PDCA管理和护理风险管理在急诊科危重患者院内转运中的应用

目的探讨PDCA循环管理和护理风险管理在急诊科危重患者院内转运中的应用效果。方法 2014年10月~2015年10月,本院急诊科室对急诊危重患者院内转运过程中应用PDCA循环联合护理风险管理,观察对比PDCA循环联合护理风险管理实施前6个月及实施6个月后急诊患者护理质量、意外风险发生及患者满意度的情况。结果实施后急诊基础护理、专科护理、病房管理、文书管理、安全管理、急救药品器械管理及总护理质量评分高于实施前,差异有统计学意义(P0.05)。实施后接收科室满意率高于实施前,而意外发生率、转运死亡率及护理纠纷事件低于实施前,差异有统计学意义(P0.05)。结论 PDCA循环管理和护理风险管理能有效提高急诊科危重患者院内转运中护理质量,降低患者意外风险,提高患者满意度。     

急诊危重症患者院内转运过程中的风险分析及护理管理

目的对急诊危重症患者院内转运过程中的风险进行识别分析,并采取相应的护理风险管理对策。方法选取2014年1月~12月本院50例急诊危重症患者作为对照组,对其实施常规院内转运;选取2015年1月~2016年8月本院50例急诊危重症患者作为观察组,对以往院内转运过程中的护理风险因素进行分析,再针对性采取相应的防范对策。对比两组患者在院内转运过程中不良事件发生率、死亡率、医疗纠纷发生率以及患者家属的满意度。结果观察组院内转运过程中不良事件发生率为12.50%,相对于对照组的33.33%有显著下降(P0.01);观察组院内转运过程中死亡率、医疗纠纷发生率分别为4.00%、0.00%,与对照组的16.00%、10.00%比较均有显著下降(P0.05);观察组患者家属满意度评分及满意率均明显高于对照组(P0.05)。结论加强对急诊危重症患者院内转运过程中的风险分析,并制定相应的护理风险管理对策,可有效减少院内转运过程中不良事件的发生,提高患者的存活率以及患者家属的满意度。     

风险管理在急诊危重症患者院内转运的应用

目的:探讨风险管理在危重症患者院内转运的重要性.方法:回顾性分析2006年6月至2009年12月危重症患者在急诊急救处理后院内转运的资料,以经院内急救处理后转运的患者为对照组(n=80)；在转运前10 min进行风险评估及风险管理再转运的患者为实验组(n=98)；比较两组转运风险评分、风险发生率与病死率、治愈率.结果:两组在风险分值无明显差异(P＞0.05)的前提下,实施风险管理的患者降低了风险发生率及病死率,提高了治愈率.结论:转运危重症患者实施风险管理可降低风险的发生.     

标准化分级转运单在危重症患者院内安全转运中的应用

目的探讨标准化分级转运单在急诊监护室危重症患者院内安全转运中的应用效果。方法将2017年1月至12月急诊监护室危重症院内转运患者217例设为对照组,将2018年1月至12月急诊监护室危重症院内转运患者228例设为试验组。对照组采用传统的转运方法及流程进行院内转运;试验组运用标准化分级转运单进行评估,根据评估结果安排对应转运医护人员及物资,确定转运时间。结果试验组患者转运至CT室、手术室、重症医学科以及普通病房的转运时间短于对照组,试验组患者不良事件发生率低于对照组,试验组患者对转运满意度高于对照组,两组比较,差异具有统计学意义(均P0.05)。结论将标准化分级转运单应用于危重患者院内安全转运中,能有效缩短危重患者院内转运时间,降低转运不良事件,确保危重患者的安全转运,提高患者的满意度,值得进一步推广和应用。     

医疗失效模式与效应分析在急诊手术患者院内转运中的应用

目的:探讨医疗失效模式与效应分析(HFMEA)应用于急诊手术患者院内转运的效果。方法:根据HFMEA方法,成立急诊手术转运团队,评估影响患者院内安全转运的因素,从术前转运及交接、术后转运及交接两个环节查找失效模式,并有针对性地制订控制方案。结果:观察组转运意外发生率和转运交接问题发生率均低于对照组,差异有统计学意义(P0.05)。结论:应用HFMEA显著提高了急诊手术患者院内转运的安全性,值得推广。     

急诊危重患者院内转运的研究进展

急诊危重患者病情变化快,生命体征不稳定,此类患者院内转运危险系数大。以往,急诊危重患者院内转运对危险因素估计不全,物资准备不足,转运交接实行口头交班,易发生意外和交接科室相互推诿责任。合理的危重患者院内转运流程,应该针对性的对急诊危重患者在转运过程中可能发生的危险因素进行充分评估,计划,合理安排护送人员并实施,做好与相应科室的交接工作,环环相扣,各科合作,保证危重患者的转运安全。因此,本文对急诊危重患者院内转运的研究进展做如下综述。     

