What problems exist in advanced nursing practice in clinical work and how to solve them?

Infusion links are complex, from executing doctor's advice, copying infusion slip, receiving medicine, placing medicine, distributing medicine, checking, infusion, changing liquid to pulling out needles, any link may be wrong. Because nurses do not have a strong awareness of practicing law, they make mistakes in their busy work, and the check system is not implemented, and because nurses are not responsible for their work and are careless. Clinically, some patients have the same name but different surnames. The nurse calls the patient, and the patient agrees if he can't hear clearly, or has the same name and surname. During transfusion, the nurse didn't check carefully, which led to the wrong blood transfusion. -Inappropriate inspection during infusion, untimely handling in case of accident, swelling at the puncture site of infusion, and failure to find drug leaking from blood vessels in time, resulting in local pain, tissue necrosis and severe disability. Adverse Drug Reactions: The imported liquid drug preparation is impure, or the patient is allergic to the injected drug, which may lead to anaphylactic shock in severe cases, and failure to rescue in time may lead to death. The primary disease of patients with cardiac arrest is not controlled, or the condition is aggravated. Patients with heart disease have atrial fibrillation and are prone to cardiac arrest. Nurses with left heart failure are not well educated. Patients or their families hope to end the infusion as soon as possible, adjust the infusion speed at will, and input too much liquid in a short time, resulting in excessive circulation load and left heart failure. Clinically, cardiopulmonary insufficiency and elderly patients are more common. In the process of air embolism infusion, air is not measured, the dropper leaks, the connection is not good, and the continuous infusion is not timely, especially when the infusion is pressurized, which is easy to cause air embolism. Shock nurses didn't know the nature of drugs, and didn't monitor blood pressure when infusion of antihypertensive drugs. For example, in intravenous drip of nitroglycerin, if the dripping speed is not strictly controlled, the blood pressure will drop rapidly, causing adverse consequences. -The low level of venipuncture technology leads to disputes. Repeated venipuncture causes vascular injury, which affects the therapeutic effect and increases the pain of patients. The needle is not pulled out correctly, which leads to bleeding at the puncture point and disputes between nurses and patients. -Blood transfusion reaction caused by liquid medicine pollution. Intravenous infusion is an invasive nursing operation, which requires high cleanliness of liquid. If it fails to meet the requirements, bacteria and particles will enter the body, which may cause fever, bacteremia, septicemia and other serious consequences. Particulate Contamination According to China Pharmacopoeia 20 10, there are no more than 20 insoluble particles with a diameter greater than 1 0 micron and no more than 2 insoluble particles with a diameter greater than 25 microns per1ml infusion. When dispensing medicine, the ampoule was not disinfected after separation, resulting in glass fragments and sand falling. If the dosing needle is not sharp or the quality of the bottle stopper is poor, it is easy to produce rubber crumbs to pollute the liquid medicine by repeatedly piercing the bottle stopper. The dosing syringe pollutes the syringe piston in the wrong way, which violates the principle of one person, one needle, one use and one change. After dispensing, put it into the next liquid to continue to use. It is reported that the average bacterial contamination rate is 2 1h, 2h and 3h after administration, and the longer the syringe is left, the higher the contamination. Contaminated nurses do not wash their hands before venipuncture, skin disinfection is not strict during venipuncture, needles are not changed after unsuccessful venipuncture, and repeated venipuncture can cause bacterial pollution, which can directly bring bacteria and particles into veins and cause pyrogen reaction. Environmental air pollution During intravenous infusion, the environmental conditions and air pollution in the treatment room have a direct impact on the quality of the liquid medicine. Dispensing and infusion in an environment with excessive bacteria will greatly increase the chance of pollution. The longer it is left, the greater the chance of pollution. Preventive measures-pay attention to infusion safety, improve nursing system, learn relevant laws and regulations, and enhance nurses' awareness of practicing law and risk. Strictly implement the operation details, standardize the nursing behavior, strictly implement the system of "three checks and seven pairs", check the patient's name before medication, and use the "telephone response method" to check. Implementing flexible scheduling and increasing the number of workers during the infusion peak period can alleviate the work pressure and avoid making mistakes when busy. -strengthen the inspection of infusion to prevent accidents. It is the basic duty of nurses to observe the condition and patrol the infusion during the infusion. For elderly patients and critically ill patients, it is particularly important to set up inspectors to check the infusion site, deal with the failure of infusion, replace the infusion bottle in time, fill in the infusion card carefully, and ask whether the patient is unwell. Nurses adjust the infusion speed according to the condition, age, physique and drug nature, carry out relevant health education for different patients, strengthen nurse-patient communication, establish a good nurse-patient relationship, and fully integrate into humanistic care. -Observe aseptic operation, stack, control infection, and cut and disinfect ampoules correctly. The length of the separation mark of "not easy to analyze" ampoules should be less than 1/4 of the neck. Wipe the neck with 75% alcohol cotton swab before opening, and avoid knocking the ampoule with tweezers and other items. Avoid repeatedly piercing the bottle stopper with a large needle when adding medicine to prevent insoluble particles from polluting the liquid medicine. The correct aspiration method should be used to aspirate the liquid medicine correctly. The needle should be placed in the middle of the ampoule. Do not hold the syringe horizontally when pumping medicine. Syringes used for pumping drugs should not be reused to ensure that the syringes are in a sterile state. Strictly clean and disinfect crutches before washing hands, and emphasize that nurses should wash their hands with disinfectant after venipuncture for the third patient before puncturing the third and second patients. Operators should strictly implement the principle of disinfection and isolation. The treatment environment is clean and the treatment table is disinfected as usual. In the process of liquid preparation and infusion, reduce people flow, avoid sweeping the floor and making the bed, and reduce dust particles in the air. There are many factors affecting the safety of intravenous infusion, which are closely related to nurses' professional knowledge, puncture technology, work responsibility, liquid quality and patients' physical condition. To improve the quality of infusion and ensure the safety of infusion, every nurse must attach great importance to it, strengthen safety awareness and quality service awareness, be cautious, meticulous and patient, take preventive measures in place, find out existing or potential safety hazards in infusion in time, grasp every link in operation, and effectively prevent medical accidents and disputes.