JCI标准下的手术病人安全核查实践

目的 探讨JCI标准下手术患者安全核查的实施措施与成效。方法 采用JCI标准的先进管理理念，总结以往手术病人、手术部位错误的发生因素，从接送患者及三方核查的各个核查环节，建立并细化一套完整、系统的、可持续改进的工作制度及要求，进一步加强手术病人的安全核查管理。结果 将JCI标准运用在手术病人的安全核查是一种安全有效的方法，能进一步防范医疗工作中的差错，确保病人安全。     

优化病人安全核查流程在眼科手术中的应用

对影响眼科手术安全核查因素进行分析,并针对原因优化手术病人安全核查流程,采取针对性的措施,结果保证了眼科手术病人安全,提高了服务满意率。     

JCI标准下手术/有创操作安全核查流程再造与应用

目的：探讨如何按照JCI标准再造手术/有创操作安全核查流程,并推广应用。方法：遵照IPSG.4修订手术/有创操作安全核查制度,再造流程;对医护人员专项培训,掌握制度、熟悉流程、恪守标准、规范执行;应用管理工具PDCA,量化考核,监督检查。结果：通过三轮PDCA循环,将手术/有创操作安全核查的执行率由创建之前的52.1%提高至99.5%、合格率由44.9%提高至97.6%,前后比较差异均有统计学意义（P<0.001）,实现了JCI标准中IPSG.4的目标。结论：以JCI标准为准则,结合管理工具的应用,有效提升了手术/有创操作安全核查的合格率,杜绝了手术时患者、部位及操作发生错误。     

连台手术安全核查的风险循证及前馈控制

[目的]探讨基于循证的前馈控制在连台手术安全核查风险管理中的应用效果。[方法]以我院连台手术病人为研究对象,于2014年11月开始对手术核查风险实施基于循证的前馈控制,按随机抽样法选择前馈控制实施前4个月(2014年7月—2014年10月)病人400例为对照组,选择前馈控制实施后4个月(2014年11月—2015年2月)病人400例为观察组。对照组按照连台手术安全核查常规程序工作,观察组在上述常规核查的基础上对各环节核查行为实施风险循证和前馈控制管理,通过对连台模式下手术安全核查隐患的风险循证,排查出高危关联因素,采取针对性前馈控制措施对管理制度、风险意识、业务素质、术前访视、核查流程、接台节点和手术环境方面的潜在风险实施超前质控。评价两组手术准备缺陷率、物品清点缺陷率、核查记录缺陷率及腕带执行率、手术部位标记率、三方核查执行率。[结果]观察组手术准备缺陷率、物品清点缺陷率、核查记录缺陷率均低于对照组(P0.01),观察组腕带执行率、手术部位标记率、三方核查执行率均高于对照组(P0.01)。[结论]前馈控制策略对手术护士核查遵守和核查参与行为有积极影响,能有效提高安全核查执行力,防范核查缺陷发生,规避手术错误风险,保障手术安全。     

数字化视频监控在手术安全核查制度中的应用与管理

目的介绍数字化视频监控在手术安全核查制度中的应用与管理。方法回顾性分析实施数字化视频监控前后存在的问题,利用数字化视频监控采集的图像对手术三方安全核查执行中存在的问题进行根本原因分析(RCA),提出改进和防范措施。结果实施数字化视频监控后,提高了手术团队成员手术患者安全核查制度依从性,未发生手术病人、手术部位、手术方式错误,确保了手术病人安全。结论提高了手术团队成员手术安全核查制度执行的依从性;实现手术室常态工作下的规范化、标准化管理,确保手术病人安全。     

“Time-out”程序在手术室工作中的应用

<正>术前核对是杜绝错误手术发生的必要前提,是手术临床执行《患者安全目标》中的重中之重[1]。"Time-out"手术核查中的意思是在即将开始的手术前,在手术的地方,由整个手术团队全体人员参加的手术核对必须步骤,它是手术前最后一次核查。医疗机构评审联合委员会(JCAHO)认为所有的错误手术都是可以而且必须预防的[2],并制订了预防错误手术的通用方案。我院参照JCAHO提出的防止错误手术的通用方案,于2010年1月开始建立并实施Time-out(暂停)程序,规范核查流程,在实践中     

