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Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) in reducing the incidence of nursing interruption with negative outcome in operating room, so as to maximize the smooth progress of the surgical process.Methods:This was a quasi experimental study. The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study. According to the surgical sequence, 38 surgeries performed in the gastrointestinal surgery suite from August 15-30, 2021 were set as the control group, and the conventional healthcare cooperation model process was implemented; 42 surgeries performed from September 15-30, 2021 were set as the intervention group, and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room, comparing the number, duration, source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results:In the control group, there were 38 observed surgeries, 190 negative outcome care interruptions, negative outcome interruptions of (5.26 ± 1.02) min duration, and no near misses; in the intervention group, there were 42 observed surgeries, 84 negative outcome care interruptions, negative outcome interruptions of (2.06 ± 0.08) min duration, and no near misses. There were statistically significant differences in the number, duration of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 18.71, t = - 20.28; all P<0.01). There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 12.71, P<0.01). Conclusions:HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room, shorten the duration of interruptions, and minimize potential safety hazards caused by nursing interruptions, which is conducive to ensuring the safety of patients.
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Objective:To explore the effect of emergency rescue ability training of operating room nurses based on video tracking method, and provide reference for improving emergency ability of operating room nurses.Methods:This study was a quasi-experimental study. In March 2021, 85 nurses working in the Department of Anesthesiology and Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were selected by cluster sampling method. We implemented a training program of rescue emergency ability based on video tracking and adopted the inspection list of rescue emergency ability assessment and doctors′ satisfaction questionnaire of operating room nurses to evaluate the scores of each item in the nurses' rescue emergency ability list and doctors' satisfaction of rescue cooperation of operating room nurses.Results:The scores of the dimensions of recognition of fatal arrhythmias, fatal arrhythmia, several situations that can directly call help, writing of emergency state nursing records and handover of medical records, use of defibrillator, correct use and maintenance of negative pressure attraction, use and management of rescue vehicle and situation disposal in the inspection list of rescue ability after training were 9.80 ± 1.61, 26.06 ± 2.20, 17.34 ± 1.29, 13.00 ± 1.57, 7.35 ± 0.74, 10.24 ± 1.14, 33.89 ± 2.73, which were higher than before training 9.24 ± 1.18, 24.92 ± 2.15, 15.69 ± 1.92, 12.21 ± 1.66, 6.55 ± 0.92, 8.94 ± 1.32, 32.94 ± 2.20. The differences were statistically significant ( t values were -6.83 to -2.51, all P<0.05); after the training, in the questionnaire of doctors' satisfaction with nurses, surgical materials and instruments preparation, first aid skill operating level, attention to surgical progress, active and correct delivery, orderly and busy, coordination and communication ability, professional knowledge, evaluation ability and foresight, ability to deal with emergencies, clear division of labor and good cooperation, and responsibility scores were 4.22 ± 0.58, 4.52 ± 0.54, 4.53 ± 0.47, 4.43 ± 0.58, 4.44 ± 0.44, 4.37 ± 0. 59, 4.45 ± 0.51, 4.51 ± 0.53, 4.51 ± 0.57, 4.17 ± 0.63, which were higher than the pre-training 4.05 ± 0.58, 4.38 ± 0.56, 4.26 ± 0.76, 4.04 ± 0.67, 4.25 ± 0.62, 4.19 ± 0.74, 4.25 ± 0.74, 4.34 ± 0.67, 4.21 ± 0.84 and 3.56 ± 0.58. All differences were statistically significant ( t values were -8.22 to -2.10, all P<0.05). Conclusions:The training method based on video tracking method improved the emergency rescue ability of operating room nurses and the doctor's satisfaction with rescue cooperation, and provided a reference for the training of operating room nurses.
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Objective:To study the effect of early immune enteral nutrition combined with glutamine (Gln) parenteral nutrition on T-lymphocyte subsets in patients with severe pulmonary infection in the intensive care unit (ICU).Methods:A total of 70 ICU patients with severe pulmonary infection who were treated in Yinzhou People′s Hospital from January 2017 to October 2019 were selected, and the patients were divided into enteral nutrition group and combined group according to a completely random method with 35 cases in each group. Both groups of patients were given conventional treatment; patients in the enteral nutrition group was given immunoenhanced enteral nutrition on the basis of conventional treatment, and those in the combined group was given Gln on the basis of enteral nutrition group. The levels of arterial oxygen partial pressure (PaO 2), arterial oxygen saturation (SaO 2), arterial partial pressure of carbon dioxide (PaCO 2), CD 8+, CD 3+, CD 4+/CD 8+, procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) before and after treatment were detected and compared between two groups. The treatment efficacy was compared between two groups too. Results:After treatment, the levels of SaO 2 and PaO 2 in combined group were higher than those in enteral nutrition group, the level of PaCO 2 in combined group was lower than that in enteral nutrition group, but there were no significant differences ( P>0.05). After treatment, the levels of CD 3+, CD 4+/CD 8+ in combined group were higher than those in enteral nutrition group [(62.37 ± 6.15)% vs. (59.35 ± 5.24)%, 1.50 ± 0.18 vs. 1.12 ± 0.11], the level of CD 8+ in combined group was lower than that in enteral nutrition group [(33.15 ± 6.11)% vs. (37.72 ± 8.57)%], and there were significant differences ( P<0.05). The levels of PCT, hs-CRP and TNF-αin combined group were lower than those in enteral nutrition group [(3.83 ± 0.82) μg/L vs. (6.47 ± 1.34) μg/L, (6.92 ± 1.25) mg/L vs. (12.72 ± 3.83) mg/L, (92.35 ± 13.05) ng/L vs. (125.26 ± 18.35) ng/L], and there were significant differences ( P<0.05). The total effective rate in combined group was higher than that in enteral nutrition group [88.57%(31/35) vs. 65.71%(23/35)], and there was significant difference ( χ2=5.185, P<0.05). Conclusions:Early immune enteral nutrition combined with Gln parenteral nutrition has significant effects on patients with severe pulmonary infection in ICU, and can improve the level of T-lymphocyte subsets, control infection, and reduce inflammatory factor levels.
