持续质量改进在ICU危重患者护理质量管理中的应用效果

目的 探讨持续质量改进(continuous quality improvement,CQI)在ICU危重患者护理质量管理中的应用效果.方法 采用柏拉图分析法对2015年1-12月收住解放军第98医院ICU的313例患者的临床资料进行动态分析.针对非计划性拔管(unplanned excubation,UEX)发生率、导管相关性血流感染(catheter related blood stream infection,CRBSI)发生率[包括经锁骨下静脉置入中心静脉导管(central venous catheter,CVC)感染率、经外周静脉置入中心静脉导管(peripherlly inserted centra lcatheter,PICC)感染率]、呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率等进行护理质量控制与改进,以2014年1-12月收治的314例患者为对照组.比较两组患者上述指标、患者住院及经济运行状况等的差异,并分析患者满意度和3项敏感指标的相关性.结果 UEX发生率与护士专业技能的满意度、护士服务态度的满意度及护理服务质量综合满意度呈负相关(均P＜0.05);CRBSI中的CVC感染发生率与护理质量的满意度、护士专业技能的满意度呈负相关(均P＜0.05);CRBSI中的PICC感染发生率与就医环境的满意度、护理质量的满意度、护士专业技能的满意度、护理服务质量综合满意度呈负相关(均P＜0.05);VAP发生率与患者就医环境的满意度、护士专业技术技能的满意度及护理服务质量综合满意度呈负相关(均P＜0.05).结论 针对UEX、CRBSI、VAP等3项护理质量敏感指标的质量控制与改进能进一步提高护理质量.     

品管圈活动在降低留置胃管患者非计划性拔管率中的应用

目的：探讨品管圈（QCC）活动在降低留置胃管患者非计划性拔管率中的效果。方法成立品管圈,确定“降低留置胃管患者非计划性拔管率”为主题,通过现状调查、分析原因、拟定对策并实施,比较QCC活动前后2组患者非计划性拔管率。结果 QCC活动后患者非计划性拔管率1．0％低于活动前6．5％,（P＜0．05）,目标达成率107．8％,进步率84．6％,圈员技能等8个方面得到提高。结论 QCC活动能有效降低留置胃管患者非计划性拔管率,提高护理管理执行力和患者的依从性,值得推广。     

非计划性拔除引流管的相关因素分析及对策

目的探讨非计划性拔除引流管的原因和护理对策。方法回顾分析24例引流管非计划性拔除的情况及原因。结果非计划性拔除引流管最多发生在0?01～8?00时段,占41.67%;其次为17:01～24:00和12:01～14:00时段,分别占25.00%和16.67%。多发生于工作1年内护士当班时,占50.00%。非计划性拔除引流管原因:医护人员因素(62.50%)明显多于患者因素(37.50%),以固定不牢固、巡视观察不及时、健康教育不细致、工作经验不足为主。结论科学安排护理人力资源,加强护士专科知识、技能培训,落实交接班制度,加强病房巡视和病情观察,保证健康教育效果,提升护理品质是防范非计划性拔除引流管的有效措施。     

Options counseling: techniques for caring for women with unintended pregnancies

An unplanned pregnancy is a crisis in a woman's life. She may request assistance from the health care provider in reviewing her options of becoming a parent, continuing the pregnancy and placing her baby for adoption, or terminating the pregnancy. To facilitate the decision-making process for women facing these choices, the clinician must first examine her own values and biases. To aid the clinician in providing nonjudgmental and nondirective counseling, this article provides factual information about abortion and adoption, values clarification exercises, and concrete approaches to help women examine their beliefs.     

UNPLANNED ADMISSIONS IN DAY‐CASE SURGERY AS A CLINICAL INDICATOR FOR QUALITY ASSURANCE

Background : Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12‐month period in respect to different surgical specialties. Methods : The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120 000. Results : For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre‐operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions. Conclusions : Strategies to reduce the unplanned admission rate which include patient selection and pre‐operative assessment, patient waiting time and education, pre‐operative anaesthesia, follow‐up with nursing care and postoperative analgesia are discussed.     

