建立医疗差错和不良事件报告系统确保病人安全

确保病人安全是医院管理以及护理管理的重要内容,也是改进医疗护理质量的基础。文章介绍了医疗差错和不良事件报告系统在提高病人安全管理中的作用,并以美国医疗机构联合认证委员会的预警事件报告和分析为例,通过详实的数据介绍了应用该系统的方法,以及与护理相关的病人安全管理目标的内容。同时,对我国护理工作中病人安全管理提出了建议。     

急诊观察室危重病人护理安全管理

加强急诊观察室危重病人的护理安全管理,减少护理差错、护理纠纷,提高护理人员的整体素质,从根本上提高护理质量。对危重病人存在或潜在的不安全因素进行分析,提出解决措施,包括组织管理、护理人员管理、病人管理。加强危重病人的护理安全管理,对消除护理安全隐患,减少护理纠纷起到重要作用。     

急诊观察室危重病人护理安全管理

加强急诊观察室危重病人的护理安全管理,减少护理差错、护理纠纷,提高护理人员的整体素质,从根本上提高护理质量。对危重病人存在或潜在的不安全因素进行分析,提出解决措施,包括组织管理、护理人员管理、病人管理。加强危重病人的护理安全管理,对消除护理安全隐患,减少护理纠纷起到重要作用。     

护理安全管理存在的问题及对策

目的为了进一步搞好护理安全管理,提高护理质量,减少护理纠纷,为病人提供安全、优质的护理服务。方法通过分析护理安全管理中存在的问题,制订一系列安全管理措施,规范关键护理过程的管理,确保护理安全。结果护理差错发生率由2%下降0.8%,病人对护理工作满意率由92%上升至96%。结论加强护理安全管理,有效地杜绝了护理差错事故的发生,减少了医疗纠纷。     

安全文化在手术室安全管理中的应用与体会

目的 探讨安全文化在手术室安全管理中应用的方法与效果.方法 将安全文化应用到手术室安全管理中,加强安全教育、强化安全观念;针对手术室常见风险因素,制订有效的防范措施;建立护理差错主动报告制度;加强与合作者及病人的交流沟通等措施,提高护士的防范意识和能力.结果 护理差错及缺陷的发生率降低,医生及病人对护理工作的满意度提高...     

浅谈互查式护患沟通在病房安全管理中的应用

目的探讨病人及家属参与管理自身治疗、护理等安全活动对病房安全管理质量指标、病人住院满意率等方面的影响。方法将2008年4月～2009年3月的1年间在呼吸科收治的1994名病人分到A、B两组,A组应用原有的工作方式由护理人员常态管理;B组全程让病人及家属参与病人的治疗、护理及涉及自身的一切安全管理,然后将2组全年发生的涉及安全的护理差错、一般差错、缺陷、病员满意率等进行统计和评定。结果B组发生的护理差错少于A组,p0.01,差异有统计学意义。结论让病人及家属参与自身治疗、护理等安全活动更有利于病房安全管理,且能够提高病员满意率。     

护理安全管理的概念分析

通过系统的文献回顾对护理安全管理的概念进行相关分析,主要从护理安全管理的定义、国内外护理安全管理的机构设置、护理安全管理的影响因素及护理安全管理的防范措施等4个方面进行理论分析。旨在通过对护理安全管理的概念进行分析,理清护理服务管理体系的管理思路,并在护理安全管理过程中,采取有效、可行的措施预防和控制护理差错及不良事件的发生,提高护理质量。     

护理安全管理现状与对策研究进展

从护理安全管理机构、护理安全(不良)事件报告系统、护理差错的分析系统、护理安全管理质量评价体系、安全管理屏障等方面介绍了国内外的护理安全管理及对策研究进展.     

护理安全文化在预防护理差错中的探索与应用

护理安全管理是护理管理的重要内容,护理安全文化是引入护理管理的新概念.建设护理安全文化首先要改变护理安全的观念,根据医院具体情况建立系统的护理差错分析方法、畅通的护理差错报告制度,制定简单的标准化工作流程,护理管理者对安全问题要积极关注与参与,并与合作者及患者加强沟通,以保证护理安全、预防护理差错的发生.     

