1 conventional nursing defects in operating room There are many links in the operating room that are prone to errors, accidents and nursing defects. Once an error occurs, it will affect the patient's treatment, delay the operation time and waste time and goods. In severe cases, patients will be disabled or even die.
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1.2 Improper surgical posture leads to pressure ulcers, tight restraint or excessive abduction of both upper limbs leads to nerve compression, and improper padding affects patients' circulation and breathing.
1.3 Incomplete instrument preparation does not meet the operation requirements. When the instrument performance is poor, the clamp end is not tight, the knife, scissors and needle are not sharp, and the ligation line is not firm, which causes the suction pipe to be blocked and uncomfortable.
1.4 Incorrect count before and after closing the body cavity, instruments, dressings, sutures, etc. Was wrongly calculated. Improper operation causes the needle to pop up and the direction is unknown, so it is difficult to find it. Ignoring the integrity of the instrument; The shortage of automatic abdominal brace screws or the negligence of prenatal examination lead to a lack of confidence.
1.5 During the operation, the instrument was not properly prepared and tested, and the electrode of the electrosurgical unit was not fixed, resulting in falling off and pollution. The patient's skin directly contacts the metal of the lifting table or operating table, causing electric burns.
1.6 wrong medication, wrong infusion and infusion timing, wrong drug placement, unclear indications of intravenous anesthetics and large infusion leading to misuse, wrong execution of oral orders, improper preservation or loss of intraoperative indications.
1.7 improper nursing care of the surgical patient, various pipes and drainage tubes falling off, the patient falling off the bed, and the X-ray film, CT film, surgical gown and other items missing after the operation.
2 Safety management
2. 1 The system guarantee is perfect, and the systematic rules and regulations are the premise of establishing the quality management system, and the guarantee of preventing errors and accidents and improving the quality of work.
2. 1 1 The general operating room system pays special attention to the implementation of the operating personnel code, hand-washing code, cleaning and sanitation system, disinfection and isolation management system, patient handover system, post responsibility system, attendance system for all kinds of personnel and reward and punishment measures.
2. 1.2 Six inspection systems of safety management system, twelve to one, four in place operation. Six check: check the patient (ward, bed number, name, sex, hospitalization number, diagnosis, preoperative preparation, preoperative medication, allergic status); Patient-patient intraoperative examination; Examination before anesthesia; Check before skin disinfection; Check when holding a knife; Check before and after closing the body cavity. Twelve pairs: department, bed number, name, gender, age, operation question mark, operation name, operation site, required drugs, articles, drug allergy, sterilization equipment, dressing whether it is qualified, and whether the materials are complete and applicable. Four in place: first aid medicine, aspirator, oxygen, electrocoagulation hemostat.
2。 1 3 counting system The system of three persons and three persons during operation refers to that the chief surgeon, hand washing nurse and visiting nurse jointly count the gauze, suture, blades and surgical instruments on the operating table before and after operation, and make records. Three-no-handover system: hand-washing nurses do not hand over before the operation is over, visiting nurses' dressings and instruments do not hand over after the operation, and nurses on duty are out of stock.
2.2 Regular discussion of nursing safety may lead to changes in department personnel, new nurses taking up their posts, increased nursing work in departments, and some systems may be deviated. In view of this situation, we should carry out nursing safety education regularly, analyze and discuss the work links that are prone to nursing defects and errors, put forward rectification measures, and review various nursing safety precautions to enhance the sense of responsibility and make the alarm bell ring. Usually, a hierarchical supervision system is formed, and violations of operating procedures are linked to annual assessment rewards and punishments.
2.3 Strengthen professional learning, encourage and support nursing staff to take self-study exams for nursing education at all levels, send business backbones out to attend lectures and learn academic exchanges, and require nurses to subscribe to various nursing publications. Strengthen the "three basics" training, improve professional skills and emergency ability, and actively cooperate in operation.
To ensure the quality of nursing, there must be the guarantee of nursing safety management system. Secondly, we should pay attention to the improvement of nurses' professional and technical quality and the post training and teaching of new nurses. The establishment of operating room management manual is a rule-based and evidence-based guide for new nurses and an inseparable crutch. Everyone must abide by the operating rules of every work link. For managers, it is convenient to act according to the rules in management, and by analogy, it is possible to nip mistakes or accidents in the bud.