cardiovascular internal medicine
According to the nursing work plan of the nursing department for 20 1 1 year, on the basis of carrying out the demonstration project of quality service, we further earnestly sum up the objectively existing quality nursing service in the department, sum up the experience, find out the shortcomings, analyze the reasons, improve the mechanism, and continuously improve it, so as to truly implement the quality nursing service, achieve the satisfaction of society, hospitals, patients and medical personnel, and comprehensively improve the quality of nursing service.
First, leaders attach importance to and improve the mechanism.
Since the demonstration project of high-quality nursing service was launched on 20 10, the department director and head nurse have always attached great importance to it and personally urged the development of this activity. Planning, implementation, inspection and clinical nursing management of head nurses' activity plan. Ordinary nurses took an active part in this activity. With the deepening of this work and the passage of time, some new problems have gradually emerged. In this regard, the director of the department, the head nurse and the branch members put forward new requirements for the new situation they will face.
Members of the Leading Group for Quality Nursing Service in Cardiology Department: Department Director-Gao Guanghua, Head Nurse-Zhao Yi, Nurse in Charge- ..........................
(1) The primary problem is the expansion of the number of patients. The increase in the number of patients requires more nurses to meet the needs of the increase in the number of patients. Therefore, first of all, we should make a good reserve of nurses' human resources. Cardiology is divided into military and local wards, with beds 100. The local ward is divided into three groups, with … as the leader of the responsibility group and … as the leader of the responsibility group of the military ward. Under the leadership of the head nurse, be responsible for and participate in the clinical nursing work in this area, and give full play to the role of mentoring.
(2) Establish three-level quality control of nursing work in departments. Because new nurses join the nursing team every year, the quality of high-quality nursing service will face the risk of decline. Therefore, the department decided to establish a three-level quality supervision mechanism for nursing work in the department, which is composed of head nurses, responsible team leaders and responsible nurses, and is responsible for implementing comprehensive and holistic nursing work for each patient. Among them, the head nurse is responsible for the overall nursing quality supervision of the whole cardiology ward, the responsible team leader is responsible for the overall implementation of high-quality nursing services for this group of patients, and the responsible nurse is responsible for the implementation of specific nursing work. The leading group of nursing quality monitoring in the department holds regular meetings to sum up experience, correct deficiencies and implement improvements.
Second, strengthen training and improve quality.
In order to further strengthen the understanding and understanding of the significance and connotation of "high-quality nursing service demonstration project", the department used various opportunities to comment on the quality of high-quality nursing service. In addition to learning relevant documents, we should focus on analyzing new situations and new problems, making a continuous improvement plan, and further explaining and explaining the specific implementation plan of each step in order to achieve the unanimous approval of all nurses. In particular, strengthen the training of basic nursing objectives, contents, norms and other knowledge, spare two hours every Wednesday afternoon, and the nurse in charge is responsible for training basic nursing norms and routine nursing technical operations item by item, and assess them once every quarter; Conduct specialist disease nursing rounds once a month. Nurses with different nursing levels are trained at different levels, with emphasis on nurses with less than three years' experience. The training of new nurses focuses on basic nursing and meeting patients' basic needs. Through intensive training for new nurses, nurses can further clarify the connotation of high-quality nursing service, improve nursing quality, benefit patients and satisfy patients. Through the concrete implementation of nursing work, the quality of basic nursing service will be further consolidated and the image of nurses will be improved. At the same time, they will reach a consensus among general nurses, strengthen the patient-centered nursing work mode and establish a people-oriented nursing management mechanism.
3. Perfecting the workflow and defining the job responsibilities are the premise of developing quality nursing service in depth and lasting. The focus of future work should be to improve the workflow, guide and standardize nurses' work behavior with workflow, and establish nursing work mode with workflow, that is, to realize patient-centered nursing work mode. On the basis of more than ten established nursing workflows, our department has further improved and established a series of nursing workflows, including oral care and perineal care, and added basic nursing operation procedures, such as general cleaning, washing hair in bed, warm bath and other specific operation procedures; Continuously improve and perfect the work flow of nurses in each class; For example, further optimize the work flow and job responsibilities of the responsible team leader, responsible nurse, night nurse, general nurse, office nurse, treatment nurse and dressing change nurse, and maximize the development of nurse human resources.
Fourthly, flexible scheduling should be implemented to develop nurses' potential.
According to the staffing situation of the nursing team in the department, we should further explore a new scheduling model and give full play to the potential of nurses. At present, there are 0/00 beds in our department and 22 nurses. According to the requirement of bed-to-nurse ratio, there should be 40 nurses in our department, nearly 1 times more than the current nurses.
Under the current shortage of nursing staff, after repeated research, we decided to start implementing a new working model. A new scheduling mode is studied, that is, the responsibility team leader is responsible, the responsibility team leader is a senior nurse, and each responsibility team leader is equipped with two nurses, which meets the work needs of the ward and improves the satisfaction of nursing work.
Five, regular evaluation, continuous improvement of quality
1, formulate the examination questions of specialized nursing theory knowledge, and check them once a month to promote the improvement of specialized nursing knowledge.
