1. First-diagnosis responsibility system
In order to effectively fulfill the hospital's responsibility to save lives and heal the wounded, standardize the medical behavior of medical staff in rescuing critically ill patients, and prevent the occurrence of unsafe medical liability incidents, this system is specially formulated This system:
(1) Patients whose vital signs are seriously ill due to various reasons or diseases, threatening the patient's life, or accidents and complications that may threaten the patient's life safety during treatment are considered for critically ill patients.
(2) The first-diagnosis responsibility for critically ill patients shall be implemented. The first-diagnosis physician and medical department must be responsible for the patient's first aid and maintenance of vital signs until a specialized medical department and physician are assigned for diagnosis and treatment.
(3) When rescuing critically ill patients, they must obey the instructions of the person in charge of the emergency team or the physician in charge, and quickly transfer the patient to the emergency room and ICU for treatment. In particularly urgent cases, emergency transfers should be rescued on the spot, and ambulances and ambulances must be summoned. The hospital emergency team rushed to rescue him.
(4) If an accident or serious complication occurs in the hospital and the patient is in critical condition or the rescue of a critical patient requires special administrative support, in addition to handling according to Article 3, it must be reported immediately to the medical office and to the director. .
(5) The transfer of critically ill patients must be accompanied by medical staff in charge or medical staff in charge of diagnosis and treatment operations. The medical level of the escort will be determined by the doctor in charge according to the condition. If a nurse is required to accompany the patient, oral or written medical advice is required. . If there is no medical advice, the supervisor (treatment) will be deemed to be personally accompanied. The nurse station must do a good job of coordination.
(6) Each medical department must set up a rescue team to be personally chaired by the head of the department. Each ward must establish a regular inspection system for first aid equipment and drugs. The pharmacy department must ensure that sufficient emergency drugs are available at all times. The auxiliary departments must ensure that the first aid inspection equipment is intact and that emergency response systems are established at any time.
(7) The emergency department and ICU are important departments in the hospital that deal with critically ill patients. They must ensure the emergency use of emergency beds and equipment and the emergency deployment of personnel. The department must establish a corresponding regular inspection and medical system.
(8) During the emergency treatment of critically ill patients, all medical staff should put the priority on saving the patient's life. After receiving the emergency pager 6120, they should drop all work and rush to the emergency site. In order to save lives, the person in charge of the rescue has the authority to sign the "Extreme Emergency First Aid" opinion and pay for the treatment first, but this authority is limited to the first time. Immediately after use, the medical administration and the general on-duty report should be reported. Any subsequent unpaid diagnosis and treatment must be subject to medical administrative approval.
(9) If violation of the above regulations is regarded as a liability incident, the hospital will impose severe penalties, and the parties involved will bear legal responsibility for the consequences.
2. Three-level ward rounds system
(1) The ward rounds of the department director, chief physician or attending physician should be attended by resident doctors, head nurses and relevant personnel. The department director and chief physician conduct ward rounds at least once or twice a week, and the attending physician conducts ward rounds 2-3 times a week. Ward rounds are generally conducted in the morning. Resident doctors should conduct ward rounds on the patients under their care at least twice a day.
(2) For critically ill patients, the resident physician should observe changes in the condition at any time and deal with them in a timely manner. If necessary, the attending physician, department director, and chief physician can be asked to temporarily check the patient.
(3) Before the ward rounds, medical staff must make preparations, such as medical records, X-ray films, various relevant examination reports and required examination equipment. During ward rounds, strict requirements should be followed step by step from top to bottom, and the residents should be serious and responsible. The treating residents should report a brief medical history, current condition, and put forward problems that need to be solved. The director or attending physician can conduct necessary examinations and analysis based on the condition, and make positive instructions.
(4) The head nurse organizes the nursing staff to conduct nursing rounds once a week, mainly to check the quality of nursing care, study and solve difficult problems, and combine it with practical teaching.
