自愿戒毒病房的管理

我院从1995年开始收治自愿戒毒病人,在工作中我们发现,戒毒病人有如下特征:(1)躯体不适和疑病倾向,难接受正确的社会价值观和遵守医院规范,具有撒谎、诈骗等行为;(2)偏执人格,紧张焦虑、自卑、古怪;(3)具有攻击个性、冷漠、无情,常常会提出不合理的要求,甚至出现冲动伤人、毁物行为,严重者出现人格障碍,不能维持亲近的人际关系.针对戒毒病人的这些情况,我们采取了相应管理措施,并取得很好效果.现将我们的方法报告如下:     

舒适护理在骨科病房的应用

舒适护理是对护理活动 +舒适的研究 ,可使病人在生理、心理、社会、灵性上达到最愉快的状态 ,或缩短、降低不愉快的程度[1] 。 1998台湾的萧丰富提出了“萧氏双C护理模式” ,强调护理人员应加强舒适护理研究 ,并将研究结果应用于病人。根据这一模式 ,我们在骨科整体护理过程中融入了舒适护理研究 ,取得了良好效果 ,现介绍如下。1　临床资料本组 182例 ,男 12 0例 ,女 6 2例 ;年龄 12～ 84岁。上肢骨折 76例 ,下肢骨折 6 2例 ,腰椎骨折 4 4例。手术治疗 116例 ,保守治疗 6 6例。2　护理2 1　入院评估　在入院评估中除一般资料及生活状况的…     

舒适护理在骨科病房的应用

舒适护理是对护理活动+舒适的研究,可使病人在生理、心理、社会、灵性上达到最愉快的状态,或缩短、降低不愉快的程度[1].     

Orthostatic hypotension in internal medicine wards

Objectives: Most studies of orthostatic hypotension (OH) have focused on community-dwelling and institutionalized patient populations. Less is known about OH in hospitalized patients. Moreover, a comprehensive review of OH in internal medicine wards has not been published in the English literature. Our purpose is to provide current information regarding OH in internal medicine inpatients.

Methods: A comprehensive search of medical databases was performed for potentially relevant articles, using the following keywords: postural or orthostatic hypotension, with the combination of hospitalization or internal medicine. Inclusion criteria were: population of patients hospitalized for acute disorders in internal medicine or geriatric wards with a sample size of ≥50 and publication as an original full-length article in the English language. Data from 14 selected studies are reviewed, including: pathophysiology, evaluation, prevalence, manifestations, risk factors, prognosis, and management.

Results: OH is a common and often symptomatic disorder in elderly internal medicine patients. The prevalence of OH in this population ranges from 22–75%. There are substantial discrepancies between the studies reviewed regarding definitions and means of evaluating OH. OH in internal medicine wards is largely non-neurogenic and multifactorial. The main predisposing factors for OH are prolonged bed rest, hypertension, and heart failure. OH in internal medicine wards is managed mainly with non-pharmacologic interventions, and is frequently reversible.

Conclusions: In internal medicine inpatients, OH warrants attention because this disorder is common, potentially dangerous, and treatable. In the hospital setting, OH should be routinely assessed on ambulation, following the current guidelines for OH definition and meaning.     

Use of antimicrobial drugs in medical wards.

Antimicrobial usage patterns in 17,750 consecutive medical in-patients, monitored between 1966 and 1972 are described. 36.4% of all patients were exposed to one or more antimicrobials and about half of them received more than one antimicrobial agent. Penicillins accounted for 49% of all exposures and use of ampicillin rose steadily over the years. Concomitant receipt of more than one antimicrobial was common (22% of all exposed patients). Of 171 possible two-drug combinations involving 19 drugs, 126 were actually encountered. Apart from combinations, 60% of antimicrobial recipients received more than one agent at different times.     

Errors in fluid therapy in medical wards

Background Intravenous fluid therapy remains an essential part of patients?? care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards. Objective The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital. Setting This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran. Methods During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients?? fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration. Main outcome measure: Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors. Results Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients?? male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the occurrence of fluid therapy errors in the patients. Conclusion Our result showed that intravenous fluid therapy errors occurred commonly in the hospitalized patients especially in the medical wards. Improvement in knowledge and attention of health-care workers about these errors are essential for preventing of medication errors in aspect of fluid therapy.     

