Objective To strengthen the management of nursing risk, reduce the incidence of nursing risk, ensure the safety of patients and ensure the quality and safety of nursing. Methods Improve the nursing risk management system and improve the risk awareness of nurses. Strengthen the management of nursing high-risk personnel and correct quality deviation in time; Strengthen the management of nursing details and improve the quality of nursing; Strengthen the care of critically ill patients, and put forward predictive nursing problems and measures. Results The risk awareness and professional level of nurses were improved, and nursing errors were reduced. Conclusion Correct understanding of the existence of nursing risks and effective risk management play an important role in reducing the occurrence of nursing disputes.
Nursing risk management; Risk identification
Nursing risk management is the identification, evaluation, treatment and scientific management of existing or potential risk events and prevention methods in nursing work. Organize and effectively take preventive measures against nursing risks to reduce the occurrence of medical nursing risks. How to strengthen the identification of nursing risk management, reduce the incidence of nursing risk and ensure nursing safety has become an urgent problem in nursing management. The problems existing in nursing risk management in our hospital in recent two years are summarized as follows.
1 method
1. 1 Analysis of nursing risk factors
1. 1. 1 Nurses are not responsible. The emergency nurse admitted a car accident patient. When I was admitted to the hospital at noon, I found no abnormality in vital signs, so I simply handled it and reported it to the doctor. About 2 hours later, the patient complained of lower abdominal pain, and B-ultrasound showed liver rupture and bleeding, causing medical disputes. Analysis: Because nurses can't perform their nursing duties, they don't take the patient seriously, mistakenly think that the patient is still grabbing the car and ignore the patient's condition. Nurses only pay attention to the implementation of doctor's advice, ignoring the active observation of the patient's condition changes, delaying the rescue opportunity of critically ill patients.
1. 1.2 The nurse performed the informed consent and told the patient with insufficient cerebral hemorrhage to turn over, and signed the turn-over card and put it in the nurse's office. Analysis: Because nurses have weak legal awareness and self-protection awareness, they can't communicate and inform patients of nursing measures well and ignore patients' evidence.
1. 1.3 Occupational protective measures for nurses are not in place. ICU nurses were stabbed by sharp instruments, the patients were HIV positive, and preventive measures were not in place. Analysis: Because nurses know little about patients' illness, they can't use regular sharp boxes, can't provide protective equipment for high-risk operations, and ignore self-protection awareness or vocational training is not in place on the grounds of high cost [1].
1. 1.4 The operation of nursing technology is not standardized. During the infusion of fat emulsion by intravenous indwelling needle in newborns, the extravasation of liquid medicine caused local tissue necrosis. Analysis: Due to the low professional technical level of nursing staff, the standardized training of nurses was not systematically carried out, and the patients were not examined in time. It was found that the treatment method of liquid medicine leakage was wrong or inexperienced, which violated the nursing technical specifications.
1. 1.5 potential safety hazards in medication care. Newly graduated nurses independently carry out medication orders and technical dispensing procedures without obtaining registered nurses. Analysis: Because the head nurse's management consciousness is vague, the key monitoring of medication safety is not implemented, nursing defects such as wrong medication, wrong needle and repeated medication occur from time to time, and there is a shortage of nursing staff, and assistant nurses who have not obtained nurse practice registration are used to carry out medical orders, resulting in adverse drug reactions.
1. 1.6 active reporting of nursing defects is not strict. After hip replacement in orthopedic patients, the nursing routine was not followed, and the nurse failed to observe the patient's condition change in time and rushed to ICU for emergency treatment, which led to nursing disputes. Analysis: Because the nursing management organization system and management system are not perfect, the routine nursing after operation is not implemented, the management function of head nurses is not fully exerted, and the supervision or guidance of the competent department is neglected and becomes a mere formality. After discussion of nursing disputes, the department still failed to report to the nursing department.
1.2 nursing link management
1.2. 1 Improve the nursing risk management system and raise nurses' risk awareness. Such as the system of nursing rounds for critically ill patients, the system of succession, the system of safety management, the system of drug management, the system of disinfection and isolation, the system of nurse training and the system of rescuing critically ill patients. Such as the process of rescuing patients with myocardial infarction, making the target process of first aid station, mastering this skill through training, and improving the success rate of rescue.
1.2.2 strengthening the management of nursing high-risk personnel and correcting the quality deviation in time have potential risks for nurses who have just graduated, nurses who have changed jobs and nurses who have graduated for five years to carry out one-on-one teaching. Pre-job training focuses on the management of nursing links, emergency plans and handling procedures [2]. The key nursing links include: patient admission, transfer, perioperative care, critical patient care, blood transfusion care, adverse drug reactions treatment, and guidance before and after special examination. Procedures for handling accidents and emergencies (such as accidental extubation of tracheal intubation, suicide, disaster, etc.). ). Spend 15 min every day asking questions to nurses, studying business every week, and assessing knowledge targets every month. After the nursing goal is achieved, nurses can identify the key links, accidents and emergencies in nursing work, and master the handling procedures and principles of accidents and emergencies (asking for instructions, rescue procedures and nursing records). Only by assessing each nurse, establishing professional files of nurses, giving timely feedback on existing problems and guiding nurses to improve nursing technology can the nursing quality be effectively improved.
