多部门联合运用FOCUS-PDCA在住院患者用药安全管理中的效果观察
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摘要
目的降低我院住院患者给药差错的发生率。方法运用FOCUS-PDCA (find-organize-clarify-understand-select-plan-do-check-act,FOCUS-PDCA)循环管理对我院2017年上半年上报的住院患者护理给药差错不良事件分析和持续质量改进,与改善后(2018上半年)的给药差错不良事件进行对比,评价管理效果。结果成立跨部门、跨专业的质量改进(CQI)小组运用FOCUS-PDCA进行住院患者护理给药质量持续改进,全院给药差错事件由改善前的0. 11‰(17/154 545)下降至改善后的0. 045‰(7/156 295),不合理类型中口服给药、肌注给药、静脉注射、雾化吸入给药和漏皮试差错均为0。结论采用FOCUS-PDCA循环管理可降低给药差错发生率。
Objective To reduce the incidence of drug administration errors in inpatients in our hospital. Methods The FOCUS-PDCA cycle management effect was evaluated by comparing the adverse events of the nursing medication errors reported in our hospital in the first half of 2017 with the first half of 2018. Results The inter-departmental and cross-professional quality improvement( CQI) group was set up to use FOCUS-PDCA to continuously improve the nursing quality of inpatients. The error events of drug administration in the whole hospital decreased from 0. 11%( 17≤154 545) to 0. 045%( 7≤156 295). There were no errors of oral administration,intramuscular administration,intravenous injection,atomization inhalation and skin leakage test. Conclusion FOCUSPDCA cycle management can reduce the incidence of the medication errors.
Objective To reduce the incidence of drug administration errors in inpatients in our hospital. Methods The FOCUS-PDCA cycle management effect was evaluated by comparing the adverse events of the nursing medication errors reported in our hospital in the first half of 2017 with the first half of 2018. Results The inter-departmental and cross-professional quality improvement( CQI) group was set up to use FOCUS-PDCA to continuously improve the nursing quality of inpatients. The error events of drug administration in the whole hospital decreased from 0. 11%( 17≤154 545) to 0. 045%( 7≤156 295). There were no errors of oral administration,intramuscular administration,intravenous injection,atomization inhalation and skin leakage test. Conclusion FOCUSPDCA cycle management can reduce the incidence of the medication errors.
引文
[1] Anderson DJ,Webster CS. A systems approach to the reduction of medication error on the hospital ward[J]. Journal of Advanced Nursing,2001,35(1):8.
[2] Fu-In Tang,Shuh-Jen Sheu,Yu S,et al. Nurses relate the contributing factors involved in medication errors[J]. Journal of Clinical Nursing,2007,16(3):11.
[3] Maraiki F,Farooq F,Ahmed M. Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide[J]. International Journal of Pharmacy Practice,2016,24(4):271-282.
[4]黄燕,刘罡,陈帆,等.运用质量管理工具分析护理不良事件降低护士用药错误发生率[J].护理研究,2014,11(28):3918-3920.
[5]陈素平,吴旭丽,王雪琴,等.细节管理在护士临床给药安全管理中的实施与效果评价[J].医院管理论坛,2010,11(27):25-27.
[6]冯下芝,梁葵,林光惠,等. 26起护理差错原因分析及对策[J].护理研究,2008,22(12):3269.
[7]蒋华,刘义兰,刘涛,等.护士上报给药差错的障碍与对策[J].中华护理杂志,2009,44(4):315-317.
[8]宋艳玲,邹晓清,赖兰萍.护理风险管理中给药差错的原因分析与防范措施[J].中华现代护理杂志,2005,11(11):876-877.
[9]郑红莉,戴志清.不同给药途径的护理[J].华北理工大学学报(医学版),2007,9(2):158.
[10]徐静,周翔.护理风险管理中给药差错的影响因素[J].中国医刊,2016,51(4):31-33.
[2] Fu-In Tang,Shuh-Jen Sheu,Yu S,et al. Nurses relate the contributing factors involved in medication errors[J]. Journal of Clinical Nursing,2007,16(3):11.
[3] Maraiki F,Farooq F,Ahmed M. Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide[J]. International Journal of Pharmacy Practice,2016,24(4):271-282.
[4]黄燕,刘罡,陈帆,等.运用质量管理工具分析护理不良事件降低护士用药错误发生率[J].护理研究,2014,11(28):3918-3920.
[5]陈素平,吴旭丽,王雪琴,等.细节管理在护士临床给药安全管理中的实施与效果评价[J].医院管理论坛,2010,11(27):25-27.
[6]冯下芝,梁葵,林光惠,等. 26起护理差错原因分析及对策[J].护理研究,2008,22(12):3269.
[7]蒋华,刘义兰,刘涛,等.护士上报给药差错的障碍与对策[J].中华护理杂志,2009,44(4):315-317.
[8]宋艳玲,邹晓清,赖兰萍.护理风险管理中给药差错的原因分析与防范措施[J].中华现代护理杂志,2005,11(11):876-877.
[9]郑红莉,戴志清.不同给药途径的护理[J].华北理工大学学报(医学版),2007,9(2):158.
[10]徐静,周翔.护理风险管理中给药差错的影响因素[J].中国医刊,2016,51(4):31-33.