Nursing defects refers to the nursing activities, due to violation of health care laws, regulations and nursing norms and other aspects of nursing technical service management errors. Nursing defects and nursing errors and accidents are not the same criteria, nursing defects contain a wide range of content, including accidents, errors and shortcomings that do not constitute an error.
Second, the judgment of the accident
The definition and analysis of nursing accidents are in accordance with the Ministry of Health promulgated the "Regulations on Medical Accident Handling and Grading Standards". In nursing activities, one of the following nursing behavior is an accident.
1, nursing staff work negligence, such as shift handover is not serious, observation of the condition is not strict, not on time rounds of the ward, etc., failed to timely detect changes in the condition of the loss of rescue time, resulting in the death of the patient and serious personal injury.
2. Nursing staff seriously violated the operating procedures, such as not seriously implement the medical advice and checking system, transfusion of the wrong blood, wrong injection, the wrong medicine; poor nursing care occurs serious burns, Ⅲ decubitus ulcers; coma, restless patients or children did not take safety measures to cause the patient to fall off the bed, the ligature tourniquet is not released in time, resulting in necrosis of the tissues, limb disability; constitutes a case of the above events, resulting in patients with serious adverse consequences or personal injury. Personal injury.
3. The instrument nurse or visiting nurse in the operating room has made a mistake in counting gauze and instruments, resulting in the retention of gauze or instruments and other foreign objects in the patient's body or soft tissues.
4, nursing staff in the emergency, critical, serious patients in the process of resuscitation, resuscitation drugs and supplies prepared in error, delayed resuscitation caused by the patient's death or serious personal injury.
5. Issuance of unsterilized or expired surgical bags and other items, resulting in serious infections.
6, local injection caused tissue necrosis, body surface area of adults greater than 2%, children greater than 5%.
Third, the classification of nursing errors and determination criteria "medical incident regulations and grading standards" in the abolition of the concept of medical errors and classified as a fourth level of medical errors, but in the nursing work of the accident is only a very small number, nursing errors are still common. Therefore, the prevention of nursing errors can effectively prevent the occurrence of nursing accidents. According to the degree of error can be divided into two categories of serious errors and general errors.
1, serious error refers to the nursing activities, due to the nursing staff's own reasons or technical reasons to the patient caused serious adverse consequences, but not yet constitute a nursing accident. Any of the following behaviors should be regarded as serious errors.
(1) Nursing staff did not seriously implement the medical advice and checking system, wrong use, omission of "poison, anesthesia, limited, dramatic" drugs and special therapeutic drugs (such as antineoplastic drugs, special cardiovascular drugs, rescue drugs, anesthetics, insulin, etc.) or the above drugs occurred in the delivery, concentration, dose, time, route and other errors, causing serious harm to the patient. The above drugs have been administered, concentration, dosage, time, route, etc., causing serious adverse consequences or significant impact on the patient.
(2) Nursing staff violated the operating procedures. Such as the use of allergic drugs, wrong or not in accordance with the provisions of the allergy test or the original history of drug allergy to give medicine; wrong baby but found in time, the collection of pleural fluid, ascites, blood, body fluids and other specimens, due to the collection of the wrong specimen, mislabeling, wrongly added anticoagulant drugs need to be re-collected or damaged, lost biopsies sent to the test specimens, resulting in serious adverse consequences or a significant impact on the person.
(3) Those who caused serious adverse consequences or significant impacts due to improper nursing care, such as causing Ⅱ degree pressure ulcers, superficial Ⅱ degree or less burns or infant buttock eruption, improper position of the patient during the surgery causing skin pressure injury and dysfunction, and bed-ridden patients who fell out of bed due to improper nursing care.
(4) In the process of infusion, due to poor nursing care caused by irritation or concentration of drugs leaking in the subcutaneous, causing local necrosis, the body surface area of adults less than 2%, children less than 5%.
(5) The person who, due to negligence, mistakenly distributes unsterilized or unqualified sterilized items, causing a significant impact.
(6) Nurses who lacked the sense of discretion, altered medical records, or falsified medical records, causing significant impact.
(7) A nurse who misplaced a newborn's wristband or held a newborn in the wrong position while breastfeeding, which was detected and corrected, but had a significant impact on the patient.
2. General error refers to the nursing activities, due to the nursing staff's own reasons or technical reasons for the occurrence of errors, but did not cause adverse effects to the patient or mild impact. For example, one of the following nursing behaviors should be regarded as a general error.
(1) The interruption or omission of general treatment due to a poor shift handover.
(2) Failure to carefully implement the checking system, the general drug treatment with the wrong injection, the wrong medicine, the wrong treatment, did not cause adverse effects on the patient.
(3) Clinical care (including basic, critical, and specialized care) fails to meet the standard requirements, and the unit causes adverse consequences.
(4) Various nursing records do not meet the requirements of the relevant regulations, the project is not filled out, but did not cause adverse effects. (5) The specimen is not retained in time, but does not affect the diagnosis.
(6) various drainage tube is not timely found, treatment or care of improper drainage tube dislodgement and need to re-insertion, but no adverse consequences.
(7) The poor management of rescue medicines and items that are not in good condition, without adverse consequences. (8) The infant's buttock is mildly eroded due to poor nursing care.