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Objective To strengthen the management of nursing risks, reduce the incidence of nursing risks, ensure the safety of patients and ensure the quality and safety of nursing. Methods Improve the nursing risk management system and improve the risk awareness of nurses. Strengthen the management of nursing high-risk personnel and correct quality deviation in time; Strengthen the management of nursing details and improve the quality of nursing; Strengthen the nursing of critical patients, and put forward predictive nursing problems and measures. Results The risk awareness and professional level of nurses were improved, and nursing errors were reduced. Conclusion Correctly understanding the existence of nursing risks and implementing effective risk management play an important role in reducing the occurrence of nursing disputes.
Keywords nursing risk management; Risk identification
Nursing risk management is the identification, evaluation, treatment and scientific management of existing or potential risk events and prevention methods in nursing work. Organize and effectively take preventive measures against nursing risks to reduce the occurrence of medical nursing risks. How to strengthen the identification of nursing risk management, reduce the incidence of nursing risk and ensure nursing safety has become an urgent problem in nursing management. The problems existing in nursing risk management in our hospital in the past two years are summarized as follows.
1 method
1.1 Analysis of nursing risk factors
1.1.1 Nurses' sense of responsibility is not strong. Emergency nurses admitted a car accident patient, and when they were admitted at noon, they found no abnormality in vital signs, so they simply dealt with it and reported it to the doctor, and then put it on the cart for further observation. About 2 hours later, the patient complained of lower abdominal pain, and B-ultrasound showed that there was liver rupture and massive bleeding, leading to medical disputes. Analysis: Because nurses can't perform their nursing duties, they don't take patients seriously, mistakenly think that patients are still grasping the car, and ignore the patient's condition. Nurses only pay attention to implementing the doctor's advice, ignoring the active observation of the patient's condition changes, which delays the rescue opportunity of critically ill patients.
1.1.2 The nurse fulfills the informed consent and informs the patients with insufficient cerebral hemorrhage to turn over, and signs the turn-over card and places it in the nurse's office. Analysis: Because nurses are weak in legal awareness and self-protection, they can't communicate and inform the nursing measures of patients well, and ignore the evidence of patients.
1.1.3 The nurses' occupational protection measures were not in place. The ICU nurses were stabbed by sharp instruments, and the patients were HIV positive, so the preventive measures were not in place. Analysis: Because nurses know little about patients' condition, they can't use regular sharp boxes, can't provide protective equipment for high-risk operations, and ignore self-protection awareness or vocational training is not in place on the grounds of high cost [1].
1.1.4 The nursing technique is not standardized. During the process of intravenous indwelling needle infusion of fat emulsion for newborns, the leakage of liquid medicine causes local tissue necrosis. Analysis: Because of the low professional technical level of nursing staff, the standardized training of nurses was not systematically carried out, the patients were not inspected in time, and the treatment methods of liquid medicine leakage were found to be wrong or inexperienced, which violated the nursing technical specifications.
1.1.5 hidden dangers in medication nursing safety. Newly graduated nurses carry out medication orders and technical dispensing processes independently without obtaining registered nurses. Analysis: Because the head nurse's management consciousness is vague, the key monitoring of medication safety is not implemented, nursing defects such as wrong medication, wrong needle and repeated medication sometimes occur, and nursing staff are in short supply, so the assistant nurses who have not obtained the nurse's practice registration are used to carry out the doctor's advice, resulting in adverse drug reactions.
1.1.6 The initiative report of nursing defects is not strict. After hip replacement of orthopedic patients, the nursing routine was not implemented, and the nurse observed the patient's condition change untimely, and rushed to ICU for rescue, resulting in nursing disputes. Analysis: Due to the imperfection of nursing management organization system and management system, the routine nursing after operation is not implemented, the management function of head nurses is not fully brought into play, and the supervision or guidance of the competent department is negligent and becomes a mere formality. The nursing dispute was discussed, and the department still failed to report it to the nursing department.
1.2 nursing link management
1.2.1 Improve nursing risk management system and improve nurses' risk awareness. Such as the system of nursing rounds for critically ill patients, the system of succession, the system of safety management, the system of drug management, the system of disinfection and isolation, the system of training nurses, and the system of rescuing critically ill patients. Such as the process of rescuing patients with myocardial infarction, making the first aid-station-target process, mastering this skill through training, and improving the success rate of rescue.
1.2.2 strengthening the management of nursing high-risk personnel and correcting the quality deviation in time have potential risks for newly graduated nurses, nurses who have changed jobs and nurses who have graduated for five years, and carrying out one-on-one teaching work. Pre-job training content focuses on the management of nursing links, emergency plans and handling procedures [2]. The key nursing links include: patients entering and leaving the hospital, transferring them to the hospital, perioperative nursing, critically ill patients' nursing, blood transfusion nursing, treatment of adverse drug reactions, and guidance before and after special examination. Procedures for handling accidents and emergencies (such as accidental extubation of tracheal intubation, suicide, disaster, etc.). Every day, I will spend 15 minutes in the shift to ask questions from nurses, study business every week, and assess the knowledge target every month. When the nursing goal is reached, nurses can identify the key links, accidents and emergencies in nursing work, and master the handling procedures and principles of accidents and emergencies (asking for instructions, rescue procedures and nursing records). Only by assessing each nurse, establishing nurse's professional files, giving timely feedback on existing problems and guiding nurses to improve nursing technology can the nursing quality be effectively improved.
