According to the JCI accreditation standard,the hospital safety culture should be established and improved by improving the quality management system,safety culture investigation,adverse event management,risk management and staff training.Compared with 2014,the safety culture response rate increased by 5.85％ in 2015.In 2016,the reporting rate of adverse events increased by 0.53％,of which the proportion of self-reporting increased by 22.41％.The incidence of harm event reduced by 0.007％,and the medical dispute claims decreased by 67.68％.
目的:探讨失效模式和效应分析(FMEA)在药物安全管理过程中的应用效果,消除药物从医生开具处方到使用过程的用药缺陷.方法:应用FMEA对医院药物给药过程中可能存在的安全隐患进行分析,选择其中失效模式优先风险指数(RPN)值最高的7个失效模式,分析失效原因和失效可能造成的后果,建立分析模型,制订改善措施并实施.结果:经过1年的工作实践,各项失效模式RPN评分均降到了30分以下.结论:通过FMEA的应用,将药物安全管理过程中失效模式的重要度加以量化,从而指明了药物安全管理改善的优先顺序,使用药安全性得到提高.
目的调查某院医务人员手卫生的依从性现状。方法采用隐蔽式现场观察的方法,根据《医务人员手卫生规范》,对128名医务人员接触患者前后手卫生的依从性进行调查。结果 128名医务人员中,接触患者前后执行手卫生者40人,手卫生依从率31.25%。手卫生依从率最高的科室为重症监护室（53.85%）,其次为妇产科（36.36%）、内科（34.62%）、急诊科（25.00%）和外科（20.00%）;不同岗位间,手卫生依从率最高的是护士（48.57%）,其次为医生（38.71%）、实习护士（20.83%）、实习医生（16.67%）、护工和保洁员（15.38%）。结论该院医务人员手卫生依从性不高,应加强宣教、监督和管理。
OBJECTIVE To survey prophylactic use of antibiotics in operating departments during perioperative period,so as to strengthen the management of antimicrobial usage.METHODS Retrospective survey was used to analyze the prophylactic use of antibiotics by 350 cases of patients during perioperative period.RESULTS Antimicrobials were used in 345 cases,the usage rate for prophylaxis was 93.62%.269 cases(77.97%) were given antirnicrobial agents 0.5-2 hours before the operations;113 cases(34.98%) received antimicrobial prophylaxis for less than 48 hours,and 210(65.02%) for more than 48 hours.8 categories of antimicrobials were used in the operations,46.85% were cephalosporins,followed by nitromidazoles(21.84%);Drugs were used mainly in single dosage.CONCLUSION Inappropriate usage of antimicrobial prophylaxis is found during perioperative period in operating departments.Education about antimicrobial prophylaxis in perioperation to surgeons must be strengthened and the management must be enhanced.
糖尿病合并乳酸性酸中毒昏迷是糖尿病的严重合并症之一，临床并非罕见，死亡率高，抢救非常困难，我们近年来抢救了4例糖尿病合并乳酸性酸中毒昏迷的患者，报告如下。 1一般资料： 4例患者男性2例，女性2例，既往有糖尿病史4～20年，平均年龄67岁。4例患者均因突发意识障碍6～24小时收入病房，入院后查血气分析pH值分别为6.799、6.909、7.224、7.270，SBE28.0、26.7、17.2、18.3mmol/L，HCO3－分别为3.0、3.5、15.1、15.3mmol/L，PaCO220.3、17.8、38mmHg;PaO277.9、40.6、46、44.6mmHg;血糖最高29.5mmol/L，最低11.0mmol/L；血钾最高8.2mmol/L，最低5.1mmol/L；AG(K＋＋Na＋－CI－－HCO3－)分别为38、35.6、15.8、20.3mmol/L；BUN均有不同程度增高；尿常规检查尿糖阳性，酮体阴性或弱阳性；血乳酸为5.5、7.23、7.8、8.0mg/dl。入院后均诊断为糖尿病Ⅱ型合并乳酸性酸中毒昏迷，其中一例同时合并高渗透压，1例入院后1小时发生心跳呼吸停止经心肺复苏成功，2例均伴有冠心病心衰，4例均伴糖尿病肾病，2例伴有陈旧性脑梗塞，3例伴有肺部感染。入院后经询问均有服用降糖灵或二甲双胍病史，剂量最大为0.5g,tid。 2治疗方法和结果： 入院后立即给予吸氧，补液，纠正酸中毒，抗感染，应用小剂量胰岛素持续静点等综合治疗。结果3例抢救成功，其中1例未使用碱性药物，1例使用5％的NaHCO3250ml，1例500ml。1例放弃抢救死亡。血乳酸24小时至48小时内降至正常水平，昏迷最长时间4天零6小时，最短10小时苏醒。