(5) Ward rounds:
1. The department director and chief physician conduct ward rounds to solve difficult and critical cases and review the diagnosis and treatment of newly admitted and difficult and critical patients. Plan and decide on major surgeries and special examinations and treatments; randomly check medical orders, medical records, and nursing quality; listen to the opinions of doctors and nurses on diagnosis, treatment, and care; and carry out necessary teaching work. The deputy chief physician should mention four aspects including the diagnostic basis of the disease, differential diagnosis, treatment plan and issues that should be paid attention to during the treatment process when making the first ward rounds for newly admitted general patients. Clinical symptoms should be mentioned for difficult cases. , the significance of physical signs and laboratory test results in differential diagnosis and the ways, measures and methods to clarify diagnosis: For patients who have been issued a "critical illness" notification, ward rounds should be conducted every day for three consecutive days starting from that day, and ward rounds need to be mentioned The current main contradictions and the ways, measures and methods to solve them.
2. Ward rounds by the attending physician: Systematic ward rounds are required to group the patients under their care, especially for newly admitted, critically ill, undiagnosed, and poorly treated patients. Nurses’ feedback, listening to patients’ statements, checking medical records and correcting errors; understanding changes in patients’ conditions and soliciting their opinions on diet and life; checking the implementation of doctor’s orders and treatment effects, and deciding on discharge and transfer issues.
3. During ward rounds, residents should focus on critically ill, difficult, undiagnosed, newly admitted, and post-operative patients; check laboratory reports, analyze test results, and propose suggestions for further examination or treatment. Check the implementation of the doctor's orders on the day; give necessary temporary medical orders and write orders for special examinations the next morning; check the patient's diet; proactively solicit the patient's opinions on medical treatment, nursing life, etc.
(6) Hospital leaders and heads of functional departments should plan and purposefully participate in ward rounds of each department regularly, check the treatment status of patients and existing problems in various aspects, and study and solve them in a timely manner.
3. Consultation system
(1) Whenever you encounter difficult cases that require consultation, you should apply for consultation in a timely manner.
(2) Inter-department consultation: proposed by the treating physician, approved by the superior physician, and filled in a consultation form. The physician in charge will accompany the consulting physician to examine the patient and give a brief introduction to the medical history. The invited doctor generally has to complete the consultation within 24 hours and write a consultation record. For mildly ill patients who require specialist consultation, the patient can be sent to a specialist for examination.
(3) Emergency consultation: The invited personnel must be on call and must arrive at the consultation location in time after receiving the consultation notice.
(4) Intra-department consultation: proposed by the treating physician or attending physician, and the department director convenes relevant medical personnel to participate.
(5) In-hospital consultation: proposed by the department director, approved by the medical office, the consultation time will be determined, and relevant personnel will be notified to participate. Generally, it is hosted by the director of the application department, and someone from the medical office participates.
(6) Out-of-hospital consultation: Difficult cases that cannot be diagnosed and treated in our hospital for the time being shall be proposed by the department director, approved by the medical office, and contacted with the relevant units to determine the consultation time. The consultation will be hosted by the applying department director. When necessary, carry medical records and accompany patients to consultations outside the hospital; medical records can also be sent to relevant units for remote consultation.
(7) Group consultation within the department, within the hospital, and outside the hospital: The treating physician must prepare for the consultation and record the consultation in detail, and introduce the medical history in detail. Doctors participating in the consultation must examine the patient in detail, promote technical democracy, and clearly put forward consultation opinions. The host should summarize and the consultation opinions should be carefully organized and implemented.
4. Graded nursing system
(1) Purpose
Graded nursing refers to determining special care or first, second and third level care according to the patient’s condition. Carry out condition observation, treatment and care, and provide basic care based on activities of daily living (ADL) assessment.
(2) Scope of application
1. Special care
(1) Organ failure (heart, brain, kidney, liver, respiratory failure).
(2) Various complex or new major surgeries.