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Objective To investigate the influence of left ventricular-arterial coupling(VAC) on clinical prognosis of elderly patients with septic shock.Methods A total of 56 elderly septic shoek patients were enrolled in this study,all of whom were admitted to Department of Intensive Care Unit in Zhejiang Hospital from August 2014 to October 2015.The patients were divided into two groups according to the status of left ventricular-arterial coupling when septic shock was diagnosed,which were left ventricular-arterial uncoupling group(UC group) and left ventricular-arterial coupling group(C group).Various parameters were recorded,including blood lactate level,central venous oxygen saturation(ScvO2),serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP) and cardiac troponin Ⅰ (cTN Ⅰ),dose of vasoactive drugs,the total fluid volume and urine volume per hour within 24 hours.The 28-day survival rate was a key index of prognosis.Multivariate logistic regression was taken to analyze risk factors related to death within 28 day.Results Compared with C group,UC group had lower values of left ventricular ejection fraction[(42.43 ±4.76)％ vs (53.17±3.01)％;P＜0.01] and cardiac index[(2.36±0.68) L· min-1 · m 2vs (2.93±0.45)L · min-1 · m-2;P ＜0.01].Yet serum levels of NT-proBNP[lg NT-proBNP 3.93 ±0.53 vs 3.40 ±0.63;P =0.004] and cTN Ⅰ [lg cTN Ⅰ-0.16 ± 0.68 vs-1.03 ± 0.69;P ＜ 0.001] in UC group were higher than those in C group.Moreover,the total fluid volume within 24 hours [(3 806.3 ± 831.4) ml vs (3 142.0±770.0) ml;P =0.016],blood lactate level[(5.61 ±2.68) mmol/L vs (3.93 ± 1.59)mmol/L;P =0.043] and dose of norepinephrine[(0.630 ±0.300) μg · kg-1 · min-1 vs (0.292 ±0.234)μg · kg-1 · min-1;P =0.001] in UC group were greater than those in C group,while ScvO2 [(60.75 ±2.91)％ vs (64.42 ±2.19)％;P＜0.001] and urine volume per hour[(0.518 ±0.358) ml vs (0.926 ±0.678) ml;P =0.007] were less than those in C group.Compared with C group,UC group had a lower 28-day survival rate [43.2％ (19/44) vs 9/12;P =0.049].Ea/Ees ratio was negatively correlated with LVEF,ScvO2 (r =-0.686,P ＜ 0.001;r =-0.411,P =0.002),positively correlated with NT-proBNP,cTN Ⅰ (r =0.294,P =0.028;r =0.363,P =0.006),yet no obvious correlation was noticed with blood lactate level (r =0.170,P =0.21).Multiple logistic regression analysis showed that VAC(OR =11.187,95％ CI 2.489-50.285;P =0.002),lactate level (OR =1.727,95 ％ CI 1.164-2.563;P =0.007) and lg cTN Ⅰ (OR =0.247,95 ％ CI 0.079-0.779;P =0.017) were independent risk factors affecting 28-day mortality.Conclutions In elderly patients with septic shock,left ventricular-arterial uncoupling indicates a lower 28-day survival rate,worse cardiac function and tissue perfusion.Ea/Ees ratio might sever as a predictive indicator of 28-day mortality.
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Objective To explore the effect of different doses of tirofiban for PCI, myocardial injury and arterial flow conditions.Methods 70 patients undergoing PCI elevation acute myocardial infarction, were randomly and equally divided into the observation group and the control group.The control group of patients before PCI given haplotype character loading dose of tirofiban, the observation group were given a double load before PCI tirofiban.Recording and analyzing two groups of patients cTnI (cardiac troponin I), 90 minST section down percentage circumstances.Results The patients after 6h, 12h, 24hcTnI contents were (2.11 ±0.50,3.50 ±1.64,3.28 ±1.15) ng/mL was significantly lower than the control group (4.09 ± 1.13,9.48 ±2.61,5.79 ±1.26) ng/mL, and the difference was significant(P<0.05); the observation group were CTFC, 90 min fall within ST respectively was significantly better than the control group ( P<0.05 ) .Conclusion Preoperative use of double loading dose of tirofiban can effectively improve the blood flow after PCI,, and reduce the incidence of myocardial injury and postoperative cardiovascular events.
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OBJECTIVE: To study the status quo and future trend of digestive system drugs used in our hospital. METHO-DS: The digestive system drugs used in our hospital between 2001 and 2005 were analyzed retrospectively in respect to drug kinds, consumption sum, DDDs, daily costs etc. RESULTS: Drugs for peptic ulcer and hepatobiliary diseases took a big proportion and experienced a year- on- year increase. No significant change was noted for the top 10 drugs on the lists of DDDs and consumption sum before and after the medical insurance reform, but their order changed a little. The DDDs of most of the cheap and effective drugs increased after the medical insurance reform. CONCLUSION: The consumption of antiulcer drugs and drugs for hepatobiliary diseases in our hospital assume an increasing tendency.