上海市三级甲等医院护理不良事件的调查
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摘要
目的了解上海市三级甲等医院护理不良事件的现状,分析其深层次原因,以期为改进护理工作流程、管理机制提供现实参考。方法 2014年10月至2015年2月,采用分层随机整群抽样方法,选择上海市4个不同经济水平区的4所三级甲等医院,在内科、外科、专科中随机抽取一个科室的护士及护生,采用基于关键事件技术的开放性问卷进行调查。结果按照不良事件发生频率,从高到低依次为护理操作相关事件(28.80%)、患者身份识别错误(25.28%)、给药错误(23.74%)、意外伤害(14.01%)、非计划拔管(8.17%)。结论通过增加护理人力配置、优化护士弹性排班,加强对低年资护士和实习护生的专业培训,建立无惩罚环境、完善护理不良事件报告系统,从而减少护理不良事件的发生。
Objective To understand the current status of nursing adverse events in Class M Grade I hospitals in Shanghai,and analysis the influencing factors,in order to provide clinical reference in improving nursing process and management mechanism.Methods By using stratified random cluster sampling,four Class Ⅲ Grade Ⅰ hospitals in Shanghai were selected.The nurses and nursing students were randomly selected from departments of internal medicine,surgical department and specialist department.The participants were interviewed by using questionnaire based on critical incident technique.Results The frequencies of adverse events from high to low in sequence were nursing operation related events(28.80%),patient identification error(25.28%),medication mistake(23.74%),accidental injury(14.01%),unplanned extubation(UEX)(8.17%).Conclusions Increasing nurse staffing,optimizing flexible scheduling,strengthening training for the young nurses and nursing students,creating a non-punitive working environment and improving the adverse events reporting system can reduce the incidence of nursing adverse events.
Objective To understand the current status of nursing adverse events in Class M Grade I hospitals in Shanghai,and analysis the influencing factors,in order to provide clinical reference in improving nursing process and management mechanism.Methods By using stratified random cluster sampling,four Class Ⅲ Grade Ⅰ hospitals in Shanghai were selected.The nurses and nursing students were randomly selected from departments of internal medicine,surgical department and specialist department.The participants were interviewed by using questionnaire based on critical incident technique.Results The frequencies of adverse events from high to low in sequence were nursing operation related events(28.80%),patient identification error(25.28%),medication mistake(23.74%),accidental injury(14.01%),unplanned extubation(UEX)(8.17%).Conclusions Increasing nurse staffing,optimizing flexible scheduling,strengthening training for the young nurses and nursing students,creating a non-punitive working environment and improving the adverse events reporting system can reduce the incidence of nursing adverse events.
引文
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[6]Itoh K,Andersen H B,Madsen M D,et al.Patient views of adverse events:Comparisons of self-reported healthcare staff attitudes with disclosure of accident information[J].Appl Ergon,2006,37(4):513-523.
[7]张小庄,叶宁,黄水清,等.激励机制在增强医院不良事件主动报告中的作用研究[J].中华医院管理杂志,2009,25(1):24-27.
[8]仇铁映,黄金.护理不良事件概念与管理研究现状[J].中国护理管理,2014,14(9):1004-1008.
[9]赵瑞萍,张兆旭,许冬梅.医药不良事件内部报告系统的构建及应用体会[J].中国医院,2015,19(2):48-50.
[10]中华人民共和国国家卫生和计划生育委员会.三级综合医院评审标准实施细则(2011年版)[EB/OL].[2011-11-25].http://www.nhfpc.gov.cn/yzygj/s3585u/201112/06f754a213d8413787904e9e6439d88b.shtml.
[2]张小庄,罗坚,张国强,等.医院主动报告的不良事件特点分析及对策探讨[J].中华医院管理杂志,2009,(8):544-546.
[3]Flanagan J C.The critical incident technique[J].Psychol Bull,1954,51(4):327-358.
[4]Colaizzi P.Psychological research as the phenomenologists views it[M].New York:Oxford Univ Press,1978:48.
[5]高玲玲,张英华,张俊娥.优化护理人力资源配置提高护理质量[J].中国护理管理,2009,9(2):46-48.
[6]Itoh K,Andersen H B,Madsen M D,et al.Patient views of adverse events:Comparisons of self-reported healthcare staff attitudes with disclosure of accident information[J].Appl Ergon,2006,37(4):513-523.
[7]张小庄,叶宁,黄水清,等.激励机制在增强医院不良事件主动报告中的作用研究[J].中华医院管理杂志,2009,25(1):24-27.
[8]仇铁映,黄金.护理不良事件概念与管理研究现状[J].中国护理管理,2014,14(9):1004-1008.
[9]赵瑞萍,张兆旭,许冬梅.医药不良事件内部报告系统的构建及应用体会[J].中国医院,2015,19(2):48-50.
[10]中华人民共和国国家卫生和计划生育委员会.三级综合医院评审标准实施细则(2011年版)[EB/OL].[2011-11-25].http://www.nhfpc.gov.cn/yzygj/s3585u/201112/06f754a213d8413787904e9e6439d88b.shtml.
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