提升化疗药物外渗安全管理质量的实践与效果

目的 提升化疗药物外渗安全管理质量.方法 成立由专科护理管理委员会、肿瘤专科护理小组、临床护士组成的预防化疗药物外渗安全管理三级监控网,修订并完善了安全管理措施,实行个案追踪护理,促进了管理质量的持续改进.结果 规范了化疗专业护理行为,降低了化疗药物外渗发生率,医疗护理纠纷的发生率为零.结论 实施化疗药物外渗安全管理,为患者提供安全、有效的护理措施,可降低化疗药物外渗发生率,避免医疗护理纠纷的发生.     

持续质量改进在静脉输液患者预防药物外渗中的应用

目的探讨持续质量改进(continuons quality improvement,CQI)在预防患者静脉输液药物外渗的效果。方法采用配对的方法,将748例在消化内科住院的患者分为两组,观察组422例,采用CQI护理管理方法预防患者静脉输液药物外渗;对照组326例,采用传统护理管理方法预防患者静脉输液药物外渗。比较两组患者药物外渗情况。结果观察组患者药物外渗发生率为6.2%,对照组患者药物外渗发生率为24.9%,两组比较,P<0.001,差异具有统计学意义。结论 CQI可有效减少患者静脉注射药物外渗发生率,确保患者用药安全,使患者治疗质量得到保障,提高护理管理质量,值得临床推广应用。     

护理风险管理在乳腺癌患者术后化疗期中的应用

目的 探讨护理风险管理在乳腺癌术后患者化疗期中的应用.方法 对2009年1～12月在我院行乳腺癌术后化疗的患者进行回顾性调查,分析可能引起药物外渗的因素,并于2010年1～12月对护理人员进行护理风险管理措施.对实施前后药物渗出情况进行比较.结果 实施护理风险管理前,乳腺癌术后化疗患者药物渗出的发生率为5.77%,皮肤坏死的发生率为0.64%;实施护理风险管理后,化疗药物的渗出率为0.59%,无皮肤坏死的情况发生.结论 实施护理风险管理可以明显减少乳腺癌术后化疗患者药物渗出的情况发生.

Abstract：

Objective To explore the application of nursing risk management in the patients with breast cancer during postoperative chemotherapy. Methods Patients with breast cancer during postoperative chemotherapy in our hospital from January to December 2009 were surveyed retrospectively, and analyzed the factors that may cause drug extravasations. Then the appropriate care and risk management measures were implemented by the nursing staff from January to December 2010. Incidence of drug extravasations was compared before and after the implementation of the measures. Results Before the implementation of nursing risk management, the incidence of drug extravasations of the patients with breast cancer of postoperative chemotherapy was 5.77%, the incidence of skin necrosis was 0.64%; after the implementation of nursing risk management,leakage of chemotherapy drugs was 0.59%, no skin necrosis occurs. Conclusions Implementation of nursing risk management can significantly reduce the incidence of chemotherapy drugs leaking in patients with breast cancer during postoperative chemotherapy.     

人性照护理论在肿瘤患者化疗中的应用

目的 探讨在肿瘤患者化疗过程中应用人性照护理论对患者的影响.方法 将150例肿瘤患者随机分为干预组和对照组各75例.干预组实施依据人性照护理论制订的护理措施,对照组按传统的护理措施进行护理,比较2组患者依从性、药液外渗或静脉炎发生率.结果 干预组依从性、药液外渗或静脉炎发生率明显优于对照组.结论 实施依据人性照护理论制订的护理措施可以提高肿瘤患者化疗的依从性、对护理质量的满意度和生活质量,值得临床推广应用.

Abstract：

Objective To explore the role of the theory of human care in cancer patients during chemotherapy.Methods 150 patients with tumor undergoing chemotherapy were divided randomly into the intervention group and the control group (each had 75 cases).The intervention group took the human nursing care,the control group was applied with the traditional nursing method,compliance,liquid extravasation or phlebitis after chemotherapy were observed and compared.Results The compliance,incidence of liquid extravasation or phlebitis in the intervention group was significantly better than those of the control group.Conclusions Implementation of the nursing care based on human care theory can improve compliance of chemotherapy,satisfaction with the quality of care and quality of life in cancer patients,and hence is worthy of being recommended in clinical practice.     