(3) Various severe traumas, burns, and damage to multiple organ functions.
2. First-level care
Those whose condition is serious or unstable require close monitoring and observation.
3. Secondary care
Those whose condition is basically stable.
4. Tertiary care
Those whose condition is stable.
(3) Main nursing requirements
1. Special nursing requirements
(1) Special care or transfer to ICU.
(2) Monitor vital signs and provide patient care according to the condition.
(3) Closely observe changes in the condition and record the patient's important physiological and psychological reactions at any time.
(4) Accurately implement medical instructions and complete treatment in a timely manner.
(5) Provide basic and specialist care to prevent nursing complications.
2. First-level nursing requirements
(1) Closely observe changes in the condition, and record vital signs and patient volume according to doctor's orders and condition monitoring.
(2) Observe the patient’s physiological and psychological reactions, understand their psychological needs, and provide overall physical and mental care.
(3) Accurately implement medical instructions and complete treatment in a timely manner.
(4) Provide specialized care related to the disease to prevent nursing complications.
(5) Provide health education and assist or guide functional exercises.
3. Secondary nursing requirements
(1) Observe the patient’s condition changes and physiological and psychological reactions, and provide physical and mental care.
(2) Accurately implement medical instructions and complete treatment in a timely manner.
(3) Provide health education, assist or guide functional exercises, and prevent nursing complications.
4. Third-level nursing requirements
(l) Accurately implement medical instructions and complete treatment in a timely manner.
(2) Understand the patient’s condition and provide health education.
(4) Assessment and nursing requirements of activities of daily living (ADL)
Nurses should assess patients' ADL and provide corresponding care.
1. Level
(1) Level 1: Completely independent, all activities can be completed safely within normal time. You can live on your own without help.
(2) Level 2: Partially independent. In completing various activities of daily living, the use of assistive devices is required and exceeds the normal time to complete the activities. The movements are not safe enough. If necessary items are provided, life can be taken care of on one's own.
(3) Level 3: Partial dependence, unable to complete daily activities independently despite best efforts. Need guidance, supervision or persuasion to assist with life care and functional exercises.
(4) Level 4: Completely dependent and completely in need of help. Need to assist with passive activities and guide some active activities.
2. Nursing quality standards
(1) The bed is smooth, clean, comfortable, free of debris, urine stains, and blood stains.
(2) The lying position is comfortable and meets the condition and treatment requirements.
(3) Keep your mouth clean and properly handle oral mucosal ulcers and bleeding.
(4) The skin is clean, intact and without damage, the perineum and anus are clean and odor-free, and the fingers, toenails, beard and hair are clean.
(5) Satisfy eating needs.
(6) Meet the needs of drinking water and excretion.
(7) Assist and guide appropriate functional exercises according to limb function.
5. Duty and shift handover system
(1) Physician duty handover and critically ill patient handover system
1. Each department shall be on duty during non-office hours and A doctor must be on duty during holidays. In principle, the resident physician should be on duty as the first line, the attending physician should be on the second line, and the deputy chief physician can participate in the third line of duty.
2. The doctor on duty should arrive at work half an hour in advance to accept the handover from doctors at all levels. During the handover, he should inspect the ward. Critically ill patients should be handed over in front of the bed.
3. Before leaving get off work, doctors should record the status and handling of new patients and critically ill patients in the shift book. The doctor on duty should also record the changes in the condition during the shift and the handling of the situation in the disease course record, and at the same time summarize the key points. Recorded in shift book.
4. Patients who are admitted to the hospital in an emergency during the duty period should, in principle, complete the medical records in a timely manner. If emergency treatment or emergency surgery is too late to write the medical records, the first course of the disease should be recorded, and then the medical records should be written according to the time.
5. The doctor on duty must perform his duties diligently and be responsible for various temporary medical work and temporary treatment of patients. When encountering difficult problems, he should ask the superior doctor to deal with them.