1.2.3 Strengthen the management of nursing details, improve the quality of nursing, enhance the professional ethics education of nurses, enhance the sense of responsibility of nurses and improve their self-quality. Strengthen the concept of legal system, organize nurses to seriously study the Nurses' Regulations, Medical Accident Handling Rules and health legal knowledge, educate nurses to learn, understand and use the law, improve their awareness of self-protection and improve their recognition of nursing risks. Standardize the workflow, clear? Patient-centered? 、? Care for illness, care for people, care for needs? Objective of humanized and detailed nursing; Standardize nursing document records: standardize the signature on the administration, injection and infusion sheet, strictly check with the double signature of the executor/checker, and carefully fill in the dispensing time, infusion time and infusion drop number. In addition to being informed, every patient in outpatient skin test must also have the double signatures of the nurse and the patient to confirm that the notification system has been fulfilled, so as to reduce the occurrence of nursing disputes. In the management of nursing safety medication, nurses lack risk awareness and crisis awareness, some nurses blindly carry out doctor's orders, lack clinical experience, and have no ability to distinguish between carrying out doctor's orders, such as copying doctor's orders and oral orders, mechanically carrying out doctor's orders and lacking records of legal documents; When rescuing critically ill patients and encountering emergencies, little is known about the storage location, performance, adverse reactions, etc., which is not only chaotic, but also unable to ensure medication at the first time; Nurses rarely observe adverse drug reactions after giving drugs and injections. Strict implementation of medication process, such as oral medication process specification, double bedside signature checking to prevent nursing errors and accidents, is a key monitoring of clinical nursing process management.
1.2.4 Strengthen the nursing care of critical patients, and put forward predictive nursing problems and measures. The head nurse conducts nursing risk assessment on critical patients every day, pays attention to quality management of key links, and reduces the occurrence of nursing risks. Go to work half an hour earlier and later every day, and check the implementation of nursing measures for critically ill patients by the responsible nurses. Make use of the 15-minute shift in the morning every day to evaluate the work, and point out the potential and existing safety hazards in time and put forward preventive measures. For example, when patients with endotracheal intubation undergo oral care technology, there are many sputum in the trachea, and if sputum aspiration is not found in time, the patient will suffocate. The head nurse trains young nurses' clinical critical thinking by means of on-site drills. Continuous improvement of nursing quality is an eternal goal.
2 Results
By correctly understanding the existence of nursing risks, nursing managers were strictly required to start from minor matters (such as oral medication) to detail management, improve the risk management system, standardize the workflow, and provide correct guidance for clinical front-line nurses. Strengthen nursing risk management, so as to reduce the incidence of nursing risk, ensure the safety of patients and improve the quality of nursing.
3 Discussion
3.1 Carry out the continuous nurse scheduling mode [3] to improve the hierarchical management of nurses. The emergency department, ICU, surgical and internal medicine wards carry out APN continuous scheduling. In order to ensure the nursing quality of night shift and increase the number of night shift nurses, night shift is a full night shift system. Nurse scheduling: ① Duty nurse class: divided into class A (8:-15:3), class P (15:-22:3) and class N (22:-8:3). Each class is led by a team leader and three duty nurses are responsible for the treatment and nursing of all patients in the class. ② Day shift: (8: -11: 3, 14: 3-17: 3) Two nurses are responsible for the processing and checking of doctor's orders, charge management, preparation and collection of commonly used drugs and articles, etc. Day shift nurses 2 * * * check the doctor's advice once. The responsible team leader is responsible for the supervision and management of nursing work, and the quality of nursing is changed from terminal control to process control, so that potential safety hazards are eliminated in the bud.
3.2 actively report nursing defects and strengthen nursing quality management. In the process of nursing activities, once nursing errors and defects occur, nurses will be punished and hide them, asking the parties to take the initiative to report and protect the patients: closely observe the condition, notify the doctor immediately, correct the errors in time, and minimize the harm of the errors as much as possible. Event reporting system: report to the higher authorities in time within 24 hours. Nursing accidents and serious mistakes should be reported immediately. Notify the night nurse and the chief duty at night. Units or individuals that make mistakes or accidents intentionally conceal them and fail to report them as required. If they are discovered by leaders or others afterwards, they will be dealt with severely according to the seriousness of the case. Reporting procedure: ward nurse? Ward head nurse? Nursing department? Hospital leaders. Only when problems are found can they be solved.
3.3 nursing safety medication specification [4], to ensure the patient's medication safety. Nurses lack risk awareness and crisis awareness, and have no sense of responsibility. Nurses blindly execute doctor's orders and lack clinical experience, and nurses mechanically execute doctor's orders and lack records of legal documents; Or in the process of rescue and in case of emergency, little is known about the storage location, performance, adverse reactions, etc., which is not only chaotic but also unable to ensure the use of drugs at the first time; Or rarely observe adverse drug reactions after drug delivery and injection. Only by finding out the weak links in the work and finding a better way to solve the problems can we achieve lasting nursing safety and quality management.
Wen Xian
[1] Chen Zhaokun. Analysis and countermeasures of difficulties in occupational protection of nurses in primary hospitals. chinese nursing management, 25,4:44-45.
[2] Tang Yuping. Practice and effect of strengthening nursing risk management. journal of nursing administration, 26,9, 26.
[3] Lan Huilan. Application and effect of hierarchical management method in comprehensive ICU. Chinese Journal of Nursing, 28,12:41-42.
[4] Shen Yunmei. Cause analysis and countermeasures of psychiatric nursing risks. Journal of Nursing, 27,11:39-4.