神经外科ICU危重病人护理的安全管理

[目的]减少和遏制护理中存在的病人安全显性和隐性问题,提高危重病人专科护理质量。[方法]对危重病人存在或潜在的安全风险进行分析,通过护理人力资源管理、病房管理、护理人员管理、病人管理消除护理安全隐患。[结果]科室连续两年零投诉、零差错。[结论]加强危重病人的安全管理,提高风险识别能力,降低不良事件的发生。     

The Influence of Patient Safety Culture and Patient Safety Error Experience on Safety Nursing Activities of Emergency Nurses in South Korea

IntroductionThe unique nature of the space and environment of emergency departments is a threat to patient safety. Enhancing patient safety and minimizing safety-related issues are important tasks for ED health care staff. The purpose of this study was to examine the relationships among patient safety culture, patient safety error, and safety nursing activities of emergency nurses in South Korea.MethodsA convenience sample of 200 emergency nurses working in 12 general hospitals in South Korea were surveyed for safety nursing activities using the Hospital Survey of Patients’ Safety Culture, a 4-item questionnaire for patient safety error and ED safety management items in the Guidelines for Patient Safety (seventh revision).ResultsHierarchical regression analysis revealed that the potential factors associated with safety nursing activities were safety training experience (β = 0.180, P=.01), organizational learning–continuous improvement (β = 0.170, P=.04), age (β = 0.160, P=.02), and implementation of domestic and foreign accreditation (β = 0.147, P=.03).DiscussionTo improve patient safety, it is essential to identify problems in medical institutions, determine areas of improvement, and improve the organization’s patient safety activity system on the basis of patient safety error experience reports. After training the emergency nurses for continuous improvement, the effect of patient safety activities must be analyzed.     

Human factors and safe patient care

Aims  This paper aims to introduce the topic of human factors to nursing management and to identify areas where it can be applied to patient safety.
Background  Human factors is a discipline established in most safety critical industries and uses knowledge about human behaviour in the analysis and design of complex systems, yet it is relatively new to many in healthcare.
Evaluation  Most safety critical industries have developed tools and techniques to apply human factors to system design, and these have been reviewed together with those resources already available for use in healthcare.
Key issues  Models of human behaviour such as the nature and patterns of human error, information processing, decision-making and team work have clear applications to healthcare. Human factors focus on a system view of safety, and propose that safety should, where possible, be 'designed in'. Other interventions such as building defences, mitigating hazards and education and training should only be used where design solutions cannot be found.
Conclusions  Simple human factors principles such as: designing for standardization; the involvement of users and staff in designing services and procuring equipment; understanding how errors occur; and the workarounds that staff will inevitably take are vital considerations in improving patient safety.
Implications for nursing management  Opportunities for the application of human factors to healthcare and improved patient safety are discussed. Some existing tools and techniques for applying human factors in nursing management are also presented.     

Nursing accreditation system and patient safety

teng c.-i., shyu y.-i.l., dai y.-t., wong m.-k., chu t.-l. & chou t.-a. (2012) Journal of Nursing Management 20, 311–318
Nursing accreditation system and patient safety Aims This study investigated whether nursing accreditation level affects patient safety. Background The nursing accreditation system evaluates the capabilities of nursing professionals in Taiwan. While this system has been in place for years, few studies have investigated whether nursing accreditation level is associated with patient safety indicators. This study can help in understanding how nursing capabilities affect patient safety and can subsequently contribute to improvements in patient safety. Methods This study adopted a cross-sectional research design using questionnaires to collect responses from nurses working in two major medical centres in northern Taiwan. Regression analyses were conducted to test the study hypothesis. Results The analytical results show that nursing accreditation level is positively related to patient safety indicators. Conclusion Health services managers should encourage nurses to advance their knowledge, skills, and professional capabilities because these may be positively related to patient safety. Implications for Nursing Management Nursing managers who seek to improve patient safety should consider encouraging nurses to advance their accreditation level.     

实习护生患者安全胜任力的现状调查及其影响因素分析*

目的：调查实习护生患者安全胜任力的现状,并分析其影响因素,为开展针对实习护生的患者安全教育和医疗风险培训提供依据。方法：便利选取天津市教学医院308名实习护生为研究对象,采用“患者安全胜任力护理人员自评表”进行横断面调查。结果： 实习护生患者安全胜任力自评得分为（3.70±0.37）分。态度因素、系统因素、知识因素和技能因素4个维度得分分别为（4.22±0.49）分、（3.94±0.51）分、（3.44±0.54）分和（3.41±0.54）分。学历和是否学过患者安全相关内容是实习护生患者安全胜任力的主要影响因素（P<0.05）。结论：实习护生患者安全胜任力总得分处于中等水平。知识因素和技能因素得分偏低。医学院校应为提高护生的患者安全认知开设患者安全教育课程,临床教学医院应通过建立非惩罚性不良事件上报系统并加强患者安全相关教育以提高实习护生的患者安全胜任力。     

