Nursing work system

Request for instructions and reporting system

Whenever major operations such as resection, transplantation, and amputation of important organs are performed on the sick and injured, important new procedures are carried out for the first time. For business and new technologies, the department must report to the Medical Department (Department) for approval by the hospital leaders, and must obtain the consent of the leaders of the units where the sick and wounded and their families are located (except for special circumstances), and complete the signature procedures.

In accidental disaster first aid, when receiving a large number of patients with trauma, poisoning, or infectious diseases, they should promptly report to the Medical Department (Department) and the leadership of the hospital; when treating sick and wounded patients involving legal issues, they should also report to the Political Department (Department) ); The medical treatment and hospitalization of foreign sick and wounded patients shall be reported in accordance with the regulations of the foreign affairs department of the large unit.

For cadres above the division level who are hospitalized, they should report to the medical department (department) and the leadership of the hospital. For cadres above the military level, the hospital should report to the Ministry of Health of a large unit or the health care leading group office. For cadres above full-time positions in a region, they should report to the military health care leading group. office.

When outpatient departments and wards discover patients with infectious diseases (including sexually transmitted diseases) regulated by the state, they should follow the "Law of the People's Republic of China on the Prevention and Control of Infectious Diseases" and the "Regulations of the People's Liberation Army of China on the Prevention and Control of Infectious Diseases" Strictly manage, make epidemic reports, and notify the health authority of the unit where the patient is located.

When special infections such as infectious diseases, tetanus, and gas gangrene occur in general wards, measures should be taken immediately and reported to the Medical Department (Department) and hospital leaders.

In the event of a medical accident, medical dispute or serious medical or nursing error, it should be reported in a timely manner in accordance with regulations. If valuable medical equipment is damaged or stolen, valuable medicines are lost, or batches of medicines are found to be spoiled, they should be reported to the medical department (department) and hospital leaders in a timely manner.

When a patient is critically ill, the department must fill out a "Critical Disease Notification Form" and send it to the medical department (office) and outpatient department, and the outpatient department will notify the patient's unit or family members. When leading cadres at or above the military level are seriously ill or require emergency treatment, the hospital shall report the case to the Ministry of Health or the Health Care Leading Group Office of each major unit, and also to the Military Health Leading Group Office.

After the death of a sick or wounded patient, the department should fill out a "Death Notice" and send it to the Medical Department (Department), College Affairs Department (Department) and Outpatient Department. If a military cadre dies, it should be sent to the Political Department (Department) at the same time. The outpatient department will notify the patient's unit or family members. The death of a military cadre above the division level should be reported to the hospital leadership in a timely manner; the death of a military cadre above the military level should be promptly reported by the hospital to the Ministry of Health or the health care group office of each major unit and the military health care leading group office. The "Death Report Form for the Sick and Sick" shall be reported to the Medical Department (Office) within 10 days after the death of the sick and wounded, and will be included in the medical record after being signed by the Medical Department (Office) and hospital leaders.

The department reports its work to the hospital leadership once every quarter; the hospital reports its medical work to the superior health authority once every six months.

Duty and shift handover system

Each department has nurses on duty day and night (clinical departments should add reserve on-duty personnel during holidays). Nurses on duty must stick to their posts, perform their duties, ensure uninterrupted nursing work, and fill in the "duty record" carefully.

When the nurse on duty really needs to leave her post, she must report to the head nurse, and the head nurse will designate someone to take over.

The nurse on duty should closely observe the changes in the condition of the undergraduate sick and wounded, complete various treatment and nursing tasks on time; be responsible for receiving newly admitted sick and wounded patients; inspect and guide the work of health workers (nursing staff).

Nurses on duty should do a good job in ward management during duty hours, and report to their superiors promptly when encountering major problems.

The department regularly holds class handovers after work in the morning, chaired by the department director and attended by all on-duty staff. The nurse on duty reports on the flow of sick and wounded patients and the condition changes of newly admitted, critically ill, pre- and post-operative, special examinations, etc. The leader gives a speech, arranges the day's work, and conveys the spirit of the hospital's weekly meeting. Shift handover usually takes no more than 15 minutes.

The person who takes over the shift should conduct bedside handover for special examinations and the condition of critically ill patients, and handover on an individual basis under special circumstances. The narcotic drugs, psychotropic drugs, toxic drugs for medical use and medical devices that are required to be handed over must be handed over face to face.