6. Doctors on duty must stick to their posts and are not allowed to leave their posts without authorization. They are not allowed to find anyone to replace them. If there are special circumstances, they can only be replaced after approval by the chief resident physician or department director and the work has been explained.
7. If the doctor on duty needs to leave temporarily for something, he must explain his whereabouts to the nurse on duty and go to the clinic immediately when called by the nurse.
8. Doctors on duty generally do not leave their daily work. If they do not get rest due to rescuing patients or other special reasons, they will be given appropriate compensatory rest as appropriate.
9. Every morning, the doctor on duty will report the patient's condition and treatment to the attending physician or chief physician, and explain the condition of the critically ill patient and the work yet to be handled to the treating physician.
10. The doctor on duty will conduct ward rounds with the nurse on duty at 9:30 every night, including a comprehensive inspection of companions, ward hygiene and safety.
(2) Relevant department duty handover system
1. Personnel on duty in the pharmacy, laboratory, radiology, electrocardiogram and other departments should arrive at their posts 15 minutes in advance and stick to their posts. AWOL.
2. Complete the shift handover of all equipment and instruments used and record them in the duty book.
3. Perform due diligence, complete all work within the class, and ensure the smooth progress of clinical medical work.
4. If you need to leave the department temporarily under special circumstances, you should explain your whereabouts to the hospital manager on duty so that you can search for them and avoid affecting your work.
6. Discussion system for difficult cases
(1) If the diagnosis cannot be confirmed within five days after admission, a discussion within the department must be held; if the diagnosis cannot be confirmed within eight days after admission, the whole hospital must be organized discuss.
(2) Discussion of cases with unsatisfactory curative effect: If the main condition cannot be controlled, the discussion within the department will be completed within five days; if the condition is still uncontrollable, the discussion with the whole hospital will be completed within eight days.
(3) Outpatient case discussion: For those who still cannot be diagnosed clearly after three visits to our hospital, relevant departments should be organized for discussion.
(4) Medical technical case discussion: For any difficult cases, or if the results are found to be obviously abnormal, and there are doubts in the report, a discussion must be organized, retested if necessary, and reviewed and signed by the deputy chief medical (technical) technician.
(5) Discussion of critical cases: Critically ill patients must complete the discussion within the department within 24 hours; if the condition cannot be controlled, the medical office shall organize a hospital-wide consultation, which shall be completed within 24 hours. Discussion at the hospital level.
7. Rescue system for critically ill patients
(1) The department director and chief (deputy) chief physician are generally responsible for organizing and presiding over the rescue work for critically ill patients. When the department director or chief (deputy) chief physician is absent, the doctor with the highest professional title will be in charge of the rescue work, but the department director or chief (deputy) chief physician must be notified in a timely manner. Special patients or patients who require cross-department collaborative rescue should promptly report to the Medical Office, Nursing Department and Vice President of Business, so that relevant departments can be organized to carry out rescue work together.
(2) For critically ill patients, no excuse should be used to postpone the rescue. We must go all out, race against time, and be serious, conscientious, meticulous, and accurate, and keep all records in a timely and comprehensive manner. If legal disputes are involved, they must be reported to the relevant departments.
(3) Medical staff participating in the rescue of critically ill patients must have a clear division of labor, work closely together, perform their respective duties, and must unconditionally obey the medical orders of the presiding rescue worker. However, any suggestions that are beneficial to rescuing patients may be submitted to the presiding officer. After the rescue personnel are identified, they will be used to rescue the patient.
(4) Nursing staff participating in rescue work should, under the leadership of the head nurse, implement the medical orders of the rescue worker, closely observe changes in the condition, and report the implementation of medical orders and changes in the condition to the rescue worker at any time. When executing the oral doctor's instructions, you should repeat them once and check the medicines with the doctor before executing them to prevent errors and accidents.