我院护理安全管理的做法和体会

目的探讨护理安全管理的方法,规避护理风险,保证护理安全。方法采取加强安全教育,强化安全意识;制订并完善《护理安全管理手册》;成立护理安全管理小组,加强护理风险预测;完善规章制度和工作流程;加强护理安全防范措施及对年轻护士专业基础知识培训等方法。结果护理缺陷及护理差错明显减少(P<0.01或P<0.05);护理质量、患者满意度均提高(P<0.01)。结论加强护理安全管理可以有效规避护理风险,确保护理安全,提高护理质量和患者满意度。     

Patient safety culture in acute care: A web‐based survey of nurse managers' and registered nurses' views in four Finnish hospitals

Nurse managers (NMs) and registered nurses (RNs) have key roles in developing the patient safety culture, as the nursing staff is the largest professional group in health‐care services. We explored their views on the patient safety culture in four acute care hospitals in Finland. The data were collected from NMs (n = 109) and RNs (n = 723) by means of a Hospital Survey on Patient Safety Culture instrument and analyzed statistically. Both groups recognized patient safety problems and critically evaluated error‐prevention mechanisms in the hospitals. RNs, in particular, estimated the situation more critically. There is a need to develop the patient safety culture of hospitals by discussing openly about them and learning from mistakes and by developing practices and mechanisms to prevent them. NMs have central roles in developing the safety culture at the system level in hospitals in order to ensure that nurses caring for patients do it safely.     

某三级甲等医院护理人员病人安全态度调查分析

目的调查临床护理人员对病人安全态度的认知现状,为护理管理者了解护理人员的病人安全文化状况,保证病人安全提供参考。方法选取某三级甲等医院190名临床护理人员,采用中文修订版安全态度调查问卷(The China Version of Safety Attitude Questionnaire,C-SAQ)进行问卷调查。结果临床护理人员的病人安全态度认知水平较好,总分(4.24±1.00)分,处于中等偏上水平。不同科室护理人员在安全氛围、管理感知、工作满意度、工作条件维度及总体得分上,不同用工形式护理人员在工作满意度及压力感知维度上差异均有统计学意义(P0.05),男性团队合作维度得分低于女性,接受过安全相关培训护理人员工作条件及压力感知维度得分高于未接受过安全相关培训护理人员,差异均有统计学意义(P0.05)。结论护理管理者应改进管理方式和方法,关心员工工作条件,增强护士工作满意度,加强不同性别护理人员的团队合作,采取系统化安全教育增强护理安全意识。     

骨科日间手术的安全管理

目的:探讨骨科日间手术患者的安全管理流程及策略,确保日间手术新型住院模式下患者安全与医疗质量。方法:对310例骨科日间手术患者采用安全管理,包括患者管理、流程管理、护士培训、医嘱管理、病室安排和应急预案的制订等方面,并评价新型护理安全管理模式的效果。结果:310例骨科日间手术患者在新型护理安全管理模式下,均在24小时内安全出入院,无护理安全差错发生。结论:骨科日间手术安全管理对手术的顺利进行和日间手术新型住院模式的发展,起到了积极的推动作用。     

Addressing the nursing work environment to promote patient safety

TOPIC: The nursing work environment has a critical impact on patient safety. Yet confusion on the specific roles and competencies of nurses, staff ratio issues, and lack of nurse empowerment create weaknesses that result in safety risks. PURPOSE: These interrelated issues must be addressed systemically to impact the nursing care system. DISCUSSION: Educational reform focusing upon standardized, higher level nursing education using a military model, appropriate staff ratio laws derived from the outcomes literature, and recurrent training incorporating policy-making powers can result in nurse empowerment and improved patient safety. CONCLUSION: Improving the nursing environment requires a broad approach to benefit patient safety. By treating the work environment as a complex system, approaches can result in greater nurse professionalism, empowerment, and patient safety.     

老年护理院护理安全管理评价指标体系的研制

目的：研制一套适合老年护理院护理安全管理的评价指标体系。方法：通过专家访谈、文献研究以及改良的Delphi法对备选指标进行筛选,采用层次分析法确定指标权重。结果：拟定出以组织管理因素、护理人员因素、环境设施因素和患者因素4项一级指标、10项二级指标和39项三级指标构成的综合指标体系。结论：建立老年护理院护理安全管理评价指标体系,为规范老年护理院的建设和管理提供了参考依据;也为护理院的老人获得安全、高质量的照护提供了有力的保障,方便行业比较以及行业监督。