Strictly implement the shift inspection system, which requires four looks, five inspections and inspections.

Fourth inspection: Check whether the doctor's orders are copied and executed correctly, whether the three check boxes are complete, and whether there are any medical orders left to be executed; the medical room reports the flow of patients throughout the day, including new, critical, surgical, and special changes in patients. Key illnesses, whether the medical treatments and nursing measures given in each shift are recorded correctly, and whether there are any omissions; check whether the temperature book measures body temperature as required, and whether there are any patients with high fever or sudden fever; check whether the nursing records are accurate, the amount of input and output Whether the records are accurate and free of omissions and errors.

Five checks: Check whether the initial treatment of newly admitted patients is complete, and whether patients with special changes in condition have been dealt with in a timely manner; check whether the preparation of surgical patients is complete, and whether all items that need to be brought to the operating room are complete; Check whether critical, severe, or paralyzed patients turn over on time, whether the bed is flat and free of debris, and whether the patient has bedsores; check whether the patient with incontinence is handled properly and whether the skin and clothes are clean and dry; check whether the patient's wound is leaking after major surgery blood, whether the dressing is appropriate, whether exhaust and urination are discharged, whether the drainage tube is unobstructed, and whether all treatments are appropriate, timely and safe.

First inspection: For critically ill, major surgery and patients with special changes in their condition, the handover personnel should conduct simultaneous inspections and bedside handovers. In addition to condition inspections, the successor also needs to know the presence and whereabouts of patients in the ward, and pay attention to the safety of the ward environment.

Disinfection and isolation system

Each clinic, treatment room, dressing room, dispensing room, rescue room, intensive care unit, operating room, preparation room, bacteria room, delivery room, newborn Rooms, neonatal wards, blood banks, blood purification rooms, sterile equipment and accessories rooms, infusion (blood) equipment cleaning and packaging rooms, isolation observation rooms, infectious disease areas, etc. should be cleaned regularly and disinfected at any time when necessary.

Medical staff on duty must wear work clothes and hats and be neatly dressed. Wash your hands before and after diagnosis and treatment, or soak them with disinfectant. During aseptic operations, masks should be worn and aseptic operating procedures should be strictly followed.

Sterile containers, instruments, and dressings should be disinfected and replaced regularly. Medication cups should be used regularly and cleaned and disinfected regularly. Soak the thermometer in disinfectant after each use. Dental drills and mouthwash cups should be thoroughly disinfected after each use. Sputum cups and toilet bowls should be cleaned and disinfected after use.

All opened sterile liquids for intravenous infusion must be marked with the date, time and specific purpose, and must not be used after more than 2 hours; various solvents after unsealing for suction must not be used for more than 24 hours.

The treatment room should clearly distinguish the sterile area, clean area and relatively contaminated area. Disinfection items must be marked with the disinfection date and effect period.

When an infectious disease is suspected, the patient should be quarantined in an observation room. When an infectious disease is detected in the non-communicable disease department, the patient should be consulted and transferred to another department in a timely manner.

Patients with infectious diseases should be isolated and treated separately according to disease type and condition, move within designated areas, and are not allowed to cross wards or go out. When infectious patients go to other departments for diagnosis and treatment, they should be isolated and disinfected; after discharge, transfer to another hospital, transfer to another department, or death, terminal disinfection should be carried out in accordance with the relevant provisions of the "Regulations of the Chinese People's Liberation Army on the Prevention and Control of Infectious Diseases".

Infectious disease department staff should wear isolation gowns, shoes and masks when entering contaminated areas; when exposed to different types of diseases, they should change isolation gowns and wash hands; when leaving contaminated areas, they should take off isolation gowns and shoes, handwashing.

The excrement and used items of infected persons must be disinfected in accordance with the "Regulations of the Chinese People's Liberation Army on the Prevention and Control of Infectious Diseases". Unsterilized items may not be taken out of the infectious disease area or used by others. Gowns used by infected patients should be disinfected and then washed. Hospital sewage must be disinfected before being discharged.

Patients with special infections such as anaerobic bacteria and Pseudomonas aeruginosa should be strictly isolated; used instruments, clothing, and rooms used should be thoroughly disinfected; used dressings and cotton balls They should be collected separately and burned.