Contribution from geriatric medicine within acute medical wards

In 1977 a scheme of attachment to acute medical wards of consultants in geriatric medicine and associated junior medical staff was instituted in a large Edinburgh teaching hospital. The effect on admissions of patients aged 65 and over was examined for comparable periods before and during this arrangement. Mean and median stays were reduced for both sexes but more noticeably for women. The mean stay for all women aged over 65 was reduced from 25 to 16 days and for women aged over 85 from 50 to 19 days. The proportion staying under two weeks was significantly increased in both sexes, and the proportion discharged home also increased, correspondingly fewer patients being transferred to convalescent wards. These changes were not accompanied by increased transfers to the geriatric department, and probably the skills and extra resources available to the geriatric service were the factors mainly responsible for the changes in performance.     

眼药水专用篮使用的临床研究

目的 深入了解我科眼药水使用现状,探索其混乱原因,规范眼科病区患者的眼药水管理,提高患者满意度.方法 成立Qc小组.根据患者眼药水使用现状,结合患者需求,制作了眼药水专用篮投入使用.对我科2011年5月至2011年7月使用眼药水的128例病人进行眼药水摆放、用药时间的知晓、眼药水的药物作用知晓、按时滴药、准确区分患眼的满意度调查.结果 使用眼药水专用篮前的平均满意度为81.6％,使用眼药水专用篮后,患者满意度提高至97.9％.结论 加强护患沟通,重视护理服务的各个方面,能达到病人最高满意度.制作的眼药水专用篮具有实用性、新颖性、科学性,值得推广使用.     

护理风险管理在精神科老年病房中的应用效果

目的探究护理风险管理在精神科老年病房中的应用效果。方法收集2015年6月～2018年6月本院收治的80例精神科老年病房患者及10名护理人员作为研究对象。识别护理风险、分析不安全因素,制定科学、全面的护理风险管理措施。结果实施护理风险管理后,护理质量评分、患者满意度评分均高于护理风险管理实施前比较,差异均有统计学意义(P 0.05)。风险管理前,80例患者中静脉穿刺成功61例(76.3%),管理后为79例(98.8%);风险管理前2名出现护理缺陷,发生率为20.0%,管理后未见护理缺陷,发生率为0,差异均有统计学意义(P 0.05)。结论对精神科老年病房的患者实施护理风险管理可有效防范了各类风险事件的发生,保证了患者安全,创造了更为安全、舒适的住院环境,提高了护理质量,值得进一步完善及推广应用。     

不同病区床头柜表面细菌学监测与分析

目的探讨不同病区床头柜表面消毒前后细菌学监测结果与医院感染的关系及其相关分析。方法采用“棉试子倾注法”分别在消化病区、CCU病区（冠心病监护病房）及传染病区床头柜表面进行消毒前后采样,计算菌落数及进行致病菌检测。结果消毒前不同病区床头柜表面细菌总数占比：传染病区〉消化病区〉CCU病区;微生物占比：革兰阳性（G^＋）球菌（占41．41％）〉革兰阳性（G^＋）杆菌（占33．84％）〉革兰阴性（G）杆菌（占14．14％）〉真菌（占6．57％）〉革兰阴性（G^＋）球菌（占4．04％）;致病菌以金黄色葡萄球菌、大肠埃希氏菌、肺炎克雷伯氏菌、铜绿假单胞菌等为主。结论在不同病区床头柜表面消毒前后分离出的菌株与医院感染病原菌存在有同源性。因此,加强医院各个区域环境的清洁消毒,可有效预防和控制因环境污染所造成的医院感染发生。     

发热隔离病房患者心理健康水平调查分析

我院于2 0 0 3年4月成立了发热门诊和隔离病房,收治因发热需隔离观察和治疗的患者。我们对发热隔离病房患者进行了心理健康调查,现报告如下。1　对象和方法1 1　对象　随机抽取发热隔离病房患者6 0名,发放问卷6 0份,收回有效问卷5 4份。其中男2 6人,女2 8人;年龄18～5 2岁,平均