品管圈活动在减少输液外渗中的效果评价

目的:运用品管圈活动法对输液外渗的不良事件进行分析,采取综合护理干预措施,减少输液外渗的再发生。方法:成立品管圈活动小组,用自行研制的调查表随机进行横断面调查,对2012年1~6月输液外渗24例进行分析并查找原因,于2012年7~12月输注高渗性营养液和细胞毒性药物时,采取输液前预防、外渗后指导和相关知识教育跟进的三维综合护理干预措施,对比干预前后输液外渗发生率。结果:干预后输注高渗性营养药,护士选择输注工具和部位正确率明显提高,输液外渗明显减少。结论:通过开展品管圈活动,提高了静脉输液的安全性,减少了输液外渗病例,达到预期干预效果,值得在临床推广使用。     

大型综合医院门诊分诊优质护理的应用

目的：探讨大型综合医院门诊分诊优质护理的效果及应用价值。方法选择我院实施门诊分诊优质护理作为节点,通过对患者进行护理质量和满意度调查,观察实施门诊分诊优质护理实施前后的效果。结果实施门诊分诊优质护理后患者护理质量评分和护理满意度高于常规护理组,护理风险事故和护理投诉的发生低于常规护理组,组间资料比较,差异有统计学意义（ P＜0.05）。结论在大型综合医院开展门诊分诊优质化护理能够更好满足患者需求,带动门诊护士的积极性,减少了护理风险事故和护理投诉的发生,提高临床护理满意度,值得在临床上大力推广使用。     

护理干预对降低碘对比剂外渗不良事件发生率的效果评价

目的 通过对碘对比剂发生外渗不良事件的原因进行分析比较,使护理管理者及时制订行之有效的解决方案,采取相应的防范措施,确保患者生命安全.方法 选择600例注射碘对比剂进行CT增强扫描检查的患者,将2009年5月至2010年4月收治的300例患者作为对照组,实施常规护理措施;将2010年5月至2011年4月收治的300例患者作为实验组,实施有效的针对对比剂外渗的防范措施.将2组注射碘对比剂后出现护理不良事件的发生率进行比较.结果 实验组实施一系列防范措施后,碘对比剂外渗的发生率为2％,显著低于对照组的10％.结论 通过实施一系列的防范措施,降低了碘对比剂护理不良事件的发生率,保障了患者的生命安全,明显降低了护理缺陷及护理投诉次数,提高了护理服务质量.     

肿瘤专科护理敏感质量指标的构建及在肿瘤科护理质量改善中的应用

目的探讨构建肿瘤专科护理敏感质量指标对肿瘤科护理质量的作用。方法采用便利抽样法,选取2019年8月—2020年2月陕西省人民医院收治的1024例肿瘤患者作为观察组,另回顾性分析2018年1月—2019年7月陕西省人民医院收治的1038例肿瘤患者作为对照组。其中对照组予以肿瘤专科常规护理干预,观察组则按照“结构—过程—结果”质量管理模式,通过循证分析以及Delphi专家函询法明确肿瘤专科护理敏感质量指标,并以此作为依据进行肿瘤专科护理。分析肿瘤专科护理敏感质量指标构建情况。比较观察组与对照组的临床指标变化。结果共形成6个肿瘤专科护理敏感质量指标,分别为化疗外渗发生率、化疗相关性恶心呕吐发生率、深静脉血栓发生率、PICC导管相关性感染发生率、肿瘤患者意外事件发生率、焦虑抑郁发生率。干预后,观察组化疗相关性恶心呕吐、深静脉血栓、PICC导管相关性感染、肿瘤患者意外事件、焦虑抑郁发生率均低于对照组,差异均有统计学意义(P<0.05)。两组化疗药物外渗发生率比较,差异无统计学意义(P>0.05)。结论通过构建肿瘤专科护理敏感质量指标可提升肿瘤专科护理质量,值得推广应用。     

