: preventing high-risk medication errors at the point of care

Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months.     

An educational collaboration for student nurse engagement on the essential skill of delegation

A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals.     

The critical elements within a journey towards the achievement of quality use of medicines

In Australia, as in much of the rest of the Western world, the changing demographics of the population has resulted ina need for the aged care industry and the nursing profession tomodify their traditional skill mix in order to better respond to changes in the needs of older Australians. In particular, the role of the Enrolled Nurse (EN) in New South Wales (NSW) Australia has been under considerable scrutiny for the last decade resulting in a number of changes in the EN's scope of practice; notably the 2004 amendment to legislation and education that enabled ENs to administer medication. This changed scope of EN practice has resulted in a need to reconsider the role of all members of the aged care medication team. Quality Use of Medicines (QUM) within a Residential Aged Care (RAC) facility is dependent upon systematic and evidence-based approaches underpinning the relevant structures and processes involved in the management of medications. Implementation of effective QUM systems and processes is particularly dependent upon the nature of relationships among members within the aged care medication team. Although there are numerous mechanisms to support QUM by nurses, the RAC sector in Australia lacks a tool that is both contemporaneous and context-specific and supports an expanded scope of practice for ENs who work in the RAC sector. This paper reports on an action research project that aimed to enhance of the health of older Australians in one RAC facility by developing an implementation framework that supports ENs as practitioners involved in QUM. The research identified the enabling factors and barriers to the achievement of QUM within the aged care medication team. The project encompassed a re-conceptualization and reconfiguration of local nursing medication-related practices and culminated in a conceptual framework to support quality medicine outcomes for older Australians. The outcomes of the research included a set of principles to guide the expanded role of the EN in SRAC.     

Older adults and NSAIDs: avoiding adverse reactions

Monitoring which medications geriatric patients are taking is crucial to their health and well-being. Many take over-the-counter nonsteroidal anti-inflammatory drugs on a daily basis for common ailments. Even when taken correctly, these drugs can harm the elderly because of normal changes that occur as people age. Techniques to monitor this population and their use of these medications are included to help nurses assist patients avoid adverse reactions and complications. This information can be valuable whether you are a nurse working in a hospital, office, nursing home, assisted living facility, or any setting where care is rendered to the elderly.     

Challenges and strategies for initiating a nursing facility practice

PURPOSE: To provide a summary analysis of five case reports describing the challenges and strategies of nurse practitioners' (NPs') first-year experiences on initiating an effective role in a nursing facility practice. DATA SOURCES: Original qualitative research analyzing written journals of five NPs and written notes from two loosely structured group discussions among project participants. CONCLUSIONS: Two broad themes emerged: Figuring it Out and Responding/Getting a Handle on Things. Common sense and good resources were identified as critical. IMPLICATIONS FOR PRACTICE: Strategies to promote ease of role transition are essential for NPs in the nursing facility. Further, in addition to a focus on care of frail older adults, emphasis on the culture of and strategies for nursing facility visits, ethical issues, and ethical decision making are important components of NP educational programs.