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Objective To explore the feasibility to apply case mix index ( CMI) in risk assessment of clinical nursing units. Methods Questionnaire was designed and used to evaluate risk ratings for 43 nursing units with wards, with the survey results subject to expert scoring. The units consisted of 16 in surgical system, 15 in internal medicine, and 7 in traditional Chinese medicine system. Statistical method was used to analyze the correlation of the expert scoring and CMI. Results The CMI of nursing units and expert scoring results had strong correlation (r=0. 69, P<0. 05). Two groups of data in surgical system and internal medicine system were highly correlated (r= 0. 716, P<0. 05; r= 0. 643, P<0. 05 respectively), while the two groups of data in traditional Chinese medicine system had no correlation (r=0. 572, P>0. 05). Conclusions CMI can be used as a reference for dynamic risk assessment of nursing units.
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Objective To explore the feasibility to apply case mix index ( CMI) in risk assessment of clinical nursing units. Methods Questionnaire was designed and used to evaluate risk ratings for 43 nursing units with wards, with the survey results subject to expert scoring. The units consisted of 16 in surgical system, 15 in internal medicine, and 7 in traditional Chinese medicine system. Statistical method was used to analyze the correlation of the expert scoring and CMI. Results The CMI of nursing units and expert scoring results had strong correlation (r=0. 69, P<0. 05). Two groups of data in surgical system and internal medicine system were highly correlated (r= 0. 716, P<0. 05; r= 0. 643, P<0. 05 respectively), while the two groups of data in traditional Chinese medicine system had no correlation (r=0. 572, P>0. 05). Conclusions CMI can be used as a reference for dynamic risk assessment of nursing units.
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Objetivou-se mensurar a taxa de efetividade do gerenciamento de riscos clínicos na terapia intensiva. Trata-se de um estudo transversal, com uma abordagem quantitativa, realizado em um hospital filantrópico do município de Caxias do Sul. A amostra foi composta pelos pacientes internados na terapia intensiva inclusos no formulário de gerenciamento de riscos no período de janeiro de 2013 a dezembro de 2014. Os riscos que foram analisados nesta pesquisa foram: queda; lesão de pele; extubação acidental; perda acidental de sonda nasoentérica e sonda nasogástrica; e perda acidental de cateter venoso central. O total da amostra foi de 51220 pacientes-dia. Os resultados encontrados evidenciaram que a taxa de efetividade nos riscos pesquisados, em sua maioria, permaneceu acima de 99%. Conclui-se que a enfermagem tem papel fundamental no gerenciamento de riscos, atividade essa que exige do enfermeiro aperfeiçoamento constante, com foco na qualidade e segurança da assistência (AU).
The present study aimed to measure the effectiveness of clinical risk management in intensive care. Cross-sectional study with quantitative approach conducted in a philanthropic hospital in the city of Caxias do Sul. The sample was composed of patients admitted to the intensive care unit included in the risk management assessment form in the period of January 2013 to December 2014. The risks analyzed in this study were fall; skin lesion; unplanned extubation; accidental removal of nasoenteral feeding tube and nasogastric tube and accidental catheter removal for central venous catheter. The sample was composed of 51,220 patients-day. According to the results obtained, the effectiveness of the management of the risks investigated in this study was above 99%. It is concluded that nursing plays a key role in risk management, an activity that requires continuing training of nurses, with focus on care quality and safety (AU).
Fue la finalidad de este estudio mensurar la taja de efectividad de la gestión de riesgos clínicos en la terapia intensiva. Trasversal y con abordaje cuantitativo, el estudio fue realizado en un hospital filantrópico del municipio de Caxias do Sul. La muestra fue compuesta por los pacientes internados en la terapia intensiva inclusos en el formulario de gestión de riesgos en el periodo de enero de 2013 a diciembre de 2014. Los riesgos analizados en esta investigación fueron caída; lesión de piel; extubación accidental; pérdida accidental de sonda nasoentérica y sonda nasogástrica; y pérdida accidental de catéter venoso central. El total de la muestra fue de 51220 pacientes al día. Los resultados evidenciaron que la taja de efectividad de la mayoría de los riesgos investigados resultó en más de 99%. La conclusión es que la enfermería tiene papel fundamental en la gestión de riesgos, la cual es una actividad que exige al enfermero constante perfeccionamiento, con énfasis en la cualidad y seguridad de la asistencia (AU).