After the patient is discharged from hospital, the bed sheets, quilt covers and pillowcases should be changed, and the bedside stools, bed frames, and bedside tables should be scrubbed and disinfected with 0.1 peracetic acid. After a patient dies or an infectious patient is discharged, bedding and pillows in the ward must be disinfected with ultraviolet light, exposed to the sun, or airtightly disinfected.

Check-up system

Clinical Department

When issuing medical orders, writing prescriptions, or conducting diagnosis and treatment, the name, gender, age, and bed of the patient should be checked. No., medical record number.

To implement medical orders, there should be "three checks and seven pairs": check after dispensing the medicine: check before taking the medicine, injection, and treatment: check after taking the medicine, injection, and treatment. Check the bed number, name, drug name, dosage, concentration, time, and usage.

When counting drugs and before using them, the quality, label, expiration date and batch number should be checked. If they are not suitable for use, they must not be used.

Before administration, you should inquire about any history of drug allergy. When using narcotic drugs, psychotropic drugs, and toxic drugs for medical use, they should be checked repeatedly. For intravenous administration, check for deterioration. When using multiple drugs, attention should be paid to incompatibility.

Attention should be paid to intravenous infusion: ① Whether the infusion bottle, hose, and Murfree's dropper are clean and whether there are foreign objects; whether the disposable medical infusion set has expired, and whether the packaging bag is damaged or leaking; ② Check the name and expiry date of the liquid; ③ Whether the glass bottle is cracked and whether the bottle cap is loose; ④ Whether the liquid is discolored, turbid, or precipitated.

Before blood transfusion, it must be checked by two people before transfusion; blood transfusion should be closely observed to ensure safety; after blood transfusion is completed, the remaining blood in the bottle should be kept for 24 hours before being handled by the department.

Operating room

When receiving the injured, the department, bed number, name, gender, diagnosis, name of the operation, and preoperative medication should be checked.

Before surgery, check the name, gender, diagnosis, and surgical site.

When performing body cavity or deep tissue surgery, the number of gauze, gauze pads, gauze (cotton) balls, instruments, suture needles and spools should be counted before the operation and before suturing; after the operation, the number should be checked again.

Specimens collected during surgery should be registered in time, and the department, name, location and specimen name should be checked.

Medication and blood transfusion should be checked according to the requirements of the clinical inspection system. Narcotic drugs, psychotropic drugs, and medical toxic drugs must be checked by two people before they can be used.

Attachment: Blood transfusion checking system

Strengthen the education and management of blood transfusion standards, and strictly supervise the implementation of the "three checks and seven pairs" system.

When blood is collected in the blood transfusion department, the department, medical record number, bed number, name, blood type, cross-matching test results, blood bottle number, blood collection date, and Blood quality, blood volume, blood type, and signatures of both parties can be taken away.

After bleeding occurs, the blood sample of the recipient should be retained for 24 hours for future reference.

The nurse or doctor should go to the blood bank to draw blood with the blood collection slip, and check and sign it with the person who has the blood. Avoid vibration during the blood collection process to prevent the rupture of red blood cells.

Before blood transfusion, two medical staff will check the cross-matching report form, blood type test form and blood bag label. Check whether the blood bag is damaged or leaking, whether the blood color is normal, and whether the plasma is turbid. , if you have any questions, you should contact the blood bank immediately.

During blood transfusion, two or more executors must go to the patient's bedside with the patient to check the patient's name, gender, age, medical record number, bed number, blood type, etc., and confirm that they are consistent with the blood matching report. After double-checking the blood, use a standard blood transfusion set and perform blood transfusion under strict aseptic operation.

Use intravenous injection of normal saline to flush the blood transfusion channel before and after blood transfusion. When continuously transfusing blood from different blood donors, intravenous injection of normal saline should be used to flush the blood transfusion set.

Blood transfusion must be carried out within 30 minutes after receiving the blood, and should be completed within 3 to 4 hours (200 to 300ml).

After blood transfusion, a blood transfusion card or blood transfusion registration form should be filled in, and the blood bag should be kept for 2 to 4 hours in case of delayed blood transfusion reaction as a test specimen.

Nurse Station Management System

The nurse station is the nurse’s office. The room must be kept quiet and smoking is prohibited.

