The application of homemade signs in risk management in psychiatric wards
The application of smiley signs can make some nursing staff change their thinking and change their concepts of quality and doing things, which in turn strengthens the nursing staff's awareness of safety, service consciousness, reduces the occurrence of errors and accidents, and provides patients with safe and high-quality nursing services. The following is a sample of my J.L's paper on the application of homemade signs in risk management in psychiatric wards for you to share.
Abstract Purpose: Self-designed psychiatric risk prevention signs to improve nurses' awareness of risk prevention and reduce nursing risks. Methods: for the common types of psychiatric risk, with different colors and sizes of smiley face stickers in the bedside card and checklist for identification, each shift nurses can clearly understand the patient's risk type, and provide targeted nursing measures. RESULTS: After the use of smiley face marking, the incidence of common risks of patients decreased (p<0.05), and the main risks of psychiatry (suicide, violent behavior, and walking out) decreased from 12% of in 2014 to 8% in 2015 (p<0.05). CONCLUSION: Smiley face signs are clear and eye-catching, operational, beautiful and practical, can warn and remind health care workers, prevent accidents, reduce the occurrence of adverse events, improve the quality of medical services, and can be clinically promoted.
Keywords smiley logo; psychiatry; risk management
Psychiatric nursing is a high-risk, high-responsibility job. Mental illness patients often due to the impact of psychiatric symptoms or serious mental stimulation and other reasons and a variety of critical events: suicide self-injury, violence and injury, outside the walk, etc.; or due to long-term use of antipsychotics, there may be dysphagia, postural hypotension, excessive sedation, and other adverse reactions, which increases the risk of choking patients, falling down and falling out of bed. Such behaviors are insidious, sudden, impulsive and unpredictable, and correctly identifying and analyzing these risk factors is a prerequisite for risk management. Based on the actual experience of clinical work, our department independently designed the smiley face logo and applied it to the clinic, which effectively improves the risk awareness and execution of nursing staff, and reduces the occurrence of accidents.
1 Objects and Methods
1.1 Objects
The patients who were hospitalized in our department in 2014 and 2015 were diagnosed as patients with mental disorders and met the ICD-10 diagnostic criteria. Among them, there were 603 patients with nursing risk in 2014, 317 males and 286 females, aged 14-78 years, with a mean age of (43.2?14.9) years. 691 patients with nursing risk in 2015, 378 males and 313 females, aged 14-82 years, with a mean age of (46.7?16.2) years. The main diagnoses were schizophrenia, depression, bipolar disorder, alcoholism psychiatric disorder, and Alzheimer's disease.
1.2 Design and application of risk prevention signs
1.2.1 According to the common critical events in psychiatry, the department has designed five kinds of prevention signs
Uniformly using the smiley face style, the red smiley face to prevent self-inflicted suicides, the yellow smiley face to prevent impulsive injuries and destruction of objects, the blue smiley face to prevent walking away from the house, the purple smiley face to prevent falling down from a fall into the bed, and the green smiley face to prevent choking and swallowing of foreign objects. The list of smiles is shown on the top of a one-centimeter diameter chart. The list above the use of one-centimeter diameter smiley, bedside card above the use of two-centimeter diameter smiley, each color of the smiley in the bedside card and the list above the position of the fixed: in order of red, yellow, blue, purple, green.
1.2.2 Use of Risk Prevention Signs
At the time of admission of new patients to the psychiatric unit, nursing staff conducted risk assessments for adverse events, including: assessment of risk behaviors for episodic aggression, assessment of suicidal risk behaviors, assessment of fall risk, assessment of risk of walking away, and assessment of risk of choking 5 items, respectively. The assessment found that in 2014, 105 patients were at risk of suicide, with 4 cases actually occurring; 219 patients were at risk of violent behavior, with 47 cases actually occurring; 178 patients were at risk of walking, with 9 cases actually occurring; 86 patients were at risk of falling, with 9 cases actually occurring; 15 patients were at risk of choking, with 3 cases actually occurring; 127 patients were at risk of suicide, with 2 cases actually occurring; 237 patients were at risk of violent behavior, with 2 cases actually occurring; and 237 patients were at risk of falling, with 9 cases actually occurring. In 2015, there were 127 patients at risk of suicide, with 2 cases actually occurring; 237 patients at risk of violence, with 36 cases actually occurring; 196 patients at risk of wandering, with 6 cases actually occurring; 114 patients at risk of falling, with 6 cases actually occurring; and 17 patients at risk of choking, with 2 cases actually occurring. There was no statistically significant difference between the two groups (p>0.05), which is comparable.
According to the assessment score to determine the risk level, and in the bedside card and checklist for smiley face identification. Responsible nurses assessed patients daily and tore off the corresponding smiley face if the patient's condition improved and the risk was lifted; if the patient's condition was serious and new risks appeared, the corresponding smiley face was labeled. A handover is performed so that the nurse on each shift is aware of the patient's risk.
1.3 Statistical methods
SPSS21.0 statistical software package was used, and statistical analysis was performed with the chi-square test. p<0.05 means that the difference is statistically significant.
2 Results
(1) By comparing the risk incidence of suicide, violence, walking outside, fall, choking and swallowing foreign objects in our department before and after the use of smiley face signs, 2015 was lower than that of 2014, as shown in Table 1.
(2) By comparing the total incidence of risk in our department before and after the use of smiley face signs. 2015 was lower than 2014, and the difference was statistically significant (P<0.05); at the same time, the total incidence of the main types of risk in the psychiatry department (suicide, violent behavior, and walking out) was also statistically significant (P<0.05).
3 Discussion
(1) Nursing logo refers to the protection of clinical medical care and patient safety, to ensure that the nursing work is carried out in an orderly manner, the quality of care is effectively improved, the application of standardized patterns, text on the nursing work need to be warned to remind. Work links for the industry characteristics of the general name of the logo. The implementation of the three preventive warning signs is to transfer the possible risk events to the ex ante prevention of a kind of forward management methods and prevention-oriented thinking, so that the staff of the ward unit to take effective intervention, to prevent before it is too late. Standardized, eye-catching signs can give people a warning message, so that they will react to it and be touched by it, thus influencing their thoughts and behaviors. The design of the smiley logo is eye-catching and aesthetically pleasing, fully reflecting the science, relevance and art. The use of the smiley face logo increases the nursing staff's awareness of risk, so that nursing staff are more adept at evaluating patients when they are admitted to the hospital and understand the real situation of patients in order to take targeted measures for patients at risk.
(2) In addition, the smiley face logo is easy to paste and remove, so it is convenient for nursing staff to dynamically assess the patient, and according to the changes in the patient's condition in a timely manner to replace; and the smiley face design, to reduce the writing of the text, not only to reduce the nursing staff's workload, but also to protect the patient's privacy is conducive to the protection of the patient's privacy, and the patient to feel the warmth and care, which fully embodies humane care.
(3) In short, the application of the smiley face logo, can make some nursing staff to change the mindset, change the quality of the concept of doing things, and then strengthen the nursing staff's awareness of safety, service consciousness, reduce the occurrence of errors and accidents, to provide patients with safe, high-quality care services. However, due to the short time of use of the smiley face logo, its specific function to be further investigated and studied.
References
[1] Li Lingjiang, ed. Psychiatric Nursing [M]. Beijing: People's Health Publishing House,2006:6,2.
[2] Wang Xueling. Nursing risk management in psychiatric wards[J]. China Medical Science,2011(24):120-121,138.
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