First, basic nursing
Basic nursing is an indispensable part of patients' daily care, including the care of ward, hair, mouth, skin, various catheters, admission and discharge. Its standard is that patients should be clean, tidy, comfortable, safe and without complications.
This standard requires:
Six clean: facial features, hair, hands and feet, perineum, anus and skin are clean. (recorded once a week)
Three short hair: short hair, beard and nails. (recorded once a week)
Four noes: no bedsore, no bed drop, no mistakes, no accidents and no complications.
Fourth, timely: inspect the ward in time; Observe the condition in time; Report the illness in time; Timely disposal and rescue.
3. Maintenance: keep all kinds of catheters in correct and unobstructed positions, and keep the bed unit clean, tidy and flat, without urine stains and blood stains; Keep the patient in a comfortable lying position, which meets the requirements of treatment and nursing.
The qualified rate of basic nursing quality = qualified number of examination items/total number of examination items × 100% ≥ 90% (health education coverage rate reaches 100%).
Specific content: 1, according to patients' needs, including ① nursing activities to meet patients' basic needs. For example, the basic nursing content is put forward from the aspects of patients' physical health and healthy life. Including breathing, circulation, body temperature, diet, excretion, cleaning, environment, activities, rest, posture, posture and other aspects of assistance. For example, gargling and brushing teeth are the basic habits for people to keep their mouths clean. When patients can't brush their teeth and rinse their mouths because of illness, they must change to oral care to make their mouths clean and moist, remove bad breath, make patients comfortable and increase their appetite; At the same time, observe whether there are abnormal changes in gums, tongue coating and mucosa. ② Nursing activities to meet patients' psychological needs. Mainly refers to the changes in the living environment and lifestyle of hospitalized patients, coupled with the impact of diseases on the body, will produce a series of psychological reactions, such as anxiety, fear, pessimism, dependence, doubt, depression and so on. At this time, nurses should understand the psychological characteristics of patients, carry out targeted nursing, and relieve the psychological pressure of patients and various psychological reactions that are not conducive to treatment and rehabilitation. Psychological nursing can run through all kinds of nursing activities, for example, when assisting patients to eat, while giving dietary guidance, pay attention to creating an adaptive eating environment to promote appetite. And make use of the kind smile, concerned expression and proper skin contact of the nursing staff. These verbal and nonverbal communication have a special soothing effect on patients.
③ Nursing activities to meet patients' treatment needs. In the course of treatment, if patients want to change some physiological states, such as semi-recumbent position after abdominal surgery, they often need the assistance of nurses to promote infection localization, reduce wound suture tension, relieve pain and promote healing. Nurses' observation of patients' vital signs, correct collection of specimens and timely implementation of medication orders also meet their treatment needs through basic nursing techniques.
2. According to the importance and urgency of nursing activities to patients, including ① general nursing techniques: entry-exit nursing, various bed-making methods, graded nursing, psychological nursing, life nursing, diet nursing, morning and evening nursing, nursing to prevent complications, corpse preparation, disinfection and isolation technology, disease observation, drug treatment, writing and recording of nursing documents, etc. ② Common rescue techniques: oxygen supply, sputum aspiration, blood transfusion, gastric lavage, chest compression, intracardiac injection, hemostasis and dressing, fracture fixation, application of emergency medicine, ECG monitoring, artificial respiration and use of artificial respiration machine. ③ Basic nursing routine and system: such as work system and disease nursing routine.
Second, the quality of intensive care and primary care.
Standard: "Seven Knows" and "Four Possesses" are required.
Seven know: know the bed number, name, diagnosis, illness (symptoms, signs, key laboratory results), treatment, nursing, diet. Implement the requirements of basic nursing quality standards.
There are four points: there are nursing plans and complete nursing records for intensive care patients; There are nursing points for critically ill patients and patients after major surgery; Have a complete and accurate nursing ward round record; Patients with consciousness disorder have safety precautions.
Prepare first-aid articles according to the needs of the illness and keep them in good standby condition.
The qualified rate of first-class nursing quality in intensive care = qualified number of examination items/total number of examination items × 100% ≥ 85% standard value 95%.
Criterion for intensive care patients
(1) 24-hour nursing.
(2) Make a nursing plan according to the requirements of basic nursing standards.