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Humanos , Gestão de Riscos , Unidades de Terapia Intensiva , Serviços de Enfermagem , Estudos TransversaisRESUMO
Revisão integrativa da literatura com o objetivo de apresentar as principais evidências de fatores de risco para sepse neonatal em recém-nascidos internados em Unidade de Terapia Neonatal. A busca foi realizada entre os meses de julho e agosto de 2015, nas bases de dados Scientific Eletronic Library Online, SciVerse Scopus e PubMed, utilizando como descritores: fatores de risco, unidade de terapia intensiva neonatal, recém-nascido e as seguintes palavras-chaves: sepse neonatal e prematuridade. A busca totalizou 31 publicações cujos resultados mostraram que os fatores preditivos para a sepse neonatal estão associados à idade gestacional, ruptura prematura das membranas amnióticas e infecção materna. Condições de nascimento, baixo peso e prematuridade são fortes evidências para sepse. Os fatores relacionados ao ambiente da unidade de terapia intensiva neonatal contribuem fortemente para a sepse tardia
Integrative literature review aimed to present the main evidence of risk factors for neonatal sepsis in newborns admitted to a Neonatal Intensive Care Unit. The search was performed between the months of July and August 2015, in the databases Scientific Electronic Library Online, SciVerse Scopus and PubMed, using the following descriptors: risk factors, neonatal intensive care unit, newborn and the following keywords: neonatal sepsis and prematurity. The search included 31 publications whose outcomes showed that the predictive factors for neonatal sepsis are associated to gestational age, premature rupture of amniotic membranes and maternal infection. Birth conditions, low weight and prematurity are strong evidence of sepsis. The factors related to the environment of the neonatal intensive care unit are potential contributing factors associated to late-onset sepsis (AU).
Revisión integrativa de literatura cuya finalidad fue presentar las principales evidencias de factores de riesgo para sepsis neonatal en recién nacidos internados en Unidad de Terapia Neonatal. La búsqueda fue hecha entre los meses de julio y agosto de 2015, en las bases de datos Scientific Eletronic Library Online, SciVerse Scopus y PubMed, utilizándose los descriptores: factores de riesgo, unidad de terapia intensiva neonatal, recién nacido; y las siguientes palabras claves: sepsis neonatal y prematuridad. La búsqueda totalizó 31 publicaciones cuyos resultados mostraron que los factores predictivos para sepsis neonatal están asociados a edad gestacional, ruptura prematura de las membranas amnióticas e infección materna. Condiciones de nacimiento, bajo peso y prematuridad son fuertes evidencias para sepsis. Los factores referentes al ambiente de la unidad de terapia intensiva neonatal contribuyen mucho para la sepsis tardía (AU).
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Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Fatores de Risco , Enfermagem Neonatal , SepseRESUMO
Objective To explore the effects of curriculum provision of nursing risk management in standardized training of new nurses. Methods Totally 140 new recruits nurses from the year 2011 to 2014 were divided into control group and experimental group with 70 cases each. The control group received standardized training. In addition, the experimental group added the curriculum of nursing risk management from different levels in the basis of standardized training. Data were statistically analyzed according to the examination results, incidence of nursing safety events ( adverse events) and post admittance rate of new nurses, in order to evaluate the effects. Results The examination results after standardized training and post admittance rate of the experimental group were higher than those of the control group:(83.61 ±6.90) points vs. (80.13±10.58) points,95.7%(67/70) vs. 82.9% (58/70), and there were significant differences, t=-2.309,χ2=6.05, P<0.05. And the incidence of nursing safety events ( adverse events) of the experimental group was lower than that of the control group in standardized training: 1.4%(1/70) vs.11.4%(8/70 ),and there was significant difference, χ2=4.275, P<0.05. Conclusions The curriculum provision of nursing risk management can enforce the safety consciousness of new nurses , culture them self-conscious and standardized nursing behaviors, reduce the incidence of nursing safety events ( adverse events) and improve the work ability of new nurses.
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To introduce the experiences of nursing risk management in Children's Cancer Center in Hongkong from aspects of organization structure and responsibility,clinical application of the risk management measures so to give reference to the hospital's nursing risk management in our country.
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Objective To explore the nursing risks on hemodialysis patients,and seek nursing countermeasures.Methods The quality and safety summaries from blood purification center of Sichuan Provincial People's Hospital (2009 to 2011,monthly) were studied.Nursing risk factors were firstly classified on the basis of adverse events which had occurred or had been avoided because of preventive measures.And then,a nursing risk management team was founded,and the main role of which was to analyze the cause and process of nursing risks,improve the process management and enhance nursing measures.Results Nursing skills and patients' satisfaction were obviously improved through strengthening the nursing risk management and training program.There were statistically significant differences between the indicators.Conclusions It can improve nursing skills and patients' satisfaction degree and reduce the occurrence of nursing risk by establishing risk management mechanism,culturing nursing stuffs risk awareness,paying more attention to detail management and continuous quality improvement.
