晨间交接班流程再造在ICU优质护理中的应用

目的:探讨晨间交接班流程再造对I CU优质护理服务的应用效果。方法:在I CU优质护理服务中,对晨间交接班流程进行流程再造,比较流程再造前后的晨间交接班流程每次所用的时间、护理交接班质量及护士病情知晓情况。结果:流程再造后的晨间交接班流程所用的时间显著低于流程再造前;流程再造后的护理交接班质量高于流程再造前;流程再造后的护士病情知晓评分高于流程再造前,差异有统计学意义。结论:晨间交接班流程再造,改进交接班模式,简化工作流程,规范交接班内容,强化交接班意识,提高护理工作质量。     

床头交接班流程的规范化管理

目的:探讨床头交接班流程的规范化管理模式,总结护理管理经验.方法:对床头交接班进行规范化管理.结果:实施规范化的床头交接班,促进各项治疗护理措施落实到位,有效减少了护理差错缺陷,保障了患者护理安全.结论:规范化的床头交接班管理,显著提高护士实际工作能力,全面提升科室护理管理质量.     

护士反式交接班的实施与效果

目的创新实施反式交接班模式,评价其实施效果。方法改变传统交接班模式,变接班者为交班者,由接班护士汇报患者情况,交班护士给予补充(反式交接班)。结果反式交接班模式未延长交接班时间,但在此模式下患者满意度显著提高(P<0.01)。结论反式交接班模式可提升接班护士责任心,促使护士落实责任制整体护理,从而提高患者满意度。     

新型冠状病毒肺炎危重症患者床旁纤维支气管镜治疗的流程管理

目的 探讨新型冠状病毒肺炎疫情下危重症患者行床旁纤维支气管镜检查和治疗的流程改进及效果。方法 对18例机械通气新型冠状病毒肺炎患者行床旁纤维支气管镜治疗,从人员培训、操作前准备、操作流程、用物消毒处理、环境处理、标本送检方面进行改进。结果 18例次的纤维支气管镜治疗操作过程顺利,送检标本合格,无医护人员感染。结论 加强新型冠状病毒肺炎危重症患者床旁纤维支气管镜治疗流程管理,对安全、高效、有序完成新冠肺炎危重症患者救治工作具有重要作用。     

基于患者满意度医院服务流程管理改进的研究

组织日常功能的棱心流程、提高核心流程性能的增强流程、为前两个流程提供必要支持的流程这三个方面来阐述如何应用管理学知识,改进医院服务流程管理,提高患者满意度.     

麻醉恢复室基于行动研究的交接班流程改进

目的 探讨基于行动研究的麻醉恢复室交接班流程改进效果。方法基于行动研究方法,通过发现问题,计划、行动、观察及反思,循环修订和完善麻醉恢复室交接班流程;对14名麻醉恢复室护士进行培训后实施方案。行动研究干预共2个循环。结果改进后的麻醉恢复室交接班流程实施后,护士病情掌握能力、流程执行情况及交接班满意度较实施前显著提升（均P＜0.05）。结论基于行动研究法改进的麻醉恢复室患者交接班流程,能有效提升护士对患者病情掌握情况,提高医护人员满意度。     

基于SBAR沟通模式的标准化床边交接班满意度评价

目的评价患者及护士对标准化床边交接班的满意度。方法选取5个外科护理单元,依据SBAR标准沟通模式实施标准化床边交接班。分别在实施前和实施6个月后调查患者、护士对床边交接班的满意度。结果实施后患者及护士对交班满意度部分条目显著高于实施前(P<0.05,P<0.01)。结论标准化床边交接班的实施,有利于提高患者满意度,保证患者安全。在床边交接班取得积极效果的基础上,护理管理者应关注患者及交接班护士的主观感知,从根本上提高床边交接班质量。     

舒心病房输液流程优化的实践

目的探讨静脉输液流程优化在舒心病房的实施及效果。方法成立输液流程管理小组,评估原有流程,从输液操作、速度管理、输液巡视、输液物品放置等方面采取优化措施,培训护理人员并组织实施,对优化后流程的执行情况监督反馈。结果输液流程优化后,患者对输液环节中部分项目评分较高(P<0.05,P<0.01);液体更换时间、肝素封管时间、药液核对分配时间显著缩短(均P<0.01);优化后患者对输液满意度、病房综合满意度、输液宣教覆盖率和宣教知晓率分别达95.00%、96.00%、100%和98.00%。结论舒心病房输液流程的优化,强化输液环节质量,提高了患者满意度,缩短了输液患者等待时间,深化了患者舒心、家属放心的舒心护理服务内涵。     

全麻复苏期患者的护理流程

目的 探讨规范全麻手术后复苏期护理内容、落实方法及流程对护理工作的价值.方法 从回病室、复苏中、复苏后3个阶段分别制定了全麻复苏期护理内容及落实流程,对1 200例患者实施护理.结果 科室自查患者满意度由实施前的96.0％上升至实施后的99.0％,基础护理满意率由90.0％上升至100％.结论 规范全麻复苏期护理内容与...     

