二、三级医院护理安全文化现状的比较

目的了解上海二、三级医院护理的安全文化现状。方法采用医院安全文化问卷，对上海二、三级医院护士共514名开展问卷调查。结果三级医院有19．7％的护士认为就职医院总体安全为极好、有59．1％的护士认为总体安全为很好，其中有87．9％的护士在过去一年内未报告意外事件。二级医院有8．7％的护士认为就职医院总体安全为极好、有51．1％的护士认为就职医院总体安全为很好，其中有85．3％的护士在过去一年内未报告意外事件（P〈0．05）。不同等级医院均在科室内团队合作、对于差错的反馈和交流、管理者促进患者安全的意愿和行动以及组织的学习与持续改进这4方面有优势，劣势则在人员配置和对差错的非惩罚性反应。结论应根据不同背景护士呈现的安全文化优劣势，在护理管理工作中采取相应措施，保持优势，改进劣势，切实保证患者安全。     

Using an Early Warning Score for Nurse Shift Patient Handover: Before-and-after Study

PurposeThis study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes.MethodsA before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence postadmission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed.ResultsRegarding nurse outcomes, handover quality (p < .001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between preintervention and postintervention.ConclusionDespite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.     

Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals

Purpose: The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes.
Methods: A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit-level average length of patient stay, patient falls, medication errors, and patient satisfaction scores.
Results: Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover ( p <.01). Nursing units with low levels of turnover were likely to have fewer patient falls than nursing units with no turnover ( p <.05). Additionally, workgroup cohesion and relational coordination had a positive impact on patient satisfaction ( p <.01), and increased workgroup learning led to fewer occurrences of severe medication errors ( p <.05).
Conclusions: The findings of this study provide specific information on the operational impact of turnover so as to better design, fund, and implement appropriate intervention strategies to prevent registered nurse exit from nursing units. Further investigation is needed to assess the turnover-outcomes relationship as well as the mediating effect of workgroup processes on this relationship.
Clinical Relevance: Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.     

护理人员对患者身份核对的现状与对策

目的了解护理人员对患者身份核对的认知程度、临床上对患者身份核对的现状以及质量控制检查的情况,为更有效地实施医院患者身份核对提供依据。方法研究者自行设计问卷,对159名护理人员进行患者身份核对知识及相关问题的调查。结果 91.2%的护理人员知道正确的患者身份确认方式。在临床实践中,81.8%的研究对象使用正确的方式确认患者身份。护士未能规范核对的原因有多种,护士核对过程缺乏管理者的督导,约1/5的护士认为因为没有规范核对而导致过差错发生。结论护理人员患者身份核对的现状不容乐观,应积极采取措施强化护士的核对意识和行为,以保障患者安全。     

Patient Safety: A Curriculum for Teaching Patient Safety in Emergency Medicine

The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine.     

患者参与患者安全策略的研究现状

通过对患者参与患者安全的研究背景、对象及意义、理论支持、意愿研究、患者参与患者安全的策略研究的探讨,提出了患者参与患者安全未来的发展方向,为使患者真正参与医疗卫生服务提供参考。     

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。     

Patient falls: Association with hospital Magnet status and nursing unit staffing

The relationships between hospital Magnet® status, nursing unit staffing, and patient falls were examined in a cross‐sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI®) data from 5,388 units in 108 Magnet and 528 non‐Magnet hospitals. In multivariate models, the fall rate was 5% lower in Magnet than non‐Magnet hospitals. An additional registered nurse (RN) hour per patient day was associated with a 3% lower fall rate in ICUs. An additional licensed practical nurse (LPN) or nursing assistant (NA) hour was associated with a 2–4% higher fall rate in non‐ICUs. Patient safety may be improved by creating environments consistent with Magnet hospital standards. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:413–425, 2010     

患者安全文化测评问卷的构建

目的编制符合我国护理特点的患者安全文化测评问卷,并检验其信效度,确保问卷科学、可靠。方法参考国内外文献形成问卷初稿,经过反复的专家咨询及探索性因素分析筛选和修订条目,编制出适用于医院护理人员的患者安全文化测评问卷。采用分层随机法抽取上海市三级、二级医院临床护士211名进行测评,使用SPSS 13．0医学统计软件,应用主成分分析法、内在一致性信度等评价问卷信效度。结果形成适用于医院护理人员的患者安全文化测评问卷,其主要内容是医院护理人员的安全态度调查,共分为5个维度、24个条目。5个维度分别是团队氛围、对工作的满意、对压力的认知、单位安全的氛围、对管理的感受,累计贡献率为59．879％,数据经方差最大正交旋转后,根据各条目最大维度负荷值归因,5个维度的负荷值都在0．4以上,各条目的共同性在0．432～0．697之间;问卷各维度的Cronbach’s a系数为0．7234-0．8523,总体为0．8861;各维度两次测量得分的Pearson相关系数为0．701～0．833,总体为0．895;各条目与问卷总体的相关系数在0．661～0．843,且相关性均有显著统计学意义（P〈0．01）;各维度得分与问卷总体的相关系数为0．381～0．854,且相关性均有显著统计学意义（P〈0．01）。结论初步编制了适用于医院护理人员的患者安全文化测评问卷,信效度良好。     

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.     

