药物医嘱全生命周期追溯对护理人员工作的影响

目的：评价药物医嘱全生命周期追溯对护士工作的影响。方法以护士工作站信息化及Itouch条形码核对为基础,通过设计药物医嘱追溯模块,实施药物医嘱执行追溯规范。比较实施前后护士医嘱处理时间及用药安全。结果实施后,护士医嘱处理时间平均每床日（4．36±1．28） min缩减为（0．97±0．34）min,差异有统计学意义（t＝20．181,P＜0．01）;护士医嘱处理错误率从每千床日0．74‰下降至0．15‰,给药错误率从每千床日1．33‰降至0．35‰,药物漏执行率从每千床日1．24‰下降至0．06‰,差异均有统计学意义（χ2值分别为13．548,19．073,36．347;P＜0．05）。结论实施药物医嘱全生命周期追溯管理,提高了工作效率,降低了护理缺陷的发生,提升了工作质量,保障了患者安全。     

医院信息化检验医嘱闭环执行系统的实践和应用效果

目的探讨通过医院信息化检验医嘱闭环执行系统的应用和实践,减少差错发生、提高工作效率的效果。方法将执行检验医嘱的全过程所有数据自动录入医院信息系统,从医嘱开立、标本采集、送检、检测、报告单交接五个环节,进行全程跟踪,对每一步实时检查和确认,实行医嘱执行的闭环管理。比较应用该系统前(2011年)及应用后(2012年)骨科-病区的标本检测前错误发生率、报告单的发送准确率、患者平均住院天数、医生满意度等。结果标本检测前错误发生率由0.88%下降到0.2%,检验报告单的发送准确率由99.6%提高到99.96%,患者平均住院天数缩短0.5d,临床医生满意度由86%提高到95%。结论检验医嘱闭环执行系统的应用可预防和减少人为差错,明显提高护士对检验医嘱执行的准确性,规范了各部门的交接流程,提高了医疗护理质量。     

基于信息技术的药物过敏试验闭环管理的设计与应用

设计药物过敏试验闭环管理执行系统,确保护理安全。优化电子病历需过敏试验药物的医嘱录入至医嘱签字各节点的设置,并采用webservice技术进行电子病历和医院信息系统的集成,将电子病历录入过敏试验结果同步至医院信息系统,病区护士站打印含过敏试验结果的输液条码,实现全流程数据跟踪及药物过敏试验闭环管理,提高了过敏试验药物的医嘱信息准确性、执行的正确性。     

NICU母乳喂养闭环信息化管理系统的开发及应用

目的运用母乳喂养闭环信息化管理理念对NICU母乳喂养进行闭环管理,保障患儿喂养安全,提高护理工作效率。方法成立多学科合作管理小组,分析原母乳喂养管理流程中存在的问题,构建母乳喂养闭环信息化管理方案,开发母乳喂养闭环信息化管理系统,实现护理信息系统与医嘱信息系统共享,母乳喂养医嘱与配方奶医嘱科学结合。结果 2016年1月—12月实施母乳喂养闭环信息化管理前,因母乳喂养信息核对环节错误发生意外事件1例,近似错误2例。2017年1月—12月实施母乳喂养闭环信息化管理后,未发生母乳喂养相关的意外事件及近似错误。实施母乳喂养闭环信息化管理前,需人工统计母乳收集量、抄写喂养单、录入喂养医嘱执行情况,每日工作时数为2 h,母乳喂养率统计每月工作时数为8 h。实施母乳喂养闭环信息化管理后,系统自动生成以上数据,无需人工统计。结论应用母乳喂养信息化闭环管理能够确保母乳喂养安全,减轻护理人员工作负荷。     

多重耐药菌感染多部门合作干预机制及临床效果评价

目的探讨在临床多重耐药菌(MDRO)医院感染预防与控制中多部门合作干预机制的应用效果。方法观察对象是临床科室培养出MDRO的住院患者,比较实施多部门合作干预机制前后MDRO感染及定植例数/千床日、MDRO占总分离细菌的比例(去除重复菌株)及MDRO医院感染发病率。结果实施多部门合作干预机制后,MDRO医院感染防控措施依从性明显提高,住院患者的MDRO占总分离细菌的比例由28.53%降至22.64%,差异有统计学意义(χ~2=49.1,P0.05),MDRO感染/定植率由3.16例/千床日下降到2.78例/千床日,差异有统计学意义(χ~2=8.19,P0.05),MDRO医院感染发病率由0.91%降至0.43%,差异有统计学意义(χ~2=44.4,P0.05)。结论采用多部门合作干预机制,可有效提高MDRO医院感染防控措施依从性,控制MDRO医院感染。     