2. Formulate detailed rules and standards for the evaluation of high-quality nursing service, and strengthen the improvement of basic nursing quality.
3, once a month, the basic nursing quality, ward management quality, nursing safety quality, treatment room management quality, drug distribution quality, dressing room management quality, department nursing documents to evaluate and score, timely improve the existing problems and put forward new rectification measures.
4. The head nurse regularly organizes nursing backbone meetings to analyze and study various problems in high-quality nursing service activities and formulate countermeasures.
5, according to the department to carry out the situation, regularly report to the general nursing department.
20 12 implementation plan for continuous improvement of quality nursing service demonstration project
cardiovascular internal medicine
On the basis of the 20 1 1 quality service demonstration project, in 20 12, the departments summarized the preliminary work, found out the shortcomings, analyzed the reasons and made continuous improvement, which will further deepen the connotation of quality nursing service this year, make the quality nursing service truly implemented and comprehensively improve the quality of nursing service.
First, strengthen the management of nursing quality and safety and implement the core system.
Assessment and inspection, clear job responsibilities and work system, strict handover and inspection system, standardized and procedural operation, and responsibility to people.
Taking advantage of the shift-over time, this paper puts forward preventive countermeasures against the hidden dangers existing in the usual nursing work, such as "putting an end to patients' venipuncture, preventing patients' phlebitis with indwelling needles, strengthening patients' turning over after operation, controlling the drip rate of infusion for children and elderly patients, and strengthening functional exercise".
Hold a nurses' meeting once a month, and use the time of the nurses' meeting to analyze the causes of adverse nursing events in the department one by one, formulate corrective measures and improve the work.
Focus on new nurses, focus on follow-up, head nurses track and check the quality of their nursing work, and conduct training-guidance-assessment.
Establish a "five-round nursing" system for head nurses; That is, before the morning meeting, during the implementation of the doctor's advice, before the handover at noon, after the handover in the afternoon and before leaving work at night, the patient rounds are conducted to supervise the implementation of the core system, understand the needs of patients and ensure the safety of nursing.
Two, flexible scheduling, the implementation of "patient-centered" group management.
According to the requirements of the work mode of the high-quality service demonstration project, the experience and shortcomings of nursing work in the previous year were summarized, and the nursing units were divided into two groups through the implementation of graded use of nursing staff, nurse responsibility system and group responsibility system. Each group consists of a nursing team leader, who is a senior nurse with strong sense of responsibility and professional ability, and is responsible for helping and leading the junior nurses in the group while taking care of the patients with relatively serious illness. Before going to work every day, the head nurse checks and comments on the work quality of the two groups through rounds.
In view of the fact that there are more major operations in wards, more emergency services at night, and more junior nurses, the night shift adopts flexible scheduling, new and old scheduling, and two-person shift system (16 * * * succession, take turns to rest after 22 o'clock, and get up at 6 o'clock the next day to complete the night shift work with good quality and quantity. At 8 o'clock in the morning, * * * will be handed in). In addition to the original oral care and perineal care time in the morning and evening, a practical basic nursing work schedule is formulated, and beard cleaning and nail cutting are added for patients every Tuesday and Friday, and the patient's shampoo day is scheduled for Wednesday.
Third, improve professional theoretical level and operational skills to provide guarantee for quality nursing service.
High-quality nursing service is the whole nursing service of the responsible nurse, which requires the professional nursing level, operational skills and health education of the responsible nurse to be improved.
This year, "morning questioning" was adopted to improve the level of specialized nursing. The specific arrangements are as follows: Monday: send a nurse to make bedside rounds for critically ill or postoperative patients for 10- 15 minutes; Tuesday: commonly used drugs in the learning department; Wednesday: Nurses give a small lecture, with topics of their own choosing and diversified contents, with time of 10 minute; Thursday: the head nurse 1-2 asks the nurse professional knowledge questions, 10- 15 minutes; Friday: The head nurse randomly selects a responsible nurse to report the "seven knowledge" of the patient in charge.
Organize a multimedia professional knowledge lecture and a nursing ward round once a month (nurses and above, head nurse comments); Responsible team leader ... trained, never taught, examined four professional operation techniques commonly used in departments-intravenous indwelling needle, perineal care, oral care and ECG monitoring. In the second half of the year, "Hundred Needle Puncture Competition" will be held, and at the end of the year, "Nurse Health Examination Knowledge Competition" will be organized. According to the evaluation standard of 12, the first, second and third prizes are awarded by quantitative scoring method, such as whether the theme of health education is based on the needs of patients, whether the teaching methods are targeted, whether the auxiliary tools are used properly, whether the education process shows respect and protection for patients, and whether patients are impressed.
Through this year's training and assessment, the level of specialized nursing and health education of all nurses has been greatly improved.
Fourthly, strengthen nursing risk identification and attach importance to nursing detail management.
1, paying special attention to the observation and nursing of key patients, focusing on patients with major surgery, the elderly, children, psychological disorders and potential medical disputes, and being closely monitored by nurses.