③ Prepare first-aid medicines and equipment.
④ The monitored patients should master and skillfully use various monitoring facilities.
⑤ Establish intensive care records and closely observe vital signs.
⑥ Correct and timely treatment, specimen collection and nursing.
⑦ Effectively prevent complications.
First-class nursing standards
(1) First-aid materials applied when necessary shall be provided according to the condition.
(2) Do morning and evening nursing according to the requirements of emergency nursing to prevent complications.
③ Observe the condition closely according to the condition (15-30 minutes).
(4) Make nursing plan and implement nursing measures.
Three. Preparation of first aid drugs and equipment
There are four requirements: fixed number, fixed position, fixed brand and fixed disinfection time.
Three noes: no liability damage, no drug deterioration and no expiration.
Timely: timely inspection and maintenance, timely collection and supplement.
The qualification rate of first-aid drugs and devices = number of qualified items/total items × 100% = 100%.
Standard: 1, ambulance
① All parts of the ambulance should be clearly marked, the articles should be placed and fixed, and there should be an external massage board.
(2) Rescue articles, equipment and medicines should be placed in a unified location, and all staff, including foreign trainees, should be familiar with all kinds of medicines and equipment in the rescue vehicle.
(3) injection needles, sterile forceps and all kinds of disinfection materials (need to be disinfected regularly to ensure ready use).
(4) blood transfusion (liquid) and commonly used first aid kits (electrostatic cutting, gas cutting, etc.). ).
⑤ First aid appliances for tracheal intubation and power wiring board (power circuit is normal).
2. Oxygen equipment
(1) Pipeline oxygen supply, check the pipeline regularly to ensure normal operation. Oxygen cylinder oxygen supply should have a fixed place, oxygen cylinder bracket car.
② All components of the oxygen flowmeter function well.
(3) The oxygen humidifying bottle is disinfected regularly and is in standby state.
3. Suction device
Regularly check the integrity of the power supply, connector and pipe wall of the suction device, the suction nozzle connector should be connected well, and the suction bottle should be disinfected and fixed regularly.
4, the storage of first aid supplies
(1) intact, fixed, in a standby state.
(2) regular inspection and maintenance, timely supplement.
(3) Special personnel shall keep it, check it regularly, place it at a fixed point, supply it quantitatively, and disinfect it regularly.
4. Writing quality of nursing documents (ward duty report, temperature list, doctor's advice record list, nursing record list and doctor's advice list)
General standard: ① The handwriting is correct and clear, there is no typo, and it is useless to alter it with a special pen. (2) the content is informative, the record is timely, the disease description is accurate and concise, the focus is prominent, the level is clear, and medical terms are used. (3) The circle line of temperature drawing point is straight, uninterrupted and without leakage; (4) the doctor's advice is copied correctly, the Latin writing is up to standard, the execution time is accurate, the full name is signed, and the review is correct.
Qualified rate of nursing document writing = qualified number of nursing documents/total number of sampling nursing documents × 100% ≥ 90%.
Verb (abbreviation of verb) Ward management quality
Standards: ① Ward management should have a strict division of labor, define the responsibilities, working procedures, quality standards and prosecution methods of personnel at all levels, and have a sound management system for recuperators. ② There are four aspects in nursing quality management: there are measures to implement nursing quality control standards; There are detection methods; Having an analysis and evaluation system; There is a sound statistical system for monthly reports. ③ Professional training and scientific research management: there are nursing teaching, scientific research and professional training plans, implementation measures and assessment systems. ④ Environmental management: neat, quiet, orderly, comfortable and safe. ⑤ Material and equipment management: including medicines, equipment, clothing, camping equipment, office supplies, etc. Do: material classification, account establishment, periodic inventory, materials and accounts are consistent, and use and consumption are registered; Goods management should not be overstocked, lost or deteriorated. Drugs limited to toxic drugs and hemp should be delivered in the specified quantity at the time of each shift, and locked for safekeeping.
Calculation formula: qualified rate of ward management = number of qualified inspection items/total number of inspection items × 100% ≥ 90%.
6. Nursing mistakes
(1) Evaluation criteria for errors and accidents All the errors that occurred in nursing work due to weak sense of responsibility, carelessness, non-compliance with rules and regulations or low technical level had a direct or indirect impact on patients, but did not cause serious adverse consequences.