基于闭环管理构建用药安全管理系统的研究

目的 :分析闭环管理方法在分子靶向药物曲妥珠单抗(赫赛汀)用药安全管理中的应用效果。方法 :运用闭环管理模式和智能信息化管理在赫赛汀医嘱开单系统设置、用药自动计算用量、用药单次单剂量计费、赠药模式规范化、药物集中配置、规范药物使用核对、输液环节安全管理等方面改进。结果:闭环管理后开具医嘱耗时、核对药物耗时增加(P0.001),首次发药耗时、配置药物耗时缩短(P0.001),输注药物耗时差异无统计学意义(P0.05),赫赛汀药物相关不良事件发生率降低(P0.001)。结论 :赫赛汀用药安全闭环管理流程实现了以患者为中心的服务模式,可明显提升用药的安全性,减少发生错误的环节,提高医护工作效率。     

PDA在神经内科医嘱执行中的效果分析

目的探讨PDA在神经内科优质护理工作中进行医嘱执行的效果分析。方法探讨常熟市第二人民医院神经内科自2013年9月~2014年9月在护理工作中应用PDA扫描患者腕带二维码、各种药物治疗条形码进行识别的医嘱执行效果分析。结果使用PDA扫描二维码、条形码后,医嘱执行导致药物不良事件从0.3%降至0。结论护士执行药物时使用PDA扫描识别可以降低不良事件发生率,提高护理工作效率,提高患者、家属及医生满意度。     

静脉输液质量监测闭环追踪系统的构建及应用

目的 构建静脉输液质量监测闭环追踪系统并探讨其应用效果。方法 成立研究团队,开发静脉输液质量监测闭环追踪系统,包括医嘱开具与审核模块、药物配置模块、医嘱执行过程及统计分析模块。该系统于2021年11月在临床试运行,2022年1月正式应用,比较系统应用前（2021年1月—12月）与应用后（2022年1月—12月）输液相关不良事件的发生数量及红灯呼叫量,采用随机抽样的方法选取1个病区统计异常输液数量。结果 系统应用前输液相关不良事件发生3例,应用后发生1例。随机抽取神经内科病房,系统应用前病区内平均月红灯呼叫数量为（5 120.25±775.82）次,应用后为（1 518.25±74.77）次,差异具有统计学意义（P<0.001）。所抽取病房内1个月的输液总量共5 184瓶,其中,滴速过快155次（2.99%）,共775 min;滴速过慢207次（3.99%）,共1 035 min;平均处理时间均为5 min。结论 静脉输液质量监测闭环追踪系统可对输液全程进行追踪与记录,为护理闭环质量检查提供准确、客观的数据,有利于管理者及时发现输液过程中潜在的问题,规范护理操作,提高静脉输液用药安...     

临床药物医嘱记录单的管理及应用

随着我国医疗事故处理条例的出台,卫生部国家中医药局制定了配套文件《病历书写基本规范(试行)》(简称《病历规范》)。其中第三章第29条规定了长期医嘱必须有执行时间和护士签名[1]。笔者结合本院实际,设计出一套新的临床药物医嘱记录单,通过实施取得较好效果。现报告如下。1住院病人药物医嘱记录单(IMR)的特点1.1 IMR单独存放住院病人的IMR均单独存放在编有床号的文件夹内,与其相应的病历记录分别放置,可避免医护之间书写病历和执行医嘱时间上的冲突。当病人入院时,护士将一份完整的未填写的IMR放在对应床号的文件夹内并填写必要的眉…     

护士转抄医嘱的弊病与对策

医嘱是指医生在医疗活动中下达的医疗指令 ,是护士完成治疗计划及查核的依据。医嘱的内容及起始、停止时间应当由医生撰写 ,不能随意剪贴和涂改。医嘱是病历的重要内容之一 ,是具有重要法律效力的文件 ,在医疗纠纷一些诉讼案件中 ,其调查处理的过程中医嘱将作为重要的依据之一 ,以判断医院的医生、护士等有关人员有无法律责任。我院自5 0年代起至 1999年一直执行护士转抄医嘱的制度 ,即医生将医嘱写在医嘱本上 ,由办公护士查核后 ,根据医嘱内容及病情缓急分配给有关护士执行 ,然后再转抄至各种执行单和医嘱单上 ,并在医嘱本上作红、兰、铅三…     

