Obstetrics emergency center management system
A, maternal emergency management, monitoring system
1, wherever possible. In the case of emergency patients, obstetrics rescue team members, the doctor in charge, the attending physician, must immediately arrive at the scene, by the director of the unified command of the organization for intense and orderly rescue. And report to the emergency center emergency team leader.
2, the head nurse led by the nurse, closely cooperate with the doctor for rescue, ready to all rescue drugs and equipment.
3, by a nurse dedicated to closely observe the patient's vital signs and a variety of monitoring data changes, accurate records, at any time to report to the relevant doctors, timely treatment.
4. The doctor in charge (or the doctor on duty) is responsible for recording the changes in the patient's condition in detail, and issuing the medical prescription and the relevant checkups.
5, strict implementation of medical advice, careful care to prevent cross-infection.
6, keep the rescue room quiet, clean.
7, doctors and nurses do a good job of shift handover, in addition to shift records, but also to do a good job of bedtime shift.
Two, maternal transport first aid system
1, with a variety of difficult labor diagnosis and treatment techniques, obstetrics and neonatal critical care, anesthesia and other technologies and corresponding equipment and first aid drugs, and first aid items at any time in a functional state.
2. The emergency telephone number is publicized to the whole society, and the 24-hour duty system is implemented to receive pregnant women and mothers free of charge. The car will be dispatched within 5 minutes after receiving the call, and the critical pregnant women will be disposed of within 5 minutes after arriving at the hospital.
3, in remote areas or areas with inconvenient transportation, the community should be mobilized to solve the transport and manpower needed for referral to the clinic, if necessary, on the one hand, manpower to transfer the mother, at the same time by the hospital ambulance, a combination of the two methods, to shorten the transfer time as much as possible.
4, referral, receiving medical personnel in the transfer of pre-hospital first aid. And according to the needs of the condition, keep in touch with the hospital in order to better prepare for the resuscitation.
3, the requirements of the referral process: hospitals in case of particularly critical or combined with serious complications of maternal, the hospital in the technical or equipment difficulties should be transferred in a timely manner. Patients transferred from lower hospitals must be carefully received and timely feedback on diagnosis, treatment and outcome of treatment.
Three, high-risk pregnancy management system
1, doctors in the early pregnancy card, should be asked in detail about the medical history and delivery history, careful examination, timely detection of high-risk factors. According to the high-risk scoring standards, pregnant women should be screened regularly for high-risk factors, register the scores and high-risk markers, and record high-risk pregnancies in a special book, and implement special case management, so as to achieve early detection, early diagnosis and early treatment, and closely follow up the follow-up.
2, strict implementation of high-risk outpatient clinic diagnosis and treatment routines, difficult to deal with critical patients have difficulties, should promptly take the initiative to ask for consultation with higher-level physicians.
3, the grass-roots transfer of high-risk pregnant women must be registered, feedback on the condition; high-risk transfer back to the original unit for exchange management.
4. High-risk pregnant women must request hospitalization for delivery. After admission, the medical staff must understand the medical history in detail, carry out the relevant examination, do a good job of explaining and comforting, health education for the condition, in order to relieve the patient's fear and concern, close observation of the condition, early detection of problems and timely treatment.
5, in the case of conditions, the critical and painful moaning patients should be placed separately, when the condition is serious, should maintain sedation, pay attention not to affect other patients.
6, to keep the ward quiet, to ensure that the patient rest, rationalize the work time, try not to carry out inspection and treatment during the patient's rest time.
7, to maintain air circulation in the ward, open the window every morning to ventilate once, urinal at any time to wash, sputum and garbage should be dealt with in a timely manner to maintain cleanliness and hygiene.
8, do a good job of collecting, organizing, analyzing and reporting relevant information.
Four, consultation system
1, in case of difficult cases, should apply for consultation in a timely manner.
2, inter-disciplinary consultation: proposed by the physician, the superior physician agreed to fill out the consultation form. Invited physicians should generally be completed within the same day, and write consultation records. If you need specialist consultation of light patients, you can go to the specialist examination.
3, emergency consultation: the invited personnel, must come with the invitation.
4. Intra-departmental consultation: proposed by the physician or attending physician, the chief of the department called the relevant medical personnel to participate.
5, hospital consultation: proposed by the director of the department, agreed by the Medical Department, and determine the consultation time, notify the relevant personnel to participate. Generally by the director of the applicant section, the medical department to be attended.