The items at the nurse station should be placed neatly, positioned and orderly, and the desktop and floor should be kept clean.

Staff must be neatly dressed and dignified during working hours.

Staff are not allowed to chat at the nurse station, and non-staff are not allowed to enter the nurse station.

Workers must speak Mandarin during all working hours and use civilized language. No personal phone calls are allowed without special circumstances.

When you hear the patient call signal, you should be on call.

Fill in and replace patient hospitalization cards in a timely manner to maintain the accuracy of the number of residents, patient information, and level of care.

Ward management system

The ward is managed by the head nurse, with active assistance from ward staff and the sick and wounded.

Keep the ward quiet, walk softly, speak softly, open and close doors lightly, and operate lightly.

Furnitures and other items in the ward unit should be positioned and arranged in a neat and orderly manner, and cannot be moved at will without the consent of the head nurse. Hospitalized patients should wear hospital uniforms and wash them 1 to 2 times a week; quilt covers, sheets, and pillowcases in hospital bed units should be changed and washed once every 1 to 2 weeks to keep them clean and hygienic.

Insist on regular cleaning every day, keep the ward clean and hygienic, and pay attention to ventilation. Smoking is prohibited in the ward.

Medical staff on duty must wear work clothes and hats and be neatly dressed. Masks must be worn when performing aseptic procedures.

Strengthen the management of camping equipment and sanitary clothing, establish accounts, keep them by designated personnel, and conduct regular inventory. When management personnel change, handover procedures should be completed.

After the sick and injured are discharged from the hospital, promptly wipe the bed unit with disinfectant, change bedding, and disinfect drinking cups, washbasins, and sputum tanks.

Establish an organization for the sick and wounded to assist in the ideological and life management of the sick and wounded, regularly organize the sick and wounded to learn political, current affairs and health science knowledge, and urge the sick and wounded to consciously abide by the "hospitalization rules" , no one is allowed to enter the medical office without the permission of the medical staff.

Medical staff are not allowed to chat, joke, play cards, etc. in the medical office during work hours. They are not allowed to make personal phone calls, do private work, or read non-medical books, newspapers, and magazines unless there are special circumstances. Personal items are not allowed to be placed in the refrigerator in the ward.

Do a good job in the management of escorts and strictly control the number of escorts.

Graded nursing system

After the sick and injured are admitted to the hospital, the doctor will decide the level of care and issue medical orders based on the patient's condition. The level of care is divided into special care and first, second and third level care, and each has a unified mark, which is displayed on the list of sick and wounded patients and on the bedside card. During the hospitalization of the sick and injured, the level of care should be changed in a timely manner according to changes in condition.

Special care: patients who are in critical condition or who may have an accident at any time after major surgery. Send a dedicated person to guard you day and night, formulate a care plan, closely observe changes in the condition, prevent complications, prepare various monitoring instruments, first aid equipment, and medicines, be ready for first aid at any time, fill in the "Special Care Record" promptly and accurately, and make it within the prescribed time Summary and conclusion. Special care symbol with red triangle.

Level 1 care: patients who require strict bed rest or have impaired consciousness after severe illness or major surgery. Provide careful care in daily life, formulate a nursing plan and keep nursing records when necessary; closely observe changes in the condition, and conduct inspections every 15 to 30 minutes; carefully provide morning and evening care; regularly change body positions, bathe, and wash hair according to the condition. Prevent complications. The first-level care sign is a red vertical bar.

Secondary care: The sick and injured who are in serious condition or recovering from serious illness, and are old and frail and cannot fully take care of themselves. Do appropriate indoor activities and provide necessary assistance in daily life; pay attention to observe changes in the condition and conduct inspections every 1 to 2 hours. Secondary care sign is a blue vertical bar.

Tertiary care: patients with mild illness or those in recovery stage. Take care of yourself under the guidance of medical staff, pay attention to the condition of the patient, and conduct inspections every 3 to 4 hours; participate in some indoor and outdoor activities according to the condition. Provide hygiene and health guidance before discharge.

Rescue system for critically ill and injured patients

The rescue of critically ill and injured patients must have a clear division of labor, close cooperation, active treatment, close observation, and detailed records. After the rescue, the experience should be carefully summarized.