非计划性拔管中行为形成因子与人为差错的定性分析

目的通过非计划性拔管中行为形成因子与人为差错的定性分析,找出人为差错类型的影响因素,降低非计划性拔管发生率。方法采用Delphi法确定16个行为形成因子,并将行为形成因子与人为差错类型关联程度利用矩阵形式表示。结果主要影响技能型疏忽与遗忘的行为形成因子是精力、工作态度、知识、工作数量及工作时间;主要影响规则型疏忽与错误的行为形成因子是工作态度、风险意识、管道风险标识、操作方法、固定约束设备;主要影响知识型错误的行为形成因子是工作的复杂性、工作的新颖性、知识、经验水平及有效监控。结论对行为形成因子与人为差错进行定性分析,可为管道护理的行为矫正提供理论指导,从而降低非计划性拔管人因失误的可能性。     

导管专项管理组在老年住院患者非计划性拔管中的应用

目的探讨建立导管专项管理组对减少老年住院患者非计划性拔管中的作用。方法增设导管专项管理组,规范导管的护理管理,用以点带面的形式提高全员对导管护理的安全意识,对典型案例进行分享,严格执行护理不良事件上报制度,对已发生的非计划性拔管进行原因分析,落实整改与评价。结果建立导管专项管理组后老年住院患者非计划性拔管的发生率由3.54%下降至1.89%(P0.01),导管护理质量的合格率提高(P0.01)。结论建立导管专项管理组,加强对导管安全管理,针对性地采取防范措施,能够有效降低老年住院患者非计划性拔管的发生率,保证患者的治疗等,对老年住院患者的安全管理具有重要的意义。     

Early unplanned readmission of patients with newly diagnosed tuberculosis discharged from acute hospital to ambulatory treatment

OBJECTIVE: The aim of this study was to examine whether patients with newly diagnosed tuberculosis (TB) discharged to ambulatory treatment are at risk of unplanned readmission through the emergency department within 28 days of discharge, and the risk factors associated with such readmission. METHODOLOGY: A cohort of 134 patients admitted to an acute medical department with TB, who were subsequently discharged to ambulatory treatment of TB, were studied by a retrospective record review for unplanned readmission in 28 days. Potential risk factors associated with the readmission were recorded during hospital stay and follow-up visits, including age, sex, length of stay, substance abuse, need of assistance in the activities of daily living (ADL), comorbidities, non-compliance, drug complications and use of non-standard drug regimen. RESULTS: Up to 20.1% of patients were readmitted. Factors independently associated with early unplanned readmission were need of assistance in ADL, drug complications, the need to use a non-standard drug regimen and more than three non-chest comorbidities. CONCLUSIONS: A significant readmission rate was found in these patients and potential risk factors were identified. Ambulatory treatment for TB may not be appropriate for selected patients. Local guidelines for the management of TB patients at high risk of readmission is needed.     

HFMEA应用于气管插管非计划性拔管防范流程制定的研究

目的 将前瞻性可靠度分析法--医疗照护的失效模式与效应分析(Healthcare Failure Mode Effect Analysis,HFMEA)应用于临床上防止气管插管非计划性拔管流程的制定,旨在让护理人员充分认识到气管插管非计划性拔管(Unplanned extubation,UEX)的潜在风险因素、列出有价值的风险评估指标,有针对性地采取行动予以控制、减少甚至消除损害的发生。本文探讨依据该理论生成的防范流程对于气管插管非计划性拔管(UEX)的控制效果。 方法 回顾自2006年1月至2009年12月期间的气管插管非计划性拔管情况,制定UEX防范流程。观察自该流程实施后自2010年1月至2013年12月期间经口插管患者的气管插管非计划性拔管发生率和因素分析。 结果 通过分析得出经过流程规整后的非计划性拔管的发生率明显下降(P<0.005)。结论 通过HFMEA的方法分析UEX的失效因素,制定完善防拔管流程,指导临床护理人员的认知和控制措施的选择应用有助于减少临床非计划性气管插管拔管的发生。     

神经外科重症监护患者非计划性拔管的特征分析

目的了解神经外科重症监护患者非计划性拔管的现状,分析其特征及影响因素,为进一步研究提供参考。方法应用自行设计的调查表前瞻性观察神经外科重症监护患者置管和拔管的情况,并对结果进行统计学分析。结果观察患者119例,置管337例次,总置管时间1 872.5d,非计划性拔管18例次,16例次为胃管、尿管等低危导管;13例次为自行拔管,其中10例次为有约束自行拔管。结论神经外科重症监护患者发生非计划性拔管的可能性高,约束并不能避免其发生,应从多方面控制,加强细节管理和重点患者的防护。