台北荣民总医院护理信息化管理及借鉴

介绍了台北荣民医院护理信息化管理模式,包括完善的护理人员"进阶制度"的信息化、护理教师临床实务指导能力考评效果的信息化、院内护理丰富资源共享性的信息化、计算机执行医嘱核对实物图片信息化等。结合大陆护理信息化管理工作实际,可参考和借鉴台北荣民总医院的护理信息化管理经验,尝试建立院内网络护理信息库,实现资源共享;计算机录入校正、显示各类药品实物图片信息,提高医嘱执行查对的准确性;加强各级护理人员信息化的管控,把护理管理者从繁琐的数据登记中解脱出来,提高工作效率。     

Validating reasons for medication discontinuation in electronic patient records at hospital discharge

Rationale, aims and objectives The accuracy of health care professionals in reporting safety events determines their usefulness for both system improvement and research. The study objectives were to: (1) validate (assess the accuracy of) the reasons recorded by doctors and pharmacists for discontinuing medication orders at discharge in a hospital's electronic patient records (EPR); (2) investigate the causes of any detected recording inaccuracy; and (3) collect preliminary data on the frequency and types of medication discontinuation. Methods This was a validation study in one English hospital. The study comprised two steps: extraction of discontinued medication orders from the EPR followed by short structured interviews with doctors and pharmacists who made the discontinuation. A total of 104 discontinued orders were discussed during 15 face‐to‐face and six telephone interviews. The software package spss was used for data analysis. Results Duplication of therapy (27, 25.2%), omission of drug (23, 21.5%) and dosage regimen change (19, 17.8%) were the three most frequent reasons given for discontinuing medications. The majority of recorded discontinuation reasons were correct (100, 96.2%) and complete (101, 97.1%), and hence were judged accurate (97, 93.3%). The difference in accurate recording between doctors (15, 88.2%) and pharmacists (82, 94.3%) was not statistically significant. Potential causes of recording inaccuracy included: slip or lapse, lack of training, carelessness and electronic system rigidity. Conclusion This study showed that doctors and pharmacists recorded accurate reasons for the majority of the discontinued medication orders. It also showed that utilizing pharmacists' recorded reasons during clinical interventions using EPR was beneficial in understanding and characterizing prescribing errors. Although they require further research, the reasons identified present preliminary data about the most prevalent types of pharmacists' interventions during hospital discharge.     

Medication reconciliation: a practical tool to reduce the risk of medication errors

Preventable adverse drug events are associated with one out of five injuries or deaths. Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. This study was performed to reduce medication errors in patient’s discharge orders through a reconciliation process in an adult surgical intensive care unit (ICU). A discharge survey was implemented as part of the medication reconciliation process. The admitting nurse initiated the survey within 24 hours of ICU admission and the charge nurse completed the survey on discharge. Baseline data were obtained through a random sampling of 10% of discharges in first 2 weeks of the study (July 2001-May 2002). Medical and anesthesia records were reviewed, allergies and home medications verified with patient/family and findings compared with orders at time of ICU discharge. Baseline data revealed that 31 of 33 (94%) patients had orders changed. By week 24, nearly all medication errors in discharge orders were eliminated. In conclusion, use of the discharge survey in this medication reconciliation process resulted in a dramatic drop in medications errors for patients discharged from an ICU. The survey is now a part of our electronic medical record and used in 4 adult ICUs and 2 medicine floors.     

品质管理活动在病房用药安全质量管理中的应用

目的 探讨品质管理活动对病房用药安全的影响,提高安全护理质量.方法 成立品质管理活动小组,设制用药错误查检表,对现况问题进行要因分析,确立并落实了5项质量改进措施.结果 用药临界差错由活动前的17.75件/周减少到4.5件/周,使病房用药安全得到了持续的质量改进.结论 品质管理活动有效地提高了病房用药安全.     

Evaluating process changes in a pediatric hospital medication system

This article describes a process change designed to increase the safety of prescribing and interpreting complex order sets. All chemotherapy orders written for pediatric oncology patients at a major teaching hospital in the Eastern United States and the affiliated ambulatory clinic from June 1998 through February 2000 (n = 1792) were reviewed to evaluate a new process for communication of chemotherapy orders. The multidisciplinary check (MDC) is a forum where all disciplines simultaneously review and change complex order sets. Evaluation of the MDC included monthly completion rate and classification of changes made to orders at MDC. Over the study period, 96% of eligible orders received a multidisciplinary check, and 44% were changed. The most common change was to clarify discrepancies between the order and the protocol. Changes were made to avoid medication errors in 99 of 451 orders. Changes to avoid medication errors were more likely to involve nonchemotherapy medications. The MDC is an efficient and feasible process to increase safety at the beginning of the medication system.     