6, out of hospital consultation: the hospital can not be diagnosed and treated difficult cases, proposed by the director of the department, agreed by the Medical Department, and contact with the relevant units to determine the consultation time. Invited hospitals should assign the director or attending physician to go to the consultation. The consultation shall be conducted by the chief of the requesting department. If necessary, carry the medical records and accompany the patient to the consultation outside the hospital. Medical records can also be sent to the relevant units, written consultation.
7, the department, the hospital, outside the hospital collective consultation: the physician should be a detailed introduction to the history of the disease, and do a good job of consultation before the preparation and consultation records. In the consultation, detailed examination, carry forward the technical democracy, and clearly put forward the consultation opinion. The moderator should make a summary and carefully organize the implementation.
V. Neonatal asphyxia resuscitation, obstetrics and pediatrics cooperation system
1, all high-risk pregnant women or estimated in the delivery of newborns may be harmful, in the delivery of the pediatrician should be notified in advance to the scene, and to do all the preparations for the resuscitation of neonatal asphyxia.
2. Obstetricians and gynecologists or midwives should work closely with pediatricians to resuscitate the newborn.
3, the pediatrician at the birth and discharge of newborns to conduct a physical examination. The mother and baby in the same room of the newborn to do a good job of health care, at least twice a day to check the room, found that the problem, timely treatment. If necessary, transfer to pediatrics for treatment.
4, health care, obstetrics and pediatricians should work closely together to manage high-risk perinatal infants from pregnancy, delivery to puerperium *** together.
5. Pediatricians should give parents information about their newborns, and instruct and educate mothers about newborn care.
6, the health department and pediatrics *** with high-risk newborn follow-up work.
V. Discussion system for acute and critical illnesses and deaths
1. Discussion of acute and critical illnesses: In all cases of acute and critical illnesses, a discussion should be organized immediately, presided over by the chief of the department or attending physician, with the participation of the relevant personnel, to discuss seriously, and to make a clear diagnosis as soon as possible, and to put forward a treatment plan. The discussion is recorded in the medical record.
2, preoperative case discussion: major, difficult and secondary surgical cases must be preoperative discussion. Chaired by the director or attending physician, surgeons, anesthesiologists, nurse practitioners, nurses and other relevant personnel to participate. Propose surgical program, postoperative observation matters, nursing requirements. For cases requiring a second operation, the reason for the operation must be put forward. The discussion is recorded in the medical record.
3, the death of the case seminar: where the death of the case, generally should be held within a week after the death, special cases should be discussed in a timely manner. Autopsy cases, to be carried out after the pathology report, but no later than two weeks. Chaired by the section chief, medical and related personnel to participate, if necessary, please send people to participate in the medical section. The discussion is recorded in the medical record.
Seven, critical patient rescue report system
1, strengthen the organization and leadership of critical patient rescue work, active, timely and effective rescue, to achieve the implementation of the organization, the implementation of the system, the implementation of measures.
2, in the event of critical patient rescue, should immediately report to the first aid team leader to organize rescue, and at the same time to the dean and the competent administrative department of health report.
3, where a critical patient is being resuscitated, to routinely fill out a critical illness notification form in triplicate, respectively, reported to the Medical Department, family or unit, leaving a copy into the medical record. And the development of their condition and prognosis for the detailed account and description, do a good job of thinking.
4, where the rescue of the patient, must be recorded in detail the changes in condition and treatment and effect, timely summary and analysis of the situation, in order to supplement, modify or adjust the treatment plan. Emergency consultation should be requested when necessary.
Eight, first aid drugs, equipment management system
1, rescue room (maternity ward) of the first aid drugs to strengthen the management of the implementation of the four: fixed personnel management, fixed base preservation (after the use of timely replenishment), fixed location storage, fixed time inspection, found that the expiration of the expired or deterioration of the drug in a timely manner to clean up, and timely replenishment, to ensure that the rescue drugs are useful at any time. The management personnel check once a day, the head nurse supervises once a week, and the nursing department supervises once a month. The supervisor will conduct random inspection at any time.
2, all configured instruments and equipment, strictly in accordance with the operating procedures, are not allowed to loan and move position (such as special circumstances must be loaned by the relevant leadership should be approved),
3, to keep the instrument clean, all instruments must be cleaned and disinfected in a timely manner after use, if any damage should be promptly reported to the relevant departments or personnel for repair, to maintain the functional status of the resuscitation equipment.
4, obstetrics medical staff must master the use of various monitoring equipment in the rescue room.
9, rescue blood management system
1, blood distribution and transfusion staff should be highly responsible and skilled operating techniques to ensure the safety of blood transfusion.
