1. Experience and gains in gynecological work
I deeply understand the qualities and conditions that a qualified obstetrician and gynecologist should have, strive to improve his professional level, constantly strengthen the study of business theory, learn knowledge about maternal and child health care, and enrich his theoretical knowledge. I often attend training, listen to lectures by experts and scholars at higher levels, and go to traditional Chinese medicine hospital to learn new medical knowledge and technology in the first half of the year, thus broadening my horizons and expanding my knowledge. Always adhere to the application of new theories and technologies to work, master the diagnosis and treatment techniques of common, frequently-occurring and difficult diseases in obstetrics and gynecology, master the diagnosis and treatment of obstetric complications such as obstetric diseases and cervical erosion, master the diagnosis and treatment of various acute and severe gynecological diseases, and be able to independently perform common gynecological operations and various family planning operations. Strict implementation of various work systems, diagnosis and treatment routines and operating procedures, careful treatment of every patient, to a certain extent, to avoid misdiagnosis and mistreatment.
Since I have been engaged in obstetrics and gynecology, the accuracy of diagnosis and treatment of gynecological diseases I have treated is over 80%. I independently completed several other gynecological operations, and all patients were discharged on time, and there was no error-free accident. Really played the role of business backbone. During my work, I worked out practical work indicators and plans according to the requirements of my superiors for maternal and child work.
The communication between doctors and patients is in place, and the staff of the department understand each other and unite as one. For pregnant women who give birth in hospital, we should closely observe the labor process, patiently communicate with doctors and patients, and let pregnant women and their families know about the labor process and possible situations, so as to have a process of psychological preparation and understanding. Surgical patients should strictly grasp the surgical indications and treat critically ill patients as soon as possible. The operation was strictly sterile and there was no puerperal infection.
Strictly abide by the scheduling system, be responsible for the formulation of the first consultation system, and prevent the occurrence of medical accidents. Disinfection responsibilities of departments are clear, formal and recorded in time.
2. Experience and harvest of gynecological work
In order to cooperate with the city's urban upgrading and public health development and construction, the leaders of our hospital decisively vacated the administrative office and set up the first high-risk obstetric ward in our city-the obstetric high-risk intensive care unit. Ward has played its due role in the treatment of severe pregnant women in our hospital and our city, which has made the number of high-risk obstetric patients such as pregnancy complications in our hospital surge, ranking first in the city. Since the ward was established from April to September this year for half a year, under the care and leadership of leaders at all levels in the hospital, with the working aim of "taking patients as the center and serving the people wholeheartedly", medical staff at all levels have been diligent and conscientious in their posts, making every effort to do a good job in the diagnosis and treatment of every patient, doing every job well, taking the hospital as the master and treating patients as relatives, and taking everything into account. First, strengthen the construction of medical ethics.
Wards often carry out medical ethics education and assessment, earnestly study, implement and enforce the rules of clean medical practice, refuse to accept red envelopes and finances, earnestly study all kinds of legal knowledge, devote themselves to health undertakings, take saving lives and preventing diseases as the heavy responsibility, love their jobs, stick to their posts, be meticulous, regardless of personal gains and losses, and complete all medical work with high quality. Establish the spirit of serving the people wholeheartedly, so that patients can get reasonable diagnosis and treatment and careful nursing. General practitioners can be polite, dignified, sincere, sympathetic, caring and considerate to patients, and patiently explain the illness and related precautions to patients and their families. Relieve the patient's pain with a treatment plan. Throughout the year, there were no phenomena such as asking for money and goods from patients and their families, issuing various false certificates and false inspection results. Departments set up suggestion books, hold patients' symposiums regularly, constantly listen to the opinions of patients and their families, improve medical and service work, adhere to strict requirements, strict organization and rigorous work attitude, and implement them in daily work. The whole department is fearless in the face of critically ill patients, United as one, and strives to rescue patients who are referred to our hospital one after another.
Two, improve the rules and regulations, conscientiously perform their duties.
In clinical work, we have established and improved various rules and regulations and operating procedures in strict accordance with Guangdong Obstetric Quality Inspection Standard, and implemented them one by one. Adhere to the 24-hour working system for young doctors, and the 24-hour resident chief physician with senior experience is stationed in the ward to be responsible for the medical work in the ward, and adhere to the systems of medical record writing, third-level doctor rounds and teaching rounds, case discussion, medical error accident registration and declaration, operation approval, medical record management, and medical quality monitoring. Require staff at all levels to conscientiously perform their duties.