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Objective To apply failure mode and effect analysis (FMEA) to reduce nursing risk of peripherally inserted central catheter (PICC).Methods 100 patients with PICC in central hospital of Minxing District of Shanghai were named as the experimental group,failure mode and effect analysis were performed in this group to obtain the value of risk priority number (PRN) and array them according to the RPN value to work out improved plan systematically and put it into practice to guide the clinical operation and nursing care.98 PICC patients in Xinzhuang health service center and Tumor Hospital of Minhang district were set as the control group,which were subjected to traditional nursing.All statistical analysis were done by SPSS 11.0 software package,the differences of the incidence of PICC-related nursing risk between the two groups due to the implementation of FMEA was analyzed by X2 test.Results Application of FMEA could reduce the nursing risk of PICC,After the application of FMEA,the incidence of PICC-related complications such as focal or systemic infection,puncture site oozing and bleeding,skin allergies,mechanical phlebitis,too deeply placed catheter,catheterization into cervical veins and reflexed into axillary vein,catheter occlusion,catheter migration,difficult removal of catheter,puncture failure in the experimental group decreased obviously,the differences had statistical meaning.Conclusions The application of failure mode and effects analysis can reduce the nursing risk of PICC,decrease medical disputes,alleviate the suffering of patients,reduce medical costs caused by PICC-related complications,and improve the satisfaction degree of patients and the quality of nursing care.
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Objective To determine the prevalence and clinical characteristics of orthostatic hypotension (OH) and orthostatic hypertension (OHT) in the elderly patients with hypertension.Methods 489 elderly patients with hypertension were enrolled and divided into the OH group,the OHT group and the non-OH-OHT group,which represents no or symptom.The orthostatic blood pressure was measured in supine position after resting for more than 5 minutes and at 3 min standing.Results The prevalence of OH in the 60～79 years old group was lower than that in ≥ 80 years old group.The morbility of coronary heart disease,diabetes and ischemic stroke was significantly higher in the OH and OHT group than that in the non-OH-OHT group.Conclusions OH and OHT are common disease in the elderly patients with hypertension and associated with increased risk of cardiovascular disease and diabetes mellitus.To strengthen nursing and health education for elderly patients with hypertension could prevent the incidence of malignant cardiovascular events due to OH and OHT.
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Objective To understand working pressure of nurses,and discuss effective measures to alleviate nursing work pressure and control nursing risk.Methods A questionnaire investigation was carried out to understand nursing pressure level,to discuss the related factors of pressure.Nursing department adopted effective measures to alleviate pressure and maintain psychological health of nurses.Pressure sources,satisfaction degree of patients and nurse-patients disputes before and after the implementation of new management methods were compared.Results After the implementation of new management methods,nursing pressure level decreased from 58.43％ to 48.76％,satisfaction degree of patients increased from 82.80％ to 94.70％.Nurse-patients disputes decreased from 0.50％ to 0.01％.Conclusions New nursing management pattern has instructive effect on restriction of nursing risk and alleviation of mental pressure as well as to increase the working zeal of nurses.
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Objective To analyze nursing risk factors in digesting internal medicine nurses,looking for effective prevention measures and observe the nursing effect. Methods Nursing risk factors were analyzed from November 2009 to October 2010,and effective preventive measures were explored and applied from November 2010 to October 2011.The incidence rate of nursing accidents,the degree of satisfaction and approval,and basic nursing quality were compared before and after the implementation of nursing risk preventive measures. Results Nursing accident before and after the implementation was 0.98％ and 0.12％,the degree of satisfaction and approval before and after the implementation was 78％ and 75％,the basic nursing quality score before and after the implementation was (93.87 ±1.26)points,(99.68 ±0.54)points,the results before and after the implementation showed significant difference. Conclusions To adopt effective nursing risk preventive measures can significantly reduce the incidence of nursing risk,improve nursing service quality and satisfaction degree of patients.
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Objective To explore the application of nursing risk management in the patients with breast cancer during postoperative chemotherapy. Methods Patients with breast cancer during postoperative chemotherapy in our hospital from January to December 2009 were surveyed retrospectively, and analyzed the factors that may cause drug extravasations. Then the appropriate care and risk management measures were implemented by the nursing staff from January to December 2010. Incidence of drug extravasations was compared before and after the implementation of the measures. Results Before the implementation of nursing risk management, the incidence of drug extravasations of the patients with breast cancer of postoperative chemotherapy was 5.77%, the incidence of skin necrosis was 0.64%; after the implementation of nursing risk management,leakage of chemotherapy drugs was 0.59%, no skin necrosis occurs. Conclusions Implementation of nursing risk management can significantly reduce the incidence of chemotherapy drugs leaking in patients with breast cancer during postoperative chemotherapy.
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Objective To explore a kind of nursing supervision method in order to relieve work pressure of nurses and provide the constructive managing mode.Methods A investigation was carried out in 150 nurses in the hospital in order to understand the ascensus of the turnover intention and the incidence rate of working lassitude.The nurse department introduced the more humanistic natural managing measure and observed the implementation effect.Results The new nursing supervision method relieved the working lassitude from 69.10% to 59.25%,reduced turnover intention from 45.53% to 35.50%,decreased the nurse-patient dispute from 0.52% to 0.01%,and increased the patient satisfaction degree from 88.00% to 94.13%.The disease incidence of nurses also lowered.Conclusions The new nursing supervision mode has an instructive meaning in controlling the nursing risk,relieving the nurse mental stress and increasing their working passion.