2. They should strictly control the indications for blood transfusion and fulfill the approval procedures.
3. Before blood transfusion, patients or their families should be talked to and signed.
4, before transfusion often stipulate the blood type and use the correct cross-matching method.
5. To ensure that the input blood is not repulsive to the patient's blood, two people must check at the same time to confirm that the blood or blood components and the patient receiving the transfusion are correct and sign.
8. Strictly implement the "three checks and eight pairs". Checking the expiration date of blood and containers (bags), checking the quality of blood, checking the transfusion device; the patient's name, bed number, hospitalization number, blood bag number, blood volume, blood type, blood type, cross-matched blood labs, including the name of the donor, blood type, number, cross-matched blood labs and so on.
7. Drugs cannot be added to blood or blood components to be transfused together.
8. The speed of blood transfusion is decided according to the condition. In principle, the speed should be slow at the beginning, 5ml/min, and the speed should be increased appropriately after observing no abnormality for 10-15 minutes, and accelerated or slowed down as appropriate in acute hemorrhagic shock or poor cardiac function.
9, strict implementation of aseptic technology and operating procedures, the implementation of one person, one needle, one tube,
10, after the transfusion, the transfusion reaction record card should be sent back to the blood bank within 24 hours, the remaining blood in the bottle should be retained for 24 hours, in order to be prepared for the occurrence of transfusion reaction review.
Ten, accept the referral of patients feedback system
1, the establishment of mother and child safety green channel, to ensure that the jurisdiction of high-risk maternal referral 24 hours unimpeded.
2. The referral unit will fill out the high-risk referral notification form according to the higher level requirements in duplicate (one copy will be deposited in the referral unit, and one copy will be handed over to the receiving unit).
3, the receiving doctor should be a detailed understanding of the condition and medication, do a good job of shift work, if necessary, to participate in the rescue, and do a good job of pre-hospital emergency records and reception of the relevant registration.
4, after the patient is discharged from the hospital will be diagnosed, treatment, treatment, outcome and other information by telephone feedback to the referral unit of the Department of Obstetrics and Gynecology. If a high-risk pregnant woman sent by a doctor has been diagnosed at that time, the situation should be immediately fed back to the doctor and the referring doctor should be instructed to participate in the treatment in order to improve his/her business skills.
5. The number of high-risk pregnant women in the previous month will be reported to the Health Care Section by the 4th of each month, and the roster of high-risk pregnant women for the whole year will be reported to the Health Care Section by the 4th of October every year.
XI, maternal workflow chart system
XII, business training system
1, by the hospital's Continuing Education Leadership Group is also managed. Medical Department, Nursing Department is responsible for the daily work and plans and specific implementation.
2, training time: at least 2 times a year for the first aid team personnel training and exercises.
3, training content: professional ethics, a variety of rescue routines, the use of first aid instruments, cardiac arrest artificial resuscitation techniques, acute cardiac failure, hemorrhagic shock rescue, rational use of blood, the use of first aid medicines.
Thirteen, the rescue team work system
1, the rescue team must have a high sense of responsibility, to ensure smooth communication, on-call, rescue patients to do personnel in place, quick action, organized, every second.
2, rescue to do a clear division of labor, close cooperation, follow the instructions, and stand firm.
3, the rescue personnel must be skilled in all kinds of rescue technology and rescue routine, to ensure the smooth progress of rescue.
4, closely observe the changes in condition, carefully and timely writing records. Record content is complete and accurate. Record time should be specific to the minute. Failure to record in a timely manner, the relevant medical personnel should be within six hours after the end of the resuscitation of truthful record, and to explain.
5, strict shift handover system and checking system, in the process of patient resuscitation, the correct implementation of medical advice. Verbal medical advice requires accurate and clear, the nurse must be reviewed before the implementation of a confirmation of error before implementation; retain the ampoule for checking afterwards.
6, after the end of the resuscitation in a timely manner to clean up a variety of items and preliminary processing, registration.
7, conscientiously do a good job in the resuscitation of the patient's basic care and life care. Agitation, coma and confusion, plus bed stalls and take protective restraints to ensure patient safety. Prevent and reduce the occurrence of complications.
8, daily check the rescue items, shift handover, so that the account is consistent. A variety of first aid medicines, equipment and goods should be "five": a fixed number of varieties, a fixed place, a special management, regular disinfection and sterilization, regular inspection and maintenance. Rescue items are not allowed to be appropriated or borrowed arbitrarily, and must be in an emergency state. Sterile goods must indicate the date of sterilization, to ensure that the use of the expiration date.