(5) Strictly implement the handover system and check-up system. There should be a dedicated person responsible day and night. The rescue process and various medications must be explained in detail. The empty ampoules of the drugs used can be discarded after two people have verified them. go. Various rescue items and instruments should be promptly cleaned, disinfected, replenished and returned to their original places for reuse after use. The rescue room must be terminally disinfected.
(6) Arrange authoritative professionals to explain the patient's condition and prognosis to the patient's family or unit in a timely manner, and complete various signature procedures in a timely manner in order to obtain the cooperation of the family member or unit.
(7) For critically ill patients who require interdisciplinary rescue, in principle, the medical office or the vice president of operations will lead the rescue work and designate the rescue worker. Physicians from various disciplines who participate in interdisciplinary rescue of patients should use their undergraduate expertise to devote themselves to patient rescue work.
(8) Medical staff who do not participate in rescue work are not allowed to enter the rescue scene, but must do a good job in the logistics of rescue.
(9) During the rescue work, the pharmacy, laboratory, radiology or other special examination departments should meet the needs of clinical rescue work and shall not refuse or delay it under any excuse. The logistics support department should ensure that water and electricity are available. , gas and other supplies.
8. Preoperative discussion system
(1) For major, difficult (4. special surgeries) and newly launched surgeries, scientific research project surgeries, larger destructive surgeries , patients over 75 years old must have preoperative discussions before surgery.
(2) Preoperative discussions must be recorded in detail, surgical indications must be clarified, surgical plans, preventive measures for complications, postoperative observations, nursing requirements, etc. must be formulated.
(3) The preoperative medical records must be signed and confirmed by the director of the department after discussion.
9. Death case discussion system
(1) All death cases are generally discussed within one week after death, and special cases should be discussed in a timely manner. Autopsy cases will be discussed after the pathological autopsy results are available, but no later than two weeks.
(2) The discussion of death medical records should be recorded in detail, including admission process, treatment process, reasons for disease deterioration, cause of death, time of death, etc. If the cause of death is unknown, please indicate it.
(3) If the death medical record is an infectious disease medical record, it must be reported to the hospital's prevention and protection department and medical office within the legal time limit. Category 1 infectious diseases must also be reported to the hospital leadership.
10. Medical check-up system
The check-up system is an important measure to ensure patient safety and prevent errors and accidents. Hospital workers must have a serious attitude at work, be focused in thinking, and be proficient in work. They must strictly implement the three checks and seven pairs system, regardless of whether they are directly or indirectly used for various treatments and inspection items (such as medicines, dressings, instruments, compresses, etc.) for patients. Gases, and treatment, first aid and monitoring equipment, etc.), must have a formal product name, clear markings, official national approval number, factory mark, date, shelf life, and the appearance of the items must meet safety requirements. Any use that is unclear, incomplete, unclearly marked, or questionable should be prohibited. If the patient experiences discomfort or other reactions during use, he or she must stop using the product immediately and conduct a check again, including all items used, until the cause is found.
(1) Operation patient checking system
1. When receiving a patient in the operating room, the department, bed number, hospitalization number, name, gender, age, diagnosis, The name and location of the operation (left and right) and its symbol.
2. The operating staff should check the department, bed number, hospital number, name, gender, age, diagnosis, surgical site, anesthesia method and medication again before the operation.
3. Relevant personnel should check the sterilization indicators in the sterile package, whether the surgical instruments are complete, and whether the categories, specifications, and quality of various supplies meet the requirements.
4. For any body cavity or deep tissue surgery, before suturing, the instrument nurse and the visiting nurse must strictly check whether the number of large gauze pads, gauze, thread rolls, and instruments are consistent with the preoperative number. After verification, Only then can the surgeon be notified to close the surgical incision to prevent foreign objects from being left in the body cavity.
(2) Checking system of relevant departments
1. Checking system of laboratory department
(1) When collecting specimens, check the department and bed number , hospitalization number, name, gender, age, purpose of examination.
(2) When collecting specimens, check the department, bed number, hospital number, name, gender, serial number, specimen quantity and quality.