实行手术安全核查制度的体会

目的：观察手术室安全核查制度的实施效果。方法：按照《手术安全核查表》的流程常规进行核查,并分析实施效果。 结果：对5215例手术病人采取安全核查,及时发现并纠正安全隐患,未发生任何手术差错事故及纠纷。结论：通过实行手术安全核查制度和《手术安全核查表》的应用增强了医护人员的风险防范意识,有效地保障了手术安全。     

失效模式与效应分析在预防眼科手术病人眼别错误中的应用

[目的]探讨应用失效模式与效应分析方法(FMEA)在预防眼科手术病人眼别错误中的效果。[方法]根据FMEA方法,成立管理小组,绘制眼科手术流程图,对潜在的失效模式进行严重度、发生的可能性、探测的可能性评分,根据其结果制定相应措施。[结果]失效模式风险优先数(RPN)由FMEA实施前的1 501分下降至210分,下降率为88. 5%。主要存在的问题为通知单有误(RPN=100分)、手术医生不做手术部位标识(RPN=150分)、未对照安全核查表进行核查(RPN=315分)、麻醉开始前巡回护士主导安全核查(RPN=360分)、手术开始前未执行三方共同核查(RPN=576分)等高风险失效模式,经采用针对性的改进措施后,RPN值分别下降至20分、0分、70分、120分、0分。[结论]应用失效模式与效应分析方法预防眼科手术病人眼别错误,效果良好,无手术部位错误相关不良事件的发生,从而保障病人的安全。     

安全核查流程在手术室的应用效果探讨

手术室具有工作任务重、节奏快特点,如何确保病人手术安全,杜绝一切差错事故的发生,严格落实安全核查流程尤为重要。中国医院协会(CHA)制定了《2009年病人安全目标》实施细则,将手术安全核查作为一项核心内容纳入手术室管理中[1]。2010年3月17日卫生部组织制定了《手术安全核     

手术安全核查标准作业流程的建立与应用

通过分析原有手术安全核查流程存在的缺陷,在查阅文献的基础上,经专题小组讨论,建立手术安全核查标准作业流程,并对医护人员进行系统化培训。手术安全核查标准作业流程包括sign in、time out和sign out 3个关键环节的标准流程,手术团队三方共同合作,分工明确,程序清晰。应用手术安全核查标准作业流程后,手术安全核查规范执行率由62.9%提升至82.3%。手术安全核查标准作业流程可有效促进手术室医护人员规范执行安全核查过程和手术团队内部的交流,是实现患者手术安全的重要保障。     

香港慢性疾病护理综合管理模式及其启示

目的 借鉴香港慢性疾病护理综合管理模式,完善中国内地慢性疾病护理. 方法采取比较研究方法为主,辅以文献研究法了解香港慢性疾病护理综合管理模式.结果 香港慢性疾病护理综合管理模式能提升慢性病患者及家属的生活质量,能促进构建和谐社会.结论 香港慢性疾病护理综合管理模式能为中国内地慢性疾病护理提供一定的借鉴.     

Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong.

This article reviews a study of pain management and its barriers in Hong Kong. Using an interview technique, several measures were used to understand the level of concern in patients about pain, the patients' hesitancy in reporting pain, use of analgesics, and adequacy of medication for pain. A total of nine barriers were identified, which include "addiction," "tolerance," "side effects," "physician distraction," "good patient," "fear of injection," "time interval," "fatalism," and "disease progression." Thirty-nine interviews were carried out. The interviewees were all cancer patients with pain in a palliative setting in Hong Kong. When the findings in Taiwan and the United States were compared, it was found that the cancer patients in Hong Kong had a higher level of concern toward the patient-related barriers. It was also found that the level of concern was generally higher in the group with hesitancy in reporting pain and using analgesics. Last of all, this project also identified the educational needs of patients and health care workers in Hong Kong.     