A controlled trial of smart infusion pumps to improve medication safety in critically ill patients

OBJECTIVE: Intravenous medications are vital during inpatient management. Errors associated with the administration of medications through intravenous infusion pumps to critically ill patients can result in adverse drug events. We sought to assess the impact of smart pumps with integrated decision support software on the incidence and nature of medication errors and adverse drug events. DESIGN: We performed a prospective, randomized time-series trial and compared the serious medication error rate between intervention (decision support on) and control (decision support off) periods. Serious medication errors included both near-misses and preventable adverse drug events. Pump software produced log reports to help identify potential events. Events were presented to physicians for rating of event type, preventability, and severity. SETTING: Cardiac surgical intensive care and step-down units between February and December 2002. PATIENTS: Pump data were available for 744 cardiac surgery admissions. INTERVENTIONS: Decision support during medication administration provided feedback including alerts, reminders, and unit-specific drug rate limits. MEASUREMENTS AND MAIN RESULTS: We found a total of 180 serious medication errors, including 14 and 11 preventable adverse drug events and 73 and 82 nonintercepted potential adverse drug events in the control and intervention periods, respectively. The serious medication error rates in the control and intervention periods were 2.03 and 2.41 per 100 patient-pump-days, respectively (p = .124). We also found numerous opportunities for safety improvement. Violations of infusion practice during the intervention periods included 571 (25%) bypasses of the drug library. Medications were also frequently administered without documentation of physician orders in both periods (n = 823; 7.7%). CONCLUSION: Intravenous medication errors and adverse drug events were frequent and could be detected using smart pumps. We found no measurable impact on the serious medication error rate, likely in part due to poor compliance. Although smart pumps have great promise, technological and nursing behavioral factors must be addressed if these pumps are to achieve their potential for improving medication safety.     

Adverse effects and medication errors: incidence and role of the organization of drug distribution

The true incidence of adverse drug events is controversial and there are few data concerning the percentage of potentially preventable adverse drug events. Over 2 months, in two internal medicine units, we asked the staff to report adverse drug events. All incidents were evaluated: adverse drug events (preventable and non-preventable) and potential adverse drug events (non-intercepted potential adverse drug events and intercepted potential adverse drug events). The severity, the stage in the process at which the error occurred and the type of error were evaluated by a physician reviewer. Over the 240 admissions, the incidence of adverse drug events is 18 per 1000 patient-days. The system design caused 77 per cent of the incidents. The medication errors occurred at all stages from ordering to administration. Adverse drug events resulting in medication errors (n = 22) were more serious than non-preventable adverse drug events (n = 26) (p = 0.003). A prevention strategy by pharmacovigilance centres (Centres Régionaux de Pharmacovigilance) should target all stages of the drug delivery process.     

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.     

以全质量管理为基础构建手术室信息平台及实施效果分析

目的 提升手术患者安全管理及手术室运行效率,构建手术室信息平台,探讨手术室全流程闭环式信息化全质量管理方案。方法 围绕以手术患者安全为主体,结合流程再造、精细化管理、全质量管理的方法,通过对手术患者围术期无缝隙闭环式信息化转运交接、手术医师医疗权限控制、手术室消毒包/器械的信息化全流程追溯、术中离体组织标本的信息化全流程管理、手术室耗材、物资的全流程信息化管理、手术室仪器设备使用全生命周期化管理等六个维度,探讨对手术室人、财、物等实施闭环式、全质量的管理。结果 两组患者的首台手术准时划皮率、术中快速病理诊断时间、手术患者PDA转运交接有效实施率、手术连台时间均有所提高（P<0.05）;实施前后患者信息识别率、手术患者高危风险评估率、非计划再次手术率、手术部位标识规范执行率、安全核查正确执行率等都得到了改善（P<0.05）。观察组患者护理总满意度99.33%优于对照组92.30% （P<0.05）,观察组医护对手术室运行效率总满意度99.54%优于对照组93.97%,（P<0.05）。结论 全质量管理体系下手术室信息平台的构建与实施促进手术室向高质、高效、低耗方向发展,做到手术围术期的全过程、全质量信息化控制,持续改善了手术患者安全管理效率和手术室运行效率。