(3) During inspection, check whether the inspection items, laboratory test sheets and specimens are consistent.
(4) After inspection, review the results.
(5) Issue reports and check departments and wards.
2. Blood bank checking system
(1) Blood type identification and cross-matching test, when two people are working, they must "double check and double sign", and when one person is working, they must do it again. .
(2) When bleeding occurs, check the department, ward, bed number, hospitalization number, name, blood type, cross test results, blood bag number, and date of blood collection with the person who took the blood , blood quality.
(3) After bleeding occurs, the blood sample of the recipient will be retained for 24 hours for necessary verification.
3. Pathology Department Checking System
(1) When collecting specimens, check the unit, hospital number, name, gender, age, serial number, specimen, and fixative.
(2) When making films, check the serial number, specimen type, clinical diagnosis, and pathological diagnosis.
(3) When issuing a report, review the examination items, results, patient name, gender, age, hospitalization number, and department.
4. Radiology department checking system
(1) During the inspection, check the department, ward, name, film number, location and purpose.
(2) When sending the report, check the diagnosis of the examination items, the patient’s name, and the department.
5. Physiotherapy Department and Acupuncture Room Checking System
(1) During various treatments, check the department, ward, hospitalization number, name, gender, age, location, Type, dose, time.
(2) During low-frequency treatment, check the polarity, current amount, and frequency.
(3) During high-frequency treatment, check whether there are metallic foreign bodies on the body surface or in the body.
(4) Before acupuncture treatment, check the number and quality of needles, and check the number of needles and whether they are broken when taking out the needles.
6. Checking system of special inspection departments
(1) During inspection, check the department, bed number, hospitalization number, name, gender, age, and purpose of inspection.
(2) During diagnosis, check the name, serial number, clinical diagnosis, and examination results.
(3) When issuing a report, review the department, ward, hospitalization number, bed number, name, gender, age, examination items, and results.
7. Pharmacy Checking System
(1) Before formulating, check the department, bed number, hospital number, name, gender, age, and prescription date.
(2) When formulating, check the content of the prescription, drug dosage, content, and incompatibility.
(3) When distributing medicine, implement "four checks and one explanation": ① Check whether the name, specification, dosage, content, usage and prescription content are consistent; ② Check the label (drug bag) Whether it matches the content of the prescription; ③ Check whether the drug packaging is intact and whether it has deteriorated. Check whether the ampoule is cracked, whether the various signs are clear, and whether it has expired; ④ Check the name and age; ⑤ Explain the usage and precautions.
11. Surgical safety verification system
1. Surgical safety verification is carried out by three parties (hereinafter referred to as the three parties): surgeons, anesthesiologists and operating room nurses with professional qualifications. Before implementation, before the operation begins, and before the patient leaves the operating room, the patient's identity and surgical site should be verified together.
2. This system is applicable to all types of surgeries at all levels, and other invasive operations can be implemented as a reference.
3. All surgical patients should wear signs with patient identification information for verification.
4. The surgical safety verification shall be presided over by the surgeon or anesthesiologist, and the three parties shall jointly conduct it and fill out the "Surgical Safety Verification Form" item by item.
5. The content and process of implementing surgical safety verification.
(1) Before the implementation of anesthesia: The three parties shall check the patient's identity (name, gender, age, medical record number), surgical method, informed consent, surgical site and identification, and anesthesia according to the "Surgical Safety Checklist" Safety inspection, skin integrity, surgical field skin preparation, intravenous access establishment, patient allergy history, antimicrobial skin test results, preoperative blood preparation, prosthesis, internal implants, imaging data, etc.
(2) Before the operation begins: The three parties will jointly verify the patient’s identity (name, gender, age), surgical method, surgical site and identification, and confirm risk warning and other contents. Verification of surgical item readiness is performed by the operating room nurse and reported to the operating surgeon and anesthetist.
