清单式互查在护士给药查对习惯培养中的应用
|
摘要
目的探讨清单式互查在护士给药查对习惯培养中的应用效果。方法根据给药操作中查对制度落实的关键节点和容易遗漏的环节制作"给药查对清单",护士使用该清单进行为期21 d的互相检查。每周根据检查中存在的主要问题进行原因分析,制定改进措施。科室质控员进行查对制度落实情况检查。结果使用清单互查前,医嘱双人查对、摆药/配药双人查对、操作时携带医嘱执行单、核查患者身份使用开放式提问、使用2种以上的方法核对患者信息、使用PDA扫描患者腕带、操作前中后完整查对、患者有疑问时查询解答的落实率分别为94. 38%、22. 47%、96. 63%、89. 89%、79. 78%、93. 26%、88. 76%、95. 51%,实施21 d互查后落实率分别为100. 00%、95. 69%、100. 00%、98. 28%、97. 41%、100. 00%、96. 55%、98. 28%,其中医嘱双人查对、摆药/配药双人查对、核查患者身份使用开放式提问、使用2种以上的方法核对患者信息、PDA扫描腕带及操作前中后完整查对的落实率互查前后比较,差异有统计学意义(P <0. 05)。结论护士使用"给药查对清单"进行给药操作中的互查,对培养护士良好的查对习惯、保障患者用药安全具有重要意义。
Objective To evaluate the application of inter-checking by checklist in the development of drug administration checking habits among nurses. Methods The head nurse made"medication checklist"according to key issues and weak links of drug administration. Nurses performed the inter-checking by the checklist for 21 days. The main problems in inter-checking were analyzed and corresponding improvement measures were carried out. The quality controller evaluated the implementation the drug administration checking before and after the implementation of inter-checking. Results Before the implementation of inter-checking with the list,implementation rate of double check for physician's orders,double check for dispensing,taking order sheet when operation,identity verification by open-ended question,using two or more methods to check patients' information,the wrist belt scan with PDA,completely check before,during and after operation,timely response to the patients' questions was 94. 38%,22. 47%,96. 63%,89. 89%,79. 78%,93. 26%,88. 76%,95. 51%,respectively,and was 100. 00%,95. 69%,100. 00%,98. 28%,97. 41%,100. 00%,96. 55%,98. 28% after implementation of inter-checking. There was a significant difference in implementation rate of double check for physician's orders,double check for dispensing,identity verification by open-ended question,two or more methods to check the patient's information,the wrist belt scan with PDA,completely check before and after implementation of inter-checking( P < 0. 05). Conclusion Inter-checking with the " medication checklist" was important for the nurses to develop good checking habit of medication,leading to safety of drug administration.
Objective To evaluate the application of inter-checking by checklist in the development of drug administration checking habits among nurses. Methods The head nurse made"medication checklist"according to key issues and weak links of drug administration. Nurses performed the inter-checking by the checklist for 21 days. The main problems in inter-checking were analyzed and corresponding improvement measures were carried out. The quality controller evaluated the implementation the drug administration checking before and after the implementation of inter-checking. Results Before the implementation of inter-checking with the list,implementation rate of double check for physician's orders,double check for dispensing,taking order sheet when operation,identity verification by open-ended question,using two or more methods to check patients' information,the wrist belt scan with PDA,completely check before,during and after operation,timely response to the patients' questions was 94. 38%,22. 47%,96. 63%,89. 89%,79. 78%,93. 26%,88. 76%,95. 51%,respectively,and was 100. 00%,95. 69%,100. 00%,98. 28%,97. 41%,100. 00%,96. 55%,98. 28% after implementation of inter-checking. There was a significant difference in implementation rate of double check for physician's orders,double check for dispensing,identity verification by open-ended question,two or more methods to check the patient's information,the wrist belt scan with PDA,completely check before and after implementation of inter-checking( P < 0. 05). Conclusion Inter-checking with the " medication checklist" was important for the nurses to develop good checking habit of medication,leading to safety of drug administration.
引文
[1]中华人民共和国国家卫生健康委员会医政医管局.关于印发医疗质量核心制度要点的通知:国卫医发[2018]8号[A/OL].(2018-04-21)[2018-06-01].http://www.nhfpc.gov.cn/yzygj/s3585/201804/aeafaa4fab304bdd88a651dab5a4553d.shtml.
[2]DONALDSON N,AYDIN C,FRIDMAN M,et al.Improving Medication Administration Safety:Using Naive Observation to Assess Practice and Guide Improvements in Process and Outcomes[J].J Healthc Qual,2014,36(6):58-68.
[3]POON E G,KEOHANE C A,YOON C S,et al.Effect of bar-code technology on the safety of medication administration[J].N Engl J Med,2010,362(18):1698-1707.
[4]胡素容,章俊梅,胡庆新,等.影响护理给药查对制度正确执行的相关因素研究[J].西部医学,2012,24(9):1818-1820.