1.2.3 Strengthen nursing detail management, improve nursing quality, strengthen nurses' professional ethics education, enhance nurses' sense of responsibility and improve their own quality. Strengthen the concept of legal system, organize nurses to seriously study the Nurses' Regulations, Rules for Handling Medical Accidents and health legal knowledge, educate nurses to learn, understand and use the law, improve their awareness of self-protection and raise their awareness of nursing risks. Standardize the workflow, is that clear? Patient-centered? 、? Care about disease, care about people, care about needs? The goal of humanized and detailed nursing; Standardize nursing document records: standardize the signatures on the administration, injection and infusion sheets, strictly check with the double signatures of the executor/auditor, and carefully fill in the dispensing time, infusion time and infusion drops. In addition to being informed, every patient in outpatient skin test must also have the double signatures of the nurse and the patient to confirm that the notification system has been implemented, so as to reduce the occurrence of nursing disputes. In the management of safe drug use in nursing, nurses lack risk awareness and crisis awareness, some nurses blindly carry out medical orders, lack clinical experience, and have no ability to distinguish between carrying out medical orders, such as copying medical orders and oral medical orders, mechanically carrying out medical orders, and lacking legal documents; When rescuing critically ill patients, little is known about the storage location, performance and adverse reactions in case of emergency. It is not only chaotic, but also can't guarantee the first time to use drugs; Nurses rarely observe adverse drug reactions after giving drugs and injections. Strict implementation of medication process, such as oral medication process specification, double bedside signature check to prevent nursing errors and accidents, is the key monitoring of clinical nursing process management.
1.2.4 Strengthen the nursing of critically ill patients, and put forward predictive nursing problems and measures. The head nurse evaluates the nursing risk of critically ill patients every day, pays attention to the quality management of key links, and reduces the occurrence of nursing risks. Go to work half an hour early and half an hour late every day, and the responsible nurse will check the implementation of nursing measures for critically ill patients. Use the morning shift of 15 min every day to evaluate the work, point out the potential and existing safety hazards in time and put forward preventive measures. For example, when patients with endotracheal intubation have oral care technology, there is a lot of sputum in the trachea. If sputum aspiration is not found in time, patients will suffocate. Head nurses cultivate young nurses' clinical critical thinking through on-site drills. Continuous improvement of nursing quality is an eternal goal.
Two results
Through the correct understanding of nursing risks by nursing managers, nursing staff are strictly required to start with small things (such as oral drugs), manage the details, improve the risk management system, standardize the workflow, and provide correct guidance for clinical frontline nurses. Strengthen the management of nursing risk, reduce the incidence of nursing risk, ensure the safety of patients and improve the quality of nursing.
3 discussion
3. 1 Carry out the continuous shift mode of nurses [3] and improve the hierarchical management of nurses. The emergency department, ICU, surgical and internal medicine wards implement APN continuous scheduling. In order to ensure the quality of night shift nursing and increase the number of night shift nurses, night shift is a full night shift system. Nurse scheduling: ① Nurse classes on duty: divided into class A (8:00- 15:30), class P (15:00-22:30) and class N (22:00-8:30), and each shift is from 1. ② Day shift: (8: 00- 1 1: 30,14: 30-17: 30) Two nurses are responsible for the processing and checking of doctor's orders, charge management, preparation and collection of commonly used drugs and articles. The nurse checked the doctor's advice 1 time for two days. The responsible team leader is responsible for the supervision and management of nursing work, and the quality of nursing is changed from terminal control to process control, so that potential safety hazards are eliminated in the bud.
3.2 Actively report nursing defects and strengthen nursing quality management. In the process of nursing activities, once nursing mistakes and defects occur, nurses will be punished and concealed, requiring the parties to take the initiative to report and protect patients: closely observe the condition, immediately notify the doctor, correct the mistakes in time, and minimize the harm of the mistakes as much as possible. Event reporting system: report to the superior in time within 24 hours. Nursing accidents and serious mistakes should be reported immediately. Notify the night nurse and the duty officer. Units or individuals that have made mistakes or accidents deliberately conceal and fail to report as required. If it is discovered by leaders or others afterwards, it will be dealt with seriously according to the seriousness of the case. Reporting procedure: ward nurse? Ward head nurse? Nursing department? Hospital leaders. Only when problems are found can they be solved.
3.3 Nursing safety medication specification [4], to ensure the safety of patients. Nurses lack risk awareness and crisis awareness, and have no sense of responsibility. Nurses blindly carry out doctor's orders, lack clinical experience, mechanically carry out doctor's orders and lack legal documents; Or in the process of rescue and emergency, little is known about the storage location, performance and adverse reactions. Not only is it confusing, but it is impossible to guarantee the first time to use drugs; Or few adverse drug reactions were observed after administration and injection. Only by finding out the weak links in the work and finding a better solution to the problem can we achieve lasting nursing safety and quality management.
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[1] Chen. Analysis of the current situation of nurses' occupational protection in primary hospitals and its countermeasures. Chinese nursing management, 2005, 4:44-45.
[2] Tang Yuping. Practice and effect of strengthening nursing risk management. Journal of nursing administration, September 26, 2006.
[3] Lan Huilan. Application and effect of hierarchical management method in comprehensive ICU. Chinese Journal of Nursing, 2008, 12:4 1-42.
[4] Shen Zhu. Cause analysis and countermeasures of nursing risk in psychiatric department. Journal of Nursing, 2007, 1 1:39-40.