Quality of life of traumatic spinal cord injured patients in Hong Kong.

OBJECTIVE: To assess the health-related quality of life of patients with traumatic spinal cord injury living in Hong Kong. DESIGN: A cross-sectional retrospective study. SUBJECTS: Subjects with paraplegia following traumatic spinal cord injury were recruited from our department, which is one of the 3 main regional spinal cord injury rehabilitation centres in Hong Kong. A total of 120 potential participants were invited to join the study. The final study group comprised 58 patients (25 (43%) men and 33 (57%) women, 30 (50%) of whom were under 40 years of age). METHODS: Health-related quality of life was assessed using the Hong Kong Chinese version of the World Health Organization Quality of Life Measure Abbreviated version (WHO-QOL-BREF(HK)). Results were summarized and compared with previous results from healthy and other disease populations in Hong Kong. RESULTS: There was no significant difference in quality of life between men and women, or between different durations of spinal cord injury, different educational levels or different marital status (p > 0.05). However, a significant difference in quality of life was found in different age groups and between people with incomplete and complete paraplegia (p < 0.05). Compared with healthy and other disease populations, people with paraplegia had the lowest quality of life in Hong Kong (p < 0.001). CONCLUSION: People with paraplegia in Hong Kong have a lower quality of life than the general Hong Kong population. More community support is required to meet the needs of these patients in the areas of transportation, medical care and social life, in particular.     

Empowerment of Chinese patients with cancer through self-help groups in Hong Kong

This study was conducted to identify the process and outcomes of empowerment as experienced by Hong Kong Chinese patients with cancer through participation in cancer self-help groups. The study involved in-depth individual interviews of self-help group members (n = 12) and participant observation of the group meetings over a period of 6 months. The empowered outcomes at a personal level included interconnectedness, confidence and hope, support and affirmation, and a feeling of usefulness. At a social level, expanded social network and opportunities to participate in more activities were reported. Collective efficacy also was demonstrated, although this happened only occasionally through participation in the group. One main theme that runs through the process of participation is empowerment among the members. On the basis of the efficacy demonstrated by self-help groups in this study, nurses should strongly consider referral of patients to such groups. Self-help groups serve as an important resource for patients with cancer in the Hong Kong Chinese community.     

Oncology nursing: professional development as a clinical specialty in Hong Kong

Cancer is a major health problem world-wide. Therefore, it is not surprising that cancer is identified as the top priority disease group for an improvement programme by the Hospital Authority in Hong Kong. Laser therapy for patients with nasopharyngeal carcinoma, for example, is evidence of the advancement of the scientific and technological developments for cancer treatment. Furthermore, the establishment of the Cancer Centre has provided ample opportunities for clinical practices and research studies. In response to the proclamation of the 'urgent need for the establishment of a cancer society in every country' by Searle in 1990, the Oncology Care Society of Hong Kong, which aims to promote both cancer education and cancer research, was established in 1993. Adopted from the core curriculum of the European Oncology Nursing Society, the specialist course of cancer nursing care was first implemented in Hong Kong in 1993 and the nurse specialist is now a permanent part of nursing career structure in Hong Kong. This paper attempts to review the development of oncology nursing in Hong Kong according to these factors and to find ways to improve the current situation.     