医疗失效模式与效应分析在急诊危重患者院内转运中的应用

目的探讨医疗失效模式与效应分析在急诊危重患者转运中的应用。方法运用医疗失效模式与效应分析院内安全转运的影响因素,从转运前、转运中及转运后3个流程查找失效模式,并有针对性地制订控制方案。结果降低了院内患者转运中意外的发生率,减少了与接收科室发生的交接问题(P<0.01或P<0.05)。结论应用医疗失效模式与效应分析可提高急诊危重患者院内转运的安全性。     

急诊气管插管患者院内转运的危险因素及护理对策

目的:分析急诊气管插管患者院内转运的危险因素,探讨相应的护理对策。方法:回顾性分析132例急诊气管插管行院内转运患者的临床资料,分析转运过程中出现的危险因素,对采取的护理措施予以总结。结果:气管插管患者院内转运的危险因素有气道阻塞、人工气道移位、供氧不足、转运人员缺乏经验和流程不畅、原发疾病影响等。患者均成功院内转运,未出现相关的并发症。结论:急诊气管插管患者院内转运前应充分做好各项准备工作,加强转运途中的护理,完善转运后的交接,是保证院内安全转运的重要措施。     

临床路径在急诊危重症患者院内转运中的应用

目的:探讨临床路径在急诊危重症患者院内转运中的临床应用效果。方法:将2010年1～7月行院内转运急诊危重症患者153例设为对照组,按照常规院内转运方式进行;将2010年8月～2011年1月同类患者142例设为实验组,采取院内安全转运临床路径,比较两组转运途中意外发生率、接收科室满意率和转运病死率。结果:实验组意外发生率低于对照组(P<0.01),而接收科室满意率高于对照组(P<0.01);两组均未发生死亡。结论:急诊危重症患者临床转运路径不仅能有效降低转运意外发生率和转运病死率,同时也能有效提高接收科室满意率,进一步提高院内转运安全性,值得临床推广应用。     

急诊危重患者院内安全转运护理进展

近年来,随着诊疗技术的不断提高和发展,急诊危重患者院内转运的安全性也有了很大提高。现将急诊危重患者院内安全转运护理进展综述如下。1院内安全转运影响因素具体如下:①急诊危重患者病情多不稳定,在转运过程中     

集束化管理策略在患者安全集体转运中的应用

目的探索科学有效的患者安全转运管理方法,保证患者集体转运的安全。方法采用集束化管理策略,组织16个科室共277例患者集体转运,成立集束化安全转运组,制订转运风险预案,相关部门间紧密合作,转运前做好设施保障准备及人员准备;转运中做到一站式服务;转运后及时收集反馈意见进行总结。结果顺利完成16个科室277例患者新病房安全转运任务,未发生医疗护理差错事故,保证了患者安全;患者满意度达96.75%。结论集束化管理策略可以将多项措施整合以发挥最大效应,填补了指南与临床实践的间隙,在患者安全转运管理中具有优势,是保障患者安全的有效方法。     

The violent patient

Encounters with violent behavior are an inevitable part of working in emergency departments. By adoption of a cohesive, multidisciplinary approach to behavioral decompensation, as is done in preparation for airway compromise, the risk for injury to patients and staff is minimized. As with airway compromise, anticipation of and preparation for deterioration can avoid the necessity of the most invasive measures and can ensure a calm, positive outcome. With the appropriate knowledge, teamwork, and skills, even patients requiring the most intensive intervention can be treated safely and professionally.     

Epidemiology of Acute Drug Intoxications: Patient Characteristics,Drugs, and Medical Complications

Abstract

Acetaminophen is the pharmaceutical most frequently ingested by small children. Although past research has allowed the safe management of 90% of these ingestions at home, several thousand are still referred to emergency departments annually. With the goal of further reducing the number of unnecessary referrals, the risk/benefit considerations of alternate referral strategies were analyzed. In a retrospective poison center chart review study from 11 centers, the records of children between the ages 1 and 6 years who acutely ingested acetaminophen and were referred to a hospital for determination of serum acetaminophen concentration in 1986 and 1987 were identified using the database of the American Association of Poison Control Centers. Risk of hepatic injury was assigned on the basis of the Rumack-Matthew acetaminophen toxicity nomogram. The cohort was stratified in terms of the amount ingested and whether a pediatric or adult preparation was ingested. The direct cost of an evaluation was estimated from four centers. Sensitivity, specificity and direct cost of each risk identification strategy were calculated. Eight hundred sixty six of 2091 patients had a timed serum acetaminophen concentration recorded. Of these, three patients had results in the “probable risk” area of the nomogram. A referral reduction strategy which would refer only children who ingest 200?mg/kg or more of an adult preparation could eliminate 82% of referrals without missing any of these “probable risk” patients. Six other children were determined to have serum acetaminophen concentrations in an area of the nomogram labeled “possible risk”. No referral reduction strategy explored identified all of these patients. The average charge for an emergency department evaluation in 1992 was $272.00. These data suggest that children less than six years of age who ingest pediatric acetaminophen products other than those from packages containing greater than 30 tablets or who ingest less than 200?mg/kg of an adult preparation may be safely managed at home without referral to a hospital. This strategy would result in significant cost savings and prevent unnecessary inconvenience to many patients and families.     