(3) Before the patient leaves the operating room: The three parties will jointly verify the patient’s identity (name, gender, age), actual surgical method, intraoperative medication and blood transfusion, count surgical supplies, and confirm Surgical specimens, check skin integrity, arteriovenous access, drainage tubes, confirm the patient's whereabouts, etc.
(4) The three parties will sign the "Surgery Safety Checklist" after confirmation.
6. The surgical safety verification must be carried out in sequence according to the above steps. Only after each step is verified correctly can the next step be carried out. The form must not be filled in in advance.
7. Verification of intraoperative medication and blood transfusion: The anesthesiologist or operating surgeon shall issue medical orders according to the needs of the situation and make corresponding records, and the operating room nurse and anesthesiologist shall jointly verify the orders.
8. The "Surgical Safety Checklist" for inpatients should be kept in the medical record, and the "Surgical Safety Checklist" for non-inpatients should be kept by the operating room for one year.
9. The heads of the surgical department, anesthesia department and operating room are the first persons responsible for implementing the surgical safety verification system in the department.
10. Relevant functional departments of medical institutions should strengthen the supervision and management of the implementation of the institution's surgical safety verification system, propose and implement continuous improvement measures.
12. Surgery hierarchical management system
(1) Category I and II surgeries shall be reviewed and approved by the attending physician in charge (in the absence of the attending physician, the designated senior resident physician shall review and approve) Arrange surgical staff.
(2) Category III and IV surgeries shall be approved by the department director or the chief and deputy chief physician and the personnel participating in the surgery shall be arranged.
(3) The use of implanted interventional medical devices requires the approval and signature of the department director.
(4) Destructive surgeries, major special surgeries and newly performed surgeries should be signed by the department director, reported to the medical office for registration and review, and approved by the business director.
13. New technology and new project access system
In order to strengthen the management of medical technology, promote the progress of health science and technology, improve the quality of medical services, and protect the health of the people, according to the "Medical Institution Management Regulations" and other relevant national laws and regulations, combined with the actual situation of our hospital, this medical technology access system is specially formulated. Any introduction of new technologies or projects that have not yet been carried out by our hospital must strictly abide by this access system.
First, conscientiously implement the medical technology access management system.
Second, implement an application system for newly launched new technologies and projects. The application content must include the feasibility analysis, risk prediction, preventive measures, etc. of the project.
Third, establish a medical technology research approval system. The use of implanted interventional medical devices must be signed by the chief surgeon. The use of implanted interventional medical devices that support and maintain life must be signed by the department director and approved by the medical office. Destructive surgeries, major special surgeries, and newly launched surgeries must be signed by the department director, reported to the medical office for registration and review, and can only be implemented after approval by the business director.
Fourth, every new technology and new project launched should be supported by corresponding technical strength, equipment and facilities. When the technical strength, equipment, and facilities of a new technology or new project change, which may affect the safety and quality of medical technology, the technology should be suspended; it can only be restarted after re-evaluation when conditions are mature and the regulations are met.
Fifth, establish a direct reporting mechanism for medical technology risk early warning network. Project leaders should conduct risk predictions on all key links in the development of new technologies. Once an accident occurs, they should proactively take corresponding measures through the online direct reporting and early warning system to minimize risks.
Sixth, newly launched new technologies and projects must comply with ethical standards. During the scientific research process, patients' right to know and choose should be fully respected, and patient safety must be protected.
Seventh, the hospital encourages the research, development and application of new medical technologies, and encourages the introduction of advanced medical technologies at home and abroad; it is prohibited to use medical technologies that are obviously backward or no longer applicable, need to be eliminated or are technical, safe or effective. , economic, social ethics and legal aspects that are not suitable for protecting the health of citizens.