Decision-making preferences towards surgical intervention in a Hong Kong Chinese population

BACKGROUND: Economic, social, ethical and legal concerns are motivating changes in western-type health practice to encourage individuals to participate in health-care decisions. Patient participation in health care is perceived to be beneficial because health care is negotiated with the patient so the selected regimen of care is more likely to be acceptable. Hong Kong, in accordance with contemporary trends in other industrialized countries, has adopted a Patient's Charter that outlines patient's rights regarding health treatment and choices. Studies indicate that not all patients wish to take part in decision making about treatment. AIM: To explore the degree to which a Hong Kong Chinese population desired to participate in decision making about surgical intervention. METHOD: 96 participants, 49 surgical and medical patients and 47 students of nursing, participated. Participants were given three hypothetical scenarios: cardiac failure, where major surgery is suggested; cholecystitis, where routine surgery is suggested; and the presence of a benign skin lesion, where minor surgery is suggested. Participants were asked about the degree to which they desired to participate in the decision-making process. There were five choices, ranging from the doctor having full control, to various types of collaborative decision making, to the individual having full control. RESULTS: When the medical condition is not severe, participants desired greater participation in the decision-making process. Younger participants desired greater collaboration with the doctor in decision making while older participants preferred the doctor to have the greater input with respect to decision making.     

Nurses' perceptions of preoperative teaching for ambulatory surgical patients

Title. Nurses’ perceptions of preoperative teaching for ambulatory surgical patients. Aim. This paper is a report of a study to examine nurses’ perceptions of the importance of providing preoperative information to ambulatory surgical patients, and factors that might influence their provision of such teaching. Background. Ambulatory surgery is now widespread and creates a challenge for nurses to provide preoperative teaching in the limited contact time they have with patients. Although nurses act as key educators in patient teaching, little is known about their perceptions of the importance of preoperative teaching, or about current practice in the provision of such teaching for ambulatory surgical patients. Methods. A self‐administered questionnaire including demographics and the Preoperative Teaching Questionnaire was completed by 91 of the 169 eligible nurses (response rate 53·8%) working in day‐surgery units, operating theatres or outpatient clinics providing ambulatory surgery services in two public hospitals in Hong Kong in 2005. Results. A discrepancy between nurses’ perceptions and practice in relation to the provision of preoperative information was found. Limited teaching aids, tight operation schedules and language barriers affected the delivery of preoperative information to ambulatory surgical patients. Conclusion. The results highlight the importance of reviewing current preoperative teaching methods and improving the effectiveness of such teaching to enhance the quality of care for ambulatory surgical patients.     

香港康复探访及启示

介绍香港康复的现状,包括康复性质,公立医院康复的设置层次和康复流程,医院康复人员的构成和各自的职责,康复部门的设置,各级医院康复的运作,从业人员的管理和考核;比较香港和内地康复的异同,总结香港康复对四川康复发展的启示。     

Development of basic nursing education in China and Hong Kong

Hong Kong returned to the sovereignty of the People's Republic of China in July 1997. In the past, Hong Kong has been greatly influenced by the British system of nurses' training, which was very different from that in mainland China. As Hong Kong is now a part of China again, there is an increased opportunity for the exchange of experience and ideas among nurse educators. The First China-Hong Kong Nursing Education Conference has provided opportunities for the authors to gain a deeper understanding of the development of nursing education in China and Hong Kong. The authors believe that it is also important for China and Hong Kong to increase networking with the international nursing community. This paper has been written largely based on the information gathered from papers presented in the Conference and the discussion with nurse educators who attended the Conference, together with a review of literature. This paper focuses on comparing the history and present development of basic nursing education in both places. The future direction for the development of nursing education in these two places will also be discussed.     

手术安全核查制度在手术不同阶段的应用效果

[目的]探讨手术安全核查制度在手术不同阶段的应用效果。[方法]对照组核查由巡回护士负责主持,核查资料由手术室保存,未实施严格的手术安全核查制度;实验组核查由麻醉医生主持,核查资料纳入病案保存,采取了严格的手术安全核查制度,比较两组在手术不同阶段安全核查的依从性。[结果]两组手术医生、麻醉医生在麻醉实施前、手术开始前及病人离开手术室前安全核查的依从性比较,实验组优于对照组,差异均有统计学意义(P<0.05);两组手术护士在麻醉实施前、手术开始前安全核查的依从性比较,实验组优于对照组,差异均有统计学意义(P<0.05)。[结论]将手术安全核查表制度作为核心制度来落实,可提高手术人员安全核查的依从性。