The director of the department is responsible for organizing the implementation of various rules and regulations and operating procedures, and adjusting the responsibilities and priorities of each class in combination with the actual situation in our hospital, so as to make the work arrangement reasonable and more conducive to patient treatment. In order to prevent all kinds of medical errors and accidents, this year, we will focus on strengthening the implementation of the three-level physician rounds system, insisting on the rounds of superior doctors before various operations, and taking the rounds of doctors above the chief resident to standardize the operation, reduce complications and improve the quality of the operation. And regularly check the implementation of various work systems and job responsibilities, find problems at any time, solve problems at any time, and put an end to medical errors and accidents in the bud.
Third, strengthen business study and improve quality in an all-round way.
At present, the medical market is highly competitive. In order to survive and develop in the medical market, we must improve the quality of medical care and attract more patients with modern management and high-quality medical care, which is particularly important for the ward in charge of critical illness rescue and management in our hospital. For doctors, there is no real skill or kung fu, and saving lives is equal to empty talk. This year, we attach great importance to the cultivation of medical personnel's quality, regard doctors as the core of productivity, and formulate a step-by-step training plan for talents. By inviting experts to our hospital, participating in various training courses, conducting regular teaching rounds, conducting regular business studies, often organizing case discussions, regularly organizing reading reports, strictly conducting resident training, and strictly conducting three-basic training and assessment, we can accelerate the cultivation of multi-level talents. Pay special attention to carefully discuss, sum up experience and draw lessons from every special and rare medical record and critically ill patients after treatment, so that doctors at all levels can deepen their impression, be skilled in diagnosis and treatment when encountering similar situations in the future, and gradually have good first-aid technical quality.
Since the ward was opened for half a year, a total of 235 cases of obstetric complications and serious complications have been treated, including 2 cases of critical gynecological patients, including amniotic fluid embolism, 5 cases of eclampsia and 6 cases of major rescue in the hospital, with a success rate of 1 00%. Because our hospital has many patients, fast turnover, heavy workload and few specialties, it is difficult to consult other specialties. According to our characteristics, the treatment of complex patients requires high comprehensive quality of medical staff. Therefore, we pay special attention to training a versatile young doctor to make them better qualified for clinical work. At present, all our doctors can carry out fetal monitoring and ECG examination, and analyze the ECG results in combination with the fetal monitoring report. Some doctors can do B-ultrasound and umbilical blood flow, and all medical staff can.
Four, vigorously develop business, carry out new projects, and comprehensively improve the level of diagnosis and treatment.
As a part of modern medicine, the development speed of critical medicine is the most remarkable. The application of critical medicine technology in obstetrics and gynecology, especially obstetrics, has formed a new critical obstetrics. On the basis of continuous ECG monitoring and blood oxygen saturation monitoring in obstetrics and gynecology department of our hospital, respiratory function monitoring can be carried out in wards of our hospital, and respiratory rhythm and electrocardiogram of critically ill women can be continuously observed to ensure timely detection and treatment of cardiopulmonary abnormalities. The newly developed deep venous puncture and central venous pressure measurement monitor blood volume for us and guide patients with heart failure, massive blood loss, pregnancy complicated with heart disease and so on. Make the diagnosis and treatment more accurate and scientific. As the most important mechanical ventilation technology in critical medicine, it can obviously improve the success rate of treatment after being applied to critical obstetrics. This year, 1 patient with "heart and lung failure, cornual pregnancy, abdominal hemorrhage" was successfully treated with ventilator-assisted mechanical ventilation for the first time in the obstetrics and gynecology department of our hospital after operation. The patients are in good condition after operation, and all of them have been discharged from the hospital, which proves that our hospital has the critical medical technology such as ventilator-assisted ventilation, which greatly increases the ability to treat critical pregnant women.
Five, strengthen the awareness of scientific research, improve the level of scientific research, and actively participate in high-level scientific and technological assistance.
At present, patients' requirements for hospitals and medical staff are constantly improving, and new technical projects are constantly emerging. In order to adapt the development of our hospital to the needs of medical level, this year we will continue to focus on scientific research, strive to improve our level and the quality of doctors through scientific research, and require every doctor to concentrate on research, read a lot of latest domestic and foreign literature, broaden their horizons, pay attention to the summary of clinical work, and combine the problems encountered in daily work with the latest medical theories to explore effective treatment methods. Actively participate in all-round high-level scientific and technological assistance, and comprehensively enhance the academic status and social influence of our institute.