The rescue of critically ill patients in the department shall be carried out by the department director, chief (deputy) chief physician or the attending medical organization, and reported to the Medical Department (Department).

Each clinical department should have an emergency room and a monitoring room, where drugs and equipment should be positioned and kept, kept by dedicated personnel, inspected regularly, and kept in good condition.

The emergency room or monitoring room should have rescue plans for common critical illnesses, and medical staff should be proficient in the use of commonly used rescue techniques and instruments.

Nursing ward rounds

The nursing department conducts ward rounds, and carries out key nursing administrative rounds (routine evaluative rounds) or quality rounds (clinical business rounds) every month ), arrange one teaching round every quarter.

The chief nurse conducts routine evaluative rounds or clinical business rounds in a focused manner every week, and arranges a teaching round every month.

The head nurse of the ward conducts key clinical ward rounds every day, and arranges a teaching-guidance ward round or a routine evaluation ward round once a week.

The professional team leader conducts routine evaluative ward rounds or clinical business rounds in a focused manner every day.

Personnel at all levels should strengthen inspections of newly admitted, critical, and major surgery patients before and after special examinations and treatments, to promptly understand changes in condition, observe nursing effects, and promptly report and handle any situations. .

For teaching rounds, if necessary, please ask the department director, chief (deputy) chief physician or attending doctor for guidance, check the quality of care, and study and solve difficult nursing problems.

The ward rounds generally take no more than 30 minutes.

Nursing rounds at all levels must correctly use the steps of nursing procedures and should be registered and recorded. Department rounds and nursing department rounds should be summarized and recorded in the nursing process or in the ward round record book.

Medical Execution System

Doctor's orders should be issued for all types of medicines and various inspection and operation items used on the sick and wounded, and recorded in the "Doctor's Order Record Sheet". The transcribing and organizing of medical orders must be accurate and must not be altered.

After the doctor issues the medical order, the nurse copies it on the "Doctor's Order Record Sheet" and various execution sheets (cards). Questionable medical orders should be checked before execution. Oral medical orders should not be followed except for first aid. When issuing an oral will, the nurse should recite it once and it can only be executed after being checked by the doctor. The doctor should make up the medical order in a timely manner afterwards.

After the doctor issues a medical order on the computer, the nurse should carefully check the order name, usage method, execution time, pricing attributes, execution department, etc., especially for medication orders, the bed number, name, The drug name, dose, concentration, time, usage and specifications of the drug, the frequency of execution of treatment or disposal medical orders should be checked, and the nursing orders should be checked to see if they are consistent with the bed, level of care and system settings, and can be saved, proofread and signed only after they are verified to be correct. .

Temporary medical orders must be executed within the specified time of 15 minutes. It is required to handle it first, then sign and sign the time. After executing the doctor's orders, determine the medication time according to the treatment needs, and edit and print out various treatment orders and care orders for each patient.

Accumulated charges will be made based on the doctor’s orders and charging standards for each treatment. Check the medical expenses of inpatients at any time, make supplementary charges in a timely manner, and classify them by billing department, project, and date.

After the doctor’s order is executed, in addition to checking it personally, the nurse in each shift must check and sign the medical order executed in the previous shift; the night shift nurse must review the day’s doctor’s order, medication order, infusion order, injection order and minor treatment order. Carry out general review; the head nurse should review and sign all medical orders once a week.

Nurses should check the medical orders during each shift, and after taking over the shift, they should check whether the medical orders from the previous shift have been processed completely. During the shift, they should enter the workbench at any time to check whether there are any new medical orders.

After surgery, delivery, transfer, discharge, or death, previous medical advice should be discontinued. For patients who have been hospitalized for a long time, if there are too many pages in the medical order record, the medical order should be reorganized.

Any temporary medical orders that need to be executed by the next nurse should be clearly stated and recorded.

Treatment room working rules

Treatment nurses must wear work clothes, work caps and masks. Wash your hands and wear a mask before operation, and strictly follow the aseptic operating procedures, so that one person has one needle and one tube.

When performing various treatment operations, operating procedures and checking systems must be strictly implemented. Allergy history should be asked before injecting penicillin, animal serum, iodine and other drugs. Do allergy testing as prescribed.

Devices and drugs should be classified and positioned, with obvious labels and clear writing. Narcotic drugs, toxic drugs for medical use and valuable drugs should be kept under lock and key by dedicated personnel, and should be carefully counted and registered during shift handover.