品管圈活动降低高渗性药物输液外渗与静脉炎的作用

目的探讨品管圈活动在降低高渗性药物输液外渗与静脉炎中的应用效果。方法采取方便抽样法,选取上海交通大学附属第六人民医院神经外科和老年科2012年1—3月接受高渗性药物输液的患者3 623例为对照组(活动前);2012年10—12月接受高渗性药物输液的患者3 772例为观察组(活动后)。2012年4—9月以"降低高渗性药物输液外渗和静脉炎的发生率"为主题开展品管圈活动。结果品管圈活动前后,高渗性药物输液外渗发生率由18.41%降为8.85%,静脉炎发生率由6.73%降为3.58%,差异有统计学意义(P0.05)。护士对高渗性药物的认知显著提高(P0.05)。活动后圈组成员在品管圈应用、团队精神、专业知识、沟通协调、活动信心与责任荣誉6个方面均有显著提高,差异有统计学意义(P0.05)。结论品管圈活动能降低高渗性药物输液外渗与静脉炎的发生,规范临床高渗性药物的输注,提高输液护理质量与安全。     

门诊静脉输液存在的问题及对策

目的研究门诊静脉输液存在的问题,以提高护理质量。方法通过从药物方面、输液质量控制方面、护理工作经验、病人查对管理等方面加以综述。结果2002年成立门诊输液室以来,病人呈逐年递增趋势,由原来的9765人/年增长为12498人/年。结论通过加强护理质量管理,提高了护理质量,杜绝了护理差错事故的发生。     

门诊静脉输液存在的问题及对策

目的研究门诊静脉输液存在的问题，以提高护理质量。方法通过从药物方面、输液质量控制方面、护理工作经验、病人查对管理等方面加以综述。结果2002年成立门诊输液室以来，病人呈逐年递增趋势，由原来的9765人／年增长为12498人／年。结论通过加强护理质量管理，提高了护理质量，杜绝了护理差错事故的发生。     

呼吸道护理小组的建立与实践

目的探讨医院内建立呼吸道护理小组的方法与效果。方法成立了呼吸道护理小组,修订和完善呼吸道管理的实践标准,进行呼吸道护理理论及技能培训,建立质量监督体系和呼吸道护理会诊制度。结果提高了呼吸道护理小组成员的理论知识及专科技能水平,降低了呼吸道护理意外的发生,提高了医生及病人对护理工作的满意度。结论呼吸道护理小组可以使住院病人的呼吸道管理更趋安全性,促进了医院专科护理的发展。     

流程优化护理分诊对门诊诊疗流程及护理质量的影响

目的探讨流程优化护理分诊对门诊诊疗流程及护理质量的影响。方法选取佛山市高明区人民医院2017年6月至2017年12月150例门诊患者为研究对象(对照组),实施常规护理分诊。选取该院2018年1月至2018年6月150例患者为研究对象(观察组),实施流程优化护理分诊。充分收集患者在门诊诊疗流程中分诊质量、意见及投诉、护患之间纠纷等发生的原因,并针对以上意见进行整体修改,制定流程优化护理分诊措施。比较两组患者分诊诊疗质量、护理质量、投诉事件、护患纠纷及风险事故、差错事件发生率。结果观察组患者门诊分诊诊疗质量明显高于对照组,各方面护理质量明显高于对照组,投诉事件、护患纠纷及风险事故、差错事件发生率均明显低于对照组,差异有统计学意义(均P<0.05)。结论流程优化护理分诊能够改善门诊分诊的诊疗质量,使患者较快地就诊完毕,且患者获得了较好的护理,减少了门诊中投诉、差错等不良事件的发生率,对门诊护理工作具有重要作用。     

Extravasation management

OBJECTIVES: To describe the mechanisms of injury associated with DNA binding and DNA non-binding vesicants. To review various procedures used in clinical practice to manage vesicant extravasations. DATA SOURCES: Journal articles, published case reports, personal experience. CONCLUSION: There is a lack of evidenced-based information and consensus about vesicant extravasation management. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants. Data suggest that administration of IV dexrazoxane is effective in preventing tissue necrosis following anthracycline extravasation. Dimethyl sulfoxide also may have a role in treating anthracycline extravasations, but further research is needed. IMPLICATIONS FOR NURSING PRACTICE: Nurses who administer vesicant chemotherapy agents must be aware of the most current (or lack of) evidence for extravasation treatment. Well-informed nurses can serve as patient advocates and may be instrumental in detecting, managing, and documenting these injuries. Most importantly, nurses play a key role in preventing vesicant extravasation injuries.     