Clinical analysis of propafenone and oxytocin in promoting cervical ripening and inducing labor in pregnant women with gestational diabetes mellitus, value analysis of β-HCG and P determination in early diagnosis of tubal pregnancy, clinical characteristics analysis of early-onset severe preeclampsia, correlation analysis of premature rupture of membranes and chorionitis, and discussion on high-risk factors and early diagnosis of tubal pregnancy written by Director Dai Bingmei in ward have all been published in China Modern Medicine and Modern Medicine. Dr. Liu Zhixiang, the chief resident of the ward, was invited by Li Yingtao, director of the Third Affiliated Hospital of Guangzhou Medical College and Guangzhou Severe Maternal Treatment Center, to participate in the writing of "China Perinatal Medicine" and was responsible for the section "Puerperal heatstroke". This book is the first mature and high-level monograph of perinatal medicine experts in the 30 years since the birth and development of China, and it is planned to be published by People's Health Publishing House in May next year. Dr. Liu Zhixiang (the sixth finisher) participated in the project "Discussion on Early Diagnosis Methods of Tubal Pregnancy" presided over by Director Kui of our hospital, and won the third prize of the Municipal Science and Technology Progress Award.
Shortcomings and Countermeasures in the Work of Intransitive Verbs
With the rapid development of medical technology, the requirements of society for medical quality and the quality of medical staff are constantly improving. Facing customers, this is an urgent problem for hospital management and improving service quality. Obstetric high-risk intensive care unit (HIICU) is a concentrated ward for special patients in obstetrics and gynecology in our hospital, especially those with critical illness, pregnancy complications and pregnancy complications. Medical risks are high and it is difficult to diagnose and treat, so it is particularly important to prevent medical hidden dangers and improve medical level. The work that needs further improvement in the future is as follows:
1) The doctors and nurses in the ward are relatively young and lack of work experience, so they underestimate their illness when dealing with critically ill patients. In the future, they must strengthen professional study, organize discussions on related critical cases, including discussions in other hospitals, sum up experience, improve various diagnosis and treatment routines, clarify the standardized use of commonly used rescue drugs, and gradually form their own mature rescue procedures and common management and diagnosis and treatment routines for critical patients, pregnancy complications.
2) As an important base for resident training in departments, wards frequently rotate doctors. First, residents with the shortest working hours participate in front-line work. Moreover, as a newly opened department, more new diagnosis and treatment routines are adopted, and there are more new businesses in the ward. The work in the ward is busy and requires high quality, which easily leads to the failure of medical documents to reflect high-quality work. Therefore, in the future, higher-level doctors should strengthen the guidance to lower-level doctors, carefully organize medical records, design more tabular medical records and conversation books with specialist characteristics as much as possible, and introduce more critical care parameters to make medical records more specialized.
3. Experience and harvest of gynecological work
The sun and the moon alternate, and the years are like songs. We have experienced the XXXX era in our work. This year, under the leadership and strong support of the nursing department, we closely focused on the working principle of "patient-centered, quality-centered", combined with the actual work of the department, further improved the workflow of the department, refined management, conscientiously implemented various work systems, and gradually improved the quality of nursing. First, strengthen ward management and consolidate basic nursing. Create a good medical environment for patients
This year, our department strengthened ward management, paid attention to morning and evening nursing, ensured that the bed sheets were flat and wrinkle-free, ensured that the bed sheets and bedding were free of blood and stains, and changed with the dirty, and formulated a system of changing the bed sheets every Monday to ensure that each patient's bed unit was flat, clean and comfortable. To achieve "three deficiencies" and "six net"; And insist on cleaning the outside for the lying-in women until they leave the hospital to ensure the cleanliness and pollution-free of the patients.
Second, with the development of quality nursing service in our hospital this year, combined with the actual situation of our department, we will formulate quality nursing measures from the following aspects:
(1) Change the service concept. In the department, Director Liu often emphasizes that our nursing work is service work. We should renew our ideas and provide good service. In the service, we should not only use civilized language, but also have warm language and kind expression. Therefore, in practical work, we not only call gynecological patients "aunts" and "mother-in-law", but also regard obstetric patients as "darlings".
(2) change the organizational structure. In X month this year, the department implemented responsible nursing, and the ward was divided into XX and XX two responsibility districts, with two responsible nurses respectively. The nurse in charge is responsible for observing the patient's condition, implementing therapeutic nursing, health education, psychological nursing and life nursing, achieving all-round nursing, ensuring that the nurse in charge of the bed is in place and the responsibility is implemented to people, which greatly changes the limitations of functional nursing in the past. The responsible nurses this year are: Hong Ying and Li Li. They try their best to provide high-quality services for patients in their posts, and participate in some management work, improving their comprehensive quality and winning the praise of some patients' families!
(3) Change the scheduling mode. In order to adapt to the frequent surgical handover at noon and reduce the pressure of nursing work at noon, the original mode of one nurse from 8 am to 4 pm was changed to the mode of two responsible nurses from 8 am to 4 pm, which reduced the intermediate handover, which was not only acceptable to nurses, but also ensured the nursing safety.