2. Pay attention to the teaching supervision of key nurses. Focusing on new nurses, intern nurses and nurses with weak sense of responsibility, nurses are required to do five noes, that is, don't simplify the operation process at will, don't ignore every examination, don't estimate things by experience, don't ignore the changes of their own condition during the operation, and don't look at the individual operations of interns without supervision.
3. Do a good job in the implementation of the obligation to inform, and incorporate safety protection knowledge such as falling prevention, falling bed prevention and theft prevention into the scope of health education.
4. Pay special attention to the management of safety warning signs. There are striking signs of falling, lying in bed, pressure sore and drip speed control. Promote the use of wristbands, strengthen the second inspection, and effectively protect the safety of patients.
5. Refine the nursing service process and introduce "five-point" service measures.
20 13 implementation plan of continuous improvement demonstration project of quality nursing service
cardiovascular internal medicine
By summarizing the achievements and experiences of developing high-quality nursing service in the past two years, the connotation of nursing service will be better deepened and continuously improved in 20 13 years, and the plan is formulated as follows:
First, emphasize the connotation and importance of basic nursing work, and actively change the concept of "emphasizing specialty, ignoring foundation, emphasizing technology and neglecting service" of nursing staff.
Most patients can't cope with life in cardiology, especially those with myocardial infarction and heart failure need careful care. Many patients will urinate or incontinence in bed, so many nurses will have psychological resistance to scrubbing and tidying for patients. Therefore, the head nurse respects and trusts every nurse while strictly demanding work, and constantly encourages nurses to pursue progress emotionally and stimulate their enthusiasm for work; Head nurses set an example in their own work, strictly demand themselves, actively participate in the direct care of critically ill patients and provide professional guidance, put the influence and appeal of head nurses into concrete work, and use their words and deeds to encourage nurses to grow up and better serve patients.
Second, broaden the theoretical knowledge and professional skills of nurses in cardiology department through various channels.
Before the implementation of high-quality nursing work, the business study arrangements in the cardiology ward were relatively random, and generally new nurses joined the department to learn the professional knowledge and operation of cardiology. After carrying out high-quality nursing work, our department arranges business learning activities in a planned way every week, constantly consolidates nurses' basic nursing theoretical knowledge through nursing rounds, morning meetings, knowledge lectures, literature study, irregular random examinations, etc., and sends nurses to visit and study hospitals and wards with good quality nursing service demonstration projects in turn, giving certain material rewards to nurses with good practical skills in general nursing assessment, and organizing all nurses to comment on the operation, learn from each other's strengths and make progress together.
Third, provide comprehensive and specific health education for patients in cardiology.
Health education is an important part of holistic nursing. Due to the particularity of cardiology, rehabilitation training is difficult and patients stay in bed for a long time. Comprehensive and specific health education is particularly important. Before the implementation of quality care, the health education for patients in our department only mechanically repeated the propaganda content 1 time to patients and their families, and rarely carried out other more humanized measures and services. After carrying out high-quality nursing service, health education was given to each patient, including hospital introduction, medication guidance, special examination guidance of cardiology department, explanation of related knowledge before and after orthopedic surgery, diet guidance, functional exercise, discharge guidance, etc. Give professional knowledge training to nurses every week and give lectures on diseases, especially the knowledge of surgery and rehabilitation that patients in cardiology department are more concerned about; Drawing lessons from the health education and nursing experience of other hospitals, taking bedside individual guidance as the main way of health education, supplemented by other forms, such as making and updating health education bulletin boards regularly, distributing publicity materials, playing relevant videos for patients, etc. Before operation, patients in cardiology department should be trained with postoperative behavior in bed, such as urination in bed, washing in bed and relaxation training. Provide rehabilitation function training and self-living ability training for cardiology patients during the rehabilitation period, such as: teaching family members how to take care of family life, and issuing discharge contact cards when patients leave the hospital, which contain basic information and precautions for future follow-up and consultation.
Fourthly, simplify the nursing documents of cardiology department and return the time to patients.
Through electronic medical records, unnecessary nursing writing in cardiology department can be cancelled, such as canceling duplication with doctors' records, simplifying patients' first admission nursing records, simplifying nursing documents and reducing the time for nurses to write nursing documents. At the same time, writing time should be arranged after nursing patients, and more time should be spent in the practice of nursing patients.
Fifth, improve the supporting measures and integrate humanistic care into the cardiology ward.
Handle daily appliances, such as microwave ovens and simple functional exercise equipment, wheelchairs, pain therapy devices, etc. In the cardiology ward; For patients who have entered the stage of disease rehabilitation in cardiology department, actively contact the rehabilitation department for the next stage of treatment and rehabilitation; Full-time nurses in cardiology department distribute medicines in a centralized way, and full-time nurses are responsible for accompanying the examination; Standardize nurses' daily language and strengthen nurses' etiquette training; Increase nurse-patient communication and active patrol time; Hang the names of the person in charge of the ward and the responsible nurse; The director and the head nurse conduct warm rounds once a week to timely understand and meet patients' satisfaction with medical staff and daily needs, taking patients as the center.