自制青黛膏治疗多柔比星外渗性皮肤损伤的效果

目的比较应用不同处理方法对兔发生多柔比星外渗性损伤后的防治效果,为临床护理提供依据。方法在10只大白兔背部制作多柔比星外渗模型,每只共4个模型,按处理方法的不同共分四组,每组模型数为10个,设立生理盐水外敷对照组及常规封闭组、自制青黛膏冰敷组、复方七叶皂苷凝胶组3个实验组,对外渗损伤愈合时间、损伤程度、病理形态学进行观察。结果在同一观察时间里,青黛膏组的溃疡面积小于其他实验组,差异有统计学意义(P<0.05)。自制青黛膏冰敷组的愈合时间明显短于其他实验组,差异有统计学意义(P<0.05)。结论局部常规封闭、自制青黛膏冰敷、复方七叶皂苷凝胶外涂均可应用于多柔比星外渗性损伤的防护,但自制青黛膏冰敷因其避免了不必要的痛苦、方法简便、效果最好而易被患者接受。     

Assessing workload in general practice in England before and after the introduction of the pay-for-performance contract

Title. Assessing workload in general practice in England before and after the introduction of the pay‐for‐performance contract. Aim. This paper is a report of a study conducted to describe changes in practice team size and composition, and the workload of doctors and nursing staff, before (2003) and after (2005) the introduction of the pay‐for‐performance contract for general practice. Background. In 2004, a new pay‐for‐performance contract for general practice was introduced in England. This improved the quality but may also have altered practice workload, including the workload of nursing staff. Method. Practice profile questionnaires and staff workload diaries were completed in 42 practices in England in 2003 and 2005. Managers provided information on team size and composition in 2003 and 2005. One week workload diaries were completed by doctors and nursing staff in both years. Diaries recorded: hours of work, number and complexity of patient visits, and types of problems (acute, chronic, preventative). Findings. The number of practice staff increased with greater increases observed for nursing staff than doctors. There was no change in the average number of hours worked per week by nursing staff or doctors but nurse visit rates increased while doctors’ rates decreased. The proportion of presenting problems described as chronic or preventative increased for doctors (χ²= 8·54, d.f. = 1, P < 0·004) but was unchanged for nursing staff. Nursing staff dealt with more complex visits in 2005 compared to 2003 (χ² = 30·70, d.f. = 3, P < 0·001) but there was no change for doctors. Conclusion. General practices may have responded to the 2004 contract by increasing staffing levels, with nursing staff absorbing a higher proportion of the clinical workload and doctors focusing more attention on chronic and preventive care. Expanding nursing staff roles may increase the quality of primary care but may lead also to intensification of nurses’ work.     

Quality of institutional care of older people as evaluated by nursing staff

Aims. The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. Background. The healthcare division of one Finnish city authorised an outside survey of long‐term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re‐survey was conducted in 2001, using the same criteria of quality assessment. Methods. A survey research method was used. All the seven institutions providing long‐term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78·6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76·8%. Results. The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. Relevance to clinical practice. The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long‐term institutional care.     

管理小组在中心静脉导管胸腔置管患者护理管理中的作用

目的 探讨管理小组在中心静脉导管胸腔置管患者护理管理中的作用.方法 成立管理小组,对行中心静脉导管胸腔置管治疗的患者实施全程护理管理,并比较管理小组成立前后两组患者胸腔置管期间并发症发生率和患者、医生对护理工作的满意度.结果 置管并发症发生率下降,患者和医生对护理工作的满意度提高(P＜0.01或P＜0.05).结论 成...