气泡式闭环管理在奥密克戎株突发疫情下急诊防控中的构建与实施

为了应对突发的奥密克戎株新冠疫情期间的急诊工作量剧增，上海市某三甲医院急诊科在本次疫情期间借鉴气泡式闭环管理模式，从管理架构、职责与分工、气泡仓的构建与功能、急救流程、环境消杀措施、感染防护与护理管理等六方面实施阳性患者急诊闭环收治；“气泡仓”模式加强了对阳性患者就诊的闭环防控，有效合理地进行防疫流程的布控，避免奥密克戎株在急诊救治患者中发生传播风险，从而提高急救护理防疫的科学性和高效性，保障高压状态下急诊护理工作的有序进行。     

对急诊科护理人员不作为行为风险认识和思考

急救护理工作是个高风险的职业,长期以来急诊科护理人员力求用最大的努力杜绝护理风险,然而事与愿违,护理纠纷时常发生。其中的原因不只是护理业务水平和工作能力的问题,更值得注意的是护理人员的护理不作为行为带来的风险。笔从急诊科护理人员院前急救、院内抢救、转科、转院的各个阶段中找出护理不作为行为的原因：分析急救护理人员对不作为行为错误的认识;从法律的角度上探讨医患合同的特点和不作为的后果;从加强急诊科护理人员急救意识、法律意识的教育、规范护理行为几个方面提出了对急诊室护理人员不作为行为风险管理的建议;说明提高急救护理人员对不作为行为的认识有利益保护医患双方共同的权利和利益。     

集体转运病人的安全管理

目的探讨医院科室间病人集体转运工作的安全管理。方法转运前向病人做好告知工作,制订全面、细致的转运预案,明确各级工作职责;转运中严格、有序地实施转运预案和流程,医护及相关职能科室紧密配合;转运后迅速落实、查找安全隐患,确保转运全过程顺利进行。结果病人转运按计划完成,转运过程中无护理投诉、差错、事故发生。结论在病人转运过程中实施安全、有效的管理,对预防因病人转运而引发的护理投诉、纠纷、差错事故具有重要作用。     

Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital

Objective: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms. Methods: This prospective, observational study investigated a sample of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis. Results: Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2. Conclusion: Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.     

急诊科危重患者院内安全转运的护理

目的:了解急诊科危重患者院内安全转运的影响因素和防范对策。方法:对该院急诊科2005年1～8月126例危重症患者转运时意外情况进行统计。结果:126例转运途中发生意外42例。讨论:要做好转运前的评估、准备工作,以及急救药品和器材的准备,加强相关科室的协调,提高护送人员的责任心,以确保危重患者院内转运的安全。     

实施过程监控提高压疮上报率的效果分析

目的探讨综合医院压疮的有效管理方法。方法建立管理流程,从病人入院到出院实施全过程监控,确定重点环节,由各级护理管理人员负责严密监控。结果2004年11月~2005年11月科室主动上报压疮81例(其中院外带入47例),压疮高发科室依次为骨科、内科、ICU、急诊、外科。31例出院时好转,5例愈合。结论通过过程监控,进一步规范了压疮管理流程。     

Pediatric and adult emergency management assistance using computerized guidelines

This study was performed to determine if computer assistance is able to improve the initial management of pediatric patients in critical emergencies. A computer program that provides an easily accessible, concise set of information to assist in the management of medical emergencies is described. It provides size- and age-specific endotracheal tube sizes, drug doses, continuous intravenous (IV) drug infusion preparation instructions, and emergency management guidelines for pediatric and adult patients with one of several acute emergencies. These emergencies include asystole, respiratory failure, anaphylaxis, shock, myocardial infarction, cardiac arrhythmias, seizures due to several common causes, and rapid sequence anesthesia induction. The use of this program was shown to reduce the time required for the preparation and administration of emergency therapy while minimizing management errors. A lap-top computer running this program may be a worthwhile addition to emergency departments and hospital resuscitation carts as a resource, especially for physicians less experienced in the care of children.