The room should be divided into clean areas and contaminated areas. Sterile items and non-sterile items should be placed in fixed locations respectively. After treatment, clean the used items and place them in the designated place. Disinfect instruments and dressings used by infected patients in a timely manner. After use, disposable treatment supplies must be destroyed and disinfected as required.

Sterilized forceps (tweezers) and their soaking solution and containers, dressing jars, iodine and alcohol bottles, etc. should be disinfected by high pressure every week. The surface of the sterile forceps soaked in disinfectant solution should be kept 2 to 3cm above the sterile shaft joint. Used syringes and infusion equipment should be replaced regularly. After being soaked in disinfectant solution, they should be replaced with the disinfection supply room.

Regularly check the expiration date of various treatment packages and sterile items, and re-disinfect and sterilize after the expiration date.

Keep the room tidy. Wet cleaning and ventilation are performed every day. Object surfaces and air are irradiated with electronic sterilization lamps or ultraviolet rays for 30 minutes every day and signatures are registered. Thorough disinfection is performed once a week. Airborne bacterial culture is performed monthly and the report sheet is retained for future reference.

Items in the treatment room are generally not loaned out. In special circumstances, with the consent of the head nurse, the borrowing procedures will be completed and they will be requested back in time.

ICU working system

All critically ill patients who need to be admitted to the ICU are determined by the attending physician or above, and are strictly implemented by the treating physician, attending physician, chief (deputy) chief physician , the department director conducts graded examinations and formulates monitoring and rescue plans. Nurses work in three shifts and provide continuous custodial care 24 hours a day. No escorts or visits are allowed.

Medical staff engaged in monitoring work must undergo relevant professional knowledge training before taking up their posts, and be proficient in first aid techniques, as well as the performance and use of indoor first aid equipment.

Medical staff on duty should stick to their posts, closely observe the condition, accurately monitor vital signs, record them in a timely manner, and deal with any changes in condition in a timely manner.

Keep the room quiet and tidy. Personnel entering a room must dress according to regulations. Strictly implement aseptic technique procedures. Sterile containers, instruments, and dressings are disinfected regularly, and the disinfectant is replaced regularly. Carry out indoor air disinfection and air bacterial culture regularly, and keep the report form for future reference.

Specialized personnel should be assigned to manage valuable medical instruments and equipment, files should be established, and regular inspections and maintenance should be carried out. Various instruments and medicines should be identified, positioned, and kept in quantitative quantities, replenished promptly after use, and kept in good condition.

Principles of Disinfection and Sterilization

Medical supplies that enter human tissues or sterile organs must be sterilized.

Utensils and supplies that come into contact with skin and mucous membranes must be disinfected.

Used medical equipment and items should be thoroughly cleaned and then disinfected or sterilized; medical equipment and items used by patients with infectious diseases should be disinfected first, thoroughly cleaned, and then disinfected or sterilized.

All medical equipment should be disinfected or sterilized before maintenance.

Choose disinfection or sterilization method according to the performance of the item. For example:

Physical sterilization is the preferred method for sterilizing high-heat-resistant items. For example, pressure steam sterilization is preferred for surgical instruments, various puncture needles, syringes, etc. Dry heat sterilization is preferred for oils, powders, ointments, etc.

Chemical disinfection method can be used for heat-intolerant items. For example, various catheters, precision instruments, endoscopes, artificial implants, etc. should be sterilized by ethylene oxide or soaked in glutaraldehyde.

The principles of chemical disinfection and sterilization are:

Reasonably select high-efficiency, medium-efficiency, and low-efficiency disinfectants and sterilants according to different situations;

Use Chemical disinfectants must master the performance, functions, usage methods, and factors that affect the disinfection effect. For example, formaldehyde cannot be used for air disinfection. Formaldehyde fumigation boxes can be used for surface disinfection of items that are intolerant to heat and moisture, but cannot be used for sterilization; heating or adding catalysts should be used for disinfection, and natural volatilization fumigation cannot be used.

The effective concentration of chemical disinfectants must be detected and regularly monitored;

Containers used for soaking disinfection and sterilization items must be disinfected and sterilized when replacing disinfectants and sterilants. Bacterial treatment.