Profiles in Patient Safety:Sidedness Error

This case describes a 45-year-old woman with significant respiratory distress secondary to a left-sided pleural effusion that mandated an urgent thoracentesis. An adverse event occurred when the physician performed the procedure on the incorrect side of the patient. Results of the incident investigation followed by a discussion of medical errors models, common errors types, human factors considerations, and conditions that contribute to error are presented. Pertinent case-specific and general concepts of a system approach to reduce this type of medical error are discussed, and educational recommendations are offered.     

The perception of hospital safety culture and selected outcomes among nurses: An exploratory study

The objectives of this study were to examine nurses' perceptions of the hospital safety culture in Jordan and to identify the relationships between aspects of hospital safety culture and selected safety outcomes. Data from 242 registered nurses in five Jordanian hospitals were analyzed. Aspects of hospital safety culture and outcomes were measured using the Hospital Survey on Patient Safety Culture. Among various aspects of hospital safety culture, teamwork within units had the highest average percentage of positive responses (49.8%). Additionally, participants reported deficits in other aspects of safety culture, particularly in staffing and nonpunitive response to errors, with average percentages of positive responses of 30.4% and 30.7%, respectively. Pearson correlation analysis revealed that 9 of 10 subscales of hospital safety culture were significantly correlated to one or more of the hospital safety outcomes. The findings of this study can help policymakers and healthcare administrators identify the weaknesses and strengths of hospital safety issues in order to propose effective strategies to improve patient safety and quality of care.     

Profiles in Patient Safety: A "Perfect Storm" in the Emergency Department

Correct and rapid diagnosis is pivotal to the practice of emergency medicine, yet the chaotic and ill-structured emergency department environment is fertile ground for the commission of diagnostic error. Errors may result from specific error-producing conditions (EPCs) or, more frequently, from an interaction between such conditions. These EPCs are often expedient and serve to shorten the decision making process in a high-pressure environment. Recognizing that they will inevitably exist, it is important for clinicians to understand and manage their dangers. The authors present a case of delayed diagnosis resulting from the interaction of a number of EPCs that produced a "perfect" situation to produce a missed or delayed diagnosis. They offer practical suggestions whereby clinicians may decrease their chances of becoming victims of these influences.     

Profiles in Patient Safety: When an Error Occurs

Medical error is now clearly established as one of the most significant problems facing the American health care system. Anecdotal evidence, studies of human cognition, and analysis of high-reliability organizations all predict that despite excellent training, human error is unavoidable. When an error occurs and is recognized, providers have a duty to disclose the error. Yet disclosure of error to patients, families, and hospital colleagues is a difficult and/or threatening process for most physicians. A more thorough understanding of the ethical and social contract between physicians and their patients as well as the professional milieu surrounding an error may improve the likelihood of its disclosure. Key among these is the identification of institutional factors that support disclosure and recognize error as an unavoidable part of the practice of medicine. Using a case-based format, this article focuses on the communication of error with patients, families, and colleagues and grounds error disclosure in the cultural milieu of medial ethics.     

Using Preoperative Assessment and Patient Instruction to Improve Patient Safety

Rates of patient transfers, cancellations, and patient visits to the emergency department after discharge are quality metrics for ambulatory surgery centers. To improve these metrics, it is imperative to establish best practices for conducting preoperative assessments, including identifying key patient conditions (ie, obstructive sleep apnea, cardiovascular disease, reactive airway disease, obesity). To guide appropriate patient selection, practitioners should review the patient's allergies and sensitivities, alcohol use, medications, and medical history. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions (eg, NPO guidelines, medications, what to bring, cancellation instructions) and discharge instructions (eg, postoperative medications, appropriate activity restrictions, diet, surgical and anesthetic side effects, special circumstances [eg, regional blocks], symptoms of possible complications, treatment and tests, access to postdischarge follow-up care). Generally, the routine outpatient surgical patient is discharged home; however, there are circumstances that occasionally necessitate transfer or admission to a higher level of care. For transfers, ambulatory surgery centers should adhere to applicable federal and state guidelines and should have a clear policy in place to guide transfers.