流程管理在神经外科开展“优质护理服务”中的应用

目的:运用流程管理理论贯彻落实“优质护理服务”.方法:运用流程管理三步骤:制作流程、优化流程,执行流程,制定优质护理服务的流程.结果:通过流程管理使“优质护理服务”得到了很好的落实,工作效率提高,患者满意度提高.结论:流程管理是为患者提供优质护理服务的重要手段和保障     

Standardised proformas improve patient handover: Audit of trauma handover practice

Background  

The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists. We present a closed-loop audit of handover practice to assess whether standardised proformas improve clinical data transfer between shifts during handover in our Orthopaedic Unit.     

Development of an orthopedic surgery trauma patient handover checklist

Background

In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist.

Methods

We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist.

Results

Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness.

Conclusion

Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.     

A patient centered decision making dialysis access algorithm

Much controversy surrounds the establishment of proper planning, placement and management (the best practice pattern) of dialysis access. These include the dialysis type and modality selection, timing of access placement and who places the access. The lack of and the difficulty of performing randomized studies with multiple confounding factors, in an extremely heterogeneous and rapidly changing ESRD population demographics, only partly explains the dialysis access conundrum. Add to this the rapidly developing and competing technologies, the wide spectrum of the professional experience, bias and socio-economic forces to make the ESRD problems as multivariate and complex as life itself. This overview describes a dialysis access algorithm approach to the patient needing renal replacement therapy, considering long-term improved patient outcome as the ultimate objective.     

基于失效模式与效应分析的手术患者术前交接流程管理

目的探讨失效模式与效应分析在手术患者术前交接流程管理中的应用效果。方法对344例手术患者术前交接流程进行梳理,分析交接中的失效模式及原因,计算优先风险数值,找出前5位的失效模式,并针对造成失效模式的主要原因,制订改进措施。实施3个月后,抽取342例手术患者,对术前交接情况进行调查。结果实施后术前准备完善率、患者关键信息规范率、手术部位标记正确率、病历资料齐全率、患者评估齐全率显著高于实施前(P<0.05,P<0.01)。结论失效模式与效应分析能够纠正手术患者术前交接失效模式,使术前交接更加顺畅、规范,保障患者手术安全。     

基于急救流程交班模板的设计及在晨会交班中的应用

目的提高急救中心危重患者抢救质量和护士急救综合能力。方法将210例患者按时间段分为对照组98例、观察组112例;对照组按急救中心常规交班;观察组基于33种疾病急救流程设计交班模板,按急救流程抢救患者后采用相对应交班模板进行晨会交班及病例救治过程讨论。实施5个月后评价效果。结果观察组抢救时滞显著短于对照组、不良事件发生率显著低于对照组,病情处置合格率及专科护理合格率显著高于对照组(P0.05,P0.01);护士病情处置能力、专科护理能力、自我评价及医生的评价显著高于实施前(均P0.01)。结论采用基于疾病急救流程交班模板交班及实时讨论,有效提高了急救护理质量和护士急救综合能力。     

Morning report: combining education with patient handover.

INTRODUCTION: The advent of resident work hour restrictions has challenged us to train residents within a shorter working week, while ensuring continuity of patient care. We instituted morning report (MR) at the University of Virginia primarily as a means to accomplish these objectives. Serendipitously MR has become an integral educational tool for the surgical residents. The rationale for the format and instructional design are discussed in the context of learning theory. METHODS: The chief residents as primary stakeholders were strongly encouraged to play a leadership role in designing MR. A faculty- led didactic format was rejected because of the importance of focusing on resident team building, and leadership, but poor faculty participation was also an issue. RESULTS: The initial obstacles included timing, and designing the format. CONCLUSIONS: MR is an opportunity for residents to exercise and improve their knowledge, leadership, presentation and problem-solving skills. We would hypothesise that the advantages for teaching are many and include that residents are prepared for actual clinical problems in a supportive environment with opportunities for immediate feedback and assessment. Reports of educational effectiveness of MR are mostly anecdotal and further studies are needed to characterise the types of learning and teaching that occur during MR and to document educational effectiveness.