[5]付京,程秀华,裴胜利,等.医院信息系统下给药护理失效模式及潜在风险因素分析[J].护理学杂志,2013,28(10):70-72.
[6]张亚南,陈宁.医院药房常见差错隐患的分析及应对措施[J].中国药物警戒,2013,10(3):181-183.
[7]谷欣,刘海云.住院患者唯一识别号的编制及在病案信息管理中的运用[J].中国病案,2013,14(1):12-13.
[8]陈丽,谢军姣,郭三兰.二维码腕带识别提高住院患者服药安全性[J].护理学杂志,2014,29(6):14-15.
[9]李玉梅,黄瑛,张贵芬,等.基于精细化管理理念制作岗位核查清单实施护理质量过程控制的效果[J].护理管理杂志,2016,16(12):886-888.
[10]刘光维,刘丽萍,赵庆华.“双向查对”制度在护理安全管理中的应用[J].护理研究,2011,25(4):913-914.
[11]高增敏,安聪娟,张丽华,等.品质管理圈活动在降低护士静脉输液环节核对差错率中的应用[J].河北医科大学学报,2014,35(5):574.
[12]LALLY P,WARDLE J,GARDNER B.Experiences of habit formation:A qualitative study[J].Psychol Health Med,2011,16(4):484-489.
[13]ALSULAMI Z,CHOONARA I,CONROY S.Paediatric nurses'adherence to the double-checking process during medication administration in a children's hospital:an observational study[J].J Adv Nurs,2014,70(6):1404-1413.
[14]肖春秀,许乐,念小云.临床护士给药操作核对执行情况床旁观察分析[J].护理学杂志,2016,31(9):58-60.
[15]陈华娟,陆瑞光.病历互查质控法在产房护理病历质量管理中的应用[J].解放军护理杂志,2013,30(9):67-68.
[16]徐娟,唐艳艳,潘振宇,等.我国三级综合医院医疗质量安全核心制度演化进程[J].中国医院管理,2017,37(11):37-39.
[17]张凤英,冯先琼.清单式管理与护理风险防范[J].中国医学伦理学,2013,26(6):729-730.
[18]XU J,REALE C,SLAGLE J M,et al.Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units[J].Nurs Res,2017,66(5):337-349.
[2]DONALDSON N,AYDIN C,FRIDMAN M,et al.Improving Medication Administration Safety:Using Naive Observation to Assess Practice and Guide Improvements in Process and Outcomes[J].J Healthc Qual,2014,36(6):58-68.
[3]POON E G,KEOHANE C A,YOON C S,et al.Effect of bar-code technology on the safety of medication administration[J].N Engl J Med,2010,362(18):1698-1707.
[4]胡素容,章俊梅,胡庆新,等.影响护理给药查对制度正确执行的相关因素研究[J].西部医学,2012,24(9):1818-1820.
[5]付京,程秀华,裴胜利,等.医院信息系统下给药护理失效模式及潜在风险因素分析[J].护理学杂志,2013,28(10):70-72.
[6]张亚南,陈宁.医院药房常见差错隐患的分析及应对措施[J].中国药物警戒,2013,10(3):181-183.
[7]谷欣,刘海云.住院患者唯一识别号的编制及在病案信息管理中的运用[J].中国病案,2013,14(1):12-13.
[8]陈丽,谢军姣,郭三兰.二维码腕带识别提高住院患者服药安全性[J].护理学杂志,2014,29(6):14-15.
[9]李玉梅,黄瑛,张贵芬,等.基于精细化管理理念制作岗位核查清单实施护理质量过程控制的效果[J].护理管理杂志,2016,16(12):886-888.
[10]刘光维,刘丽萍,赵庆华.“双向查对”制度在护理安全管理中的应用[J].护理研究,2011,25(4):913-914.
[11]高增敏,安聪娟,张丽华,等.品质管理圈活动在降低护士静脉输液环节核对差错率中的应用[J].河北医科大学学报,2014,35(5):574.
[12]LALLY P,WARDLE J,GARDNER B.Experiences of habit formation:A qualitative study[J].Psychol Health Med,2011,16(4):484-489.
[13]ALSULAMI Z,CHOONARA I,CONROY S.Paediatric nurses'adherence to the double-checking process during medication administration in a children's hospital:an observational study[J].J Adv Nurs,2014,70(6):1404-1413.
[14]肖春秀,许乐,念小云.临床护士给药操作核对执行情况床旁观察分析[J].护理学杂志,2016,31(9):58-60.
[15]陈华娟,陆瑞光.病历互查质控法在产房护理病历质量管理中的应用[J].解放军护理杂志,2013,30(9):67-68.
[16]徐娟,唐艳艳,潘振宇,等.我国三级综合医院医疗质量安全核心制度演化进程[J].中国医院管理,2017,37(11):37-39.
[17]张凤英,冯先琼.清单式管理与护理风险防范[J].中国医学伦理学,2013,26(6):729-730.
[18]XU J,REALE C,SLAGLE J M,et al.Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units[J].Nurs Res,2017,66(5):337-349.