14. Critical value reporting system
(2) Electrocardiogram "critical value" items and scope
1. Cardiac arrest
2. Acute myocardial ischemia
3. Acute myocardial injury
4. Acute myocardial infarction
5. Fatal arrhythmia
(1) Ventricular tachycardia
(2) Multisource, RonT-type premature ventricular contractions
(3) Ventricular arrest greater than 2 seconds
(4) Frequent ventricular premature beats and prolonged Q-T interval
(5) Preexcitation with rapid atrial fibrillation
(6) Heartbeat with a ventricular rate greater than 180 beats/min Tachycardia
(7) High-grade, third-degree atrioventricular block
(8) Bradycardia with ventricular rate less than 45 beats/min
( 3) "Critical value" items and report scope of the medical imaging department:
1. Central nervous system:
(1) Severe intracranial hematoma, contusion and laceration, subarachnoid Acute phase of intracavitary hemorrhage;
(2) Acute phase of subdural/epidural hematoma;
(3) Cerebral herniation and acute hydrocephalus;
(4) Brain CT or MRI scan diagnoses acute large-area intracranial cerebral infarction (extending to one lobe or the entire brainstem or more);
(5) Review CT of cerebral hemorrhage or cerebral infarction Or MRI, the degree of bleeding or infarction is aggravated, and the comparison with recent films exceeds 15%.
2. Severe bone and joint trauma:
(1) X-ray or CT examination diagnosed spinal fracture, angular deformity of the long axis of the spine, and comminuted fracture of the vertebral body compressing the dural sac. Causes spinal stenosis and spinal cord compression. Spinal fractures accompanied by angular deformity of the long axis of the spine;
(2) Multiple rib fractures accompanied by pulmonary contusions and hydropneumothorax;
(3) Pelvic ring fractures.
3. Respiratory system:
(1) Foreign bodies in the trachea and bronchus;
(2) Pneumothorax and hydropneumothorax, especially tension pneumothorax (compression ratio More than 50%);
(3) Pulmonary embolism, pulmonary infarction;
(4) Atelectasis of one lung;
(5) Acute pulmonary Edema.
4. Circulatory system:
(1) Cardiac tamponade, mediastinal swing;
(2) Acute aortic dissection aneurysm;
(3) Heart rupture;
(4) Mediastinal vessel rupture and bleeding;
(5) Acute pulmonary embolism;
5. Digestion System:
(1) Esophageal foreign body;
(2) Acute gastrointestinal perforation, acute intestinal obstruction;
(3) Acute bile duct obstruction;
p>
(4) Acute hemorrhagic necrotizing pancreatitis;
(5) Contusion, laceration, and bleeding of liver, spleen, pancreas, kidney and other abdominal organs;
(6) Intestine Intussusception.
6. Maxillofacial emergencies:
(1) Foreign body in the orbit or eyeball;
(2) Eyeball rupture, orbital fracture;
(3) Maxillofacial and skull base fractures.
7. Ultrasound findings:
(1) Critically ill patients with abdominal effusion and suspected rupture and bleeding of internal organs such as liver, spleen or kidney in emergency trauma;
(2) Acute cholecystitis: consider patients with gallbladder suppuration and acute perforation;
(3) consider acute necrotizing pancreatitis;
(4) suspected ectopic pregnancy rupture and intra-abdominal bleeding;
(5) Oligohydramnios in late pregnancy and fetal breathing and heart rate too fast;
(6) Heart enlargement combined with acute heart failure;
(7) Large area of ??myocardial necrosis;
(8) Massive pericardial effusion combined with cardiac tamponade.
(4) "Critical value" items and reporting scope of the pathology department:
1. The pathological examination results are malignant lesions that clinicians cannot estimate.
2. Malignant tumors have positive resection margins.
3. Conventional section diagnosis is inconsistent with frozen section diagnosis.
4. The specimen submitted for inspection does not match the inspection form.
5. In special circumstances of rapid pathology (such as specimens that are too large, too many materials taken, or multiple frozen specimens sent for inspection at the same time, etc.), the reporting time exceeds 30 minutes.
6. When there are questions about the frozen specimens submitted for examination or the frozen results are inconsistent with the clinical diagnosis.