Third, strengthen the continuing education of nurses and cultivate specialized nursing talents.
At the beginning of this year, we made a talent training plan for this major, including in-class study and off-campus study to participate in training courses, and all of them have completed the training plan. In-department learning is to use the morning meeting every day to strengthen the training of basic nursing, nursing routine, health education and other nursing knowledge and techniques, and constantly improve the professional knowledge level of nurses in departments. I went out to train a specialist nurse in obstetrics this year, and I can work independently.
In addition, there are one-to-one nursing teachers for new nurses to adapt to their jobs as soon as possible, actively encourage nurses who have worked for more than one year to continue their studies, and allow them to learn by themselves in various forms to improve their academic qualifications. This year, two nurses got university degrees, and the head nurse got the title of nurse in charge.
Fourth, strictly implement the core system to reduce the occurrence of nursing errors. The key point is:
(a) strict bedside shift, adhere to the daily night shift to sort out the diagnosis, treatment and operation of all hospitalized patients, so that the morning shift is more meticulous and rigorous, and check the basic nursing situation at any time, point out the existing problems in time and correct them in time to ensure the safety of patients.
(2) Improve the nursing inspection system. In view of the irregular stop of doctor's orders in our department, a double-person and double-BANCHA checking system is specially designed, that is, after checking the doctor's orders in the day shift and general affairs every afternoon, check the doctor's orders with the midwife again in the evening, thus avoiding the phenomenon of missed inspection and repeated execution.
5. There are many young nurses in our department. In order to make them more confident, we advocate the concept of studious and enterprising in the department and actively participate in various activities organized by the hospital:
For example, XX operation contest and knowledge contest, our department actively participated in these activities and won the third prize in the knowledge contest. The participation of these activities not only makes them happy in the activities, but also makes them grow up in the activities! At the same time, our nurse XX was rated as "excellent nurse"!
Sixth, standardize the writing of nursing documents and reduce the writing pressure of nurses.
Our department adopts tabular nursing documents according to the characteristics of specialties, which greatly reduces the time for nurses to record. Let nurses have more time to provide patients with direct nursing services.
Seven, innovative service forms, so that patients can really feel our concern and care.
In order to enhance the connotation of high-quality nursing service in our department, some new service measures have been specially formulated, so that patients can truly feel our medical services and taste our high quality. For example:
(1) Send a cup of hot milk powder to the patient who has just finished the abortion operation;
(2) Give the parturient a cup of brown sugar water;
(3) designing and sewing skirts for lying-in women and patients;
(4) In obstetric service, we also use the mode of responsible nursing for reference, and adopt the mode of one-on-one midwifery, so that pregnant women can get the overall service. And establish a QQ group for pregnant women, assign a special person to be on duty every day, and answer questions raised by pregnant women in time.
(5) Specially apply for an induction cooker to the hospital to provide convenience for the parturient.
(6) In the nursing of newborns, not only the mother-infant sharing room is strictly implemented, but also the daily bathing is completed. During the hospitalization, the midwife personally feeds the newborn and changes diapers.
(7) Strengthen the follow-up after discharge, timely understand the nursing problems encountered by patients, parturients and newborns after discharge, conduct telephone consultation, and come to the hospital for examination in time for special problems. This year, X people were followed up by telephone, which was widely praised by patients and their families.
Eight, strengthen the management of delivery room, and actively control hospital infection.
In strict accordance with the management standards of key departments of the hospital, standardize various emergency procedures and emergency plans for all kinds of acute and critical diseases, add special drugs for all kinds of acute and critical diseases in obstetrics in the rescue vehicle, implement various disinfection and isolation systems, and strengthen various infection monitoring.
Improve the quality inspection standard of delivery room. Midwives' meetings were held regularly to feed back the problems existing in the work, carefully summarize and analyze them, formulate the next rectification measures, and carry out follow-up inspection of quality defects, which improved midwives' quality awareness and management awareness and successfully passed the obstetric nursing quality inspection.
Nine, establish and improve the performance appraisal and incentive mechanism, fully mobilize the enthusiasm of nurses, and reflect the excellent work and more pay.
Over the past year, although some work has been done and some achievements have been made, there are still many shortcomings: the content of quality nursing service needs to be deepened and the service form needs to be innovated; Young nurses still need to learn basic theoretical knowledge and specialized nursing knowledge, and the enthusiasm and initiative of service need to be further enhanced; Nursing scientific research and thesis writing are also very weak. Therefore, in the new year, we will sum up experience, make bold innovations and make unremitting efforts for the sustainable development of hospitals.