(1) A common mistake is one that does not affect the treatment or cause pain to the patient;
(2) Those who affect the treatment effect, bring pain to patients, and prolong the hospitalization time are classified as serious mistakes;
(3) Anyone who causes serious consequences such as disability and death of the patient is designated as an accident.
(2) Annual error rate: serious errors (2 pieces/year, error handling accuracy > 98%) ≤0.5 times/100 beds, and general errors are controlled by each unit system.
General nursing error rate = number of nursing errors/total number of beds occupied by patients × 100%.
(The annual error accident rate is 0, the patient complaint rate is 0, and the patient's satisfaction with nursing work and service attitude is ≥ 95%)
Nursing error rate = number of nursing errors/total times of treatment and disposal × 100%.
Seven, the incidence of bedsore
Bedsore is a complication of long-term bedridden patients and critically ill patients. Special patients are not allowed to turn over regularly for skin care due to illness. For bedsore patients prone to high fever, we must strengthen basic nursing and take various effective measures to prevent bedsore.
The standard value is 0%
Bedsore incidence = number of bedsores/total number of patients who can't take care of themselves in bed × 100%.
Eight. Adjoint rate
Accompanying is related to clinical nursing quality, service attitude and nursing management, as well as medical care and logistics. In nursing management, we should focus on basic nursing work, reassure family members and satisfy patients, and take active storage measures in nursing management.
The standard value of municipal hospitals is less than 5%, and that of district hospitals is less than 8% (Ministry of Health).
Nine, disinfection and isolation qualified rate
Preventing hospital infection is an important content of hospital management. Nurses bear certain responsibilities, so hospitals must establish quality inspection institutions, systems and measures to prevent nosocomial infection, and have the means to test the disinfection and sterilization effect. The standard value is 95%
The qualified rate of sterile articles = number of qualified articles/total number of samples × 100%.
(The qualified rate of disinfection and sterilization of conventional instruments 100%, and the implementation rate of one needle and one tube per person 100%)
make the bed
The sickbed is an appliance for patients to rest and sleep. The diet and excretion of patients who stay in bed for a long time are on the bed, so the sickbed must conform to the principles of use, durability, comfort and safety. Bed units should be kept clean and tidy.
Standby bed
(1) Objective To keep the ward clean and prepare to accept new patients.
(2) Key points of operation
1. Write things on the bedside in the order of use. Remove the desk and chair beside the bed and put things on the chair. Turn the mattress over and unfold it.
2. Requirements for laying large sheets: The front of the large sheets is facing upwards, the center line is aligned with the center line of the bed, and the corners are tightly shaped. Achieve labor-saving, time-saving, smooth, compact and wrinkle-free.
3, quilt cover requirements: the head is full of bed, both sides are folded into a tube shape and flush with the edge of the bed, and the tail is folded at the end of the bed.
4. Put the pillowcase pillow core into the pillowcase with full corners, put it on the bedside and open the back door.
5. Move back to the desk and chair beside the bed.
(3) Precautions
1, the patient stops making the bed while eating or doing treatment.
2. Pay attention to the principle of labor saving, raise the bed that can be lifted to avoid excessive bending, lower the center of gravity when making the bed, expand the supporting surface and enhance the stability of the body.
(4) Operation evaluation
The sickbed conforms to the principles of practicality, durability, comfort and safety, and the environment of the ward and patient unit is clean and beautiful.
Temporary empty bed
(1) Purpose
1, keep the ward clean and tidy to meet new patients.
2. For patients who get out of bed temporarily.
(2) Key points of operation
1. Fold the bedspread for the last three times.
2. Add rubber plate and thin plate appropriately. The center line is flush with the center line of the bed, and the upper edge is 45-50 cm away from the bed.
(3) The precautions are the same as those of the spare bed.
(4) Spare bed for operation evaluation.
Drunk bed
(1) Purpose
1, defecation, reception and nursing of patients after anesthesia operation.
2. Make patients feel safe and comfortable, and prevent complications.
3. Protect bedding from vomit or blood pollution.
(2) Preparation before operation
Evaluate the patient's diagnosis, condition, preoperative preparation, anesthesia, postoperative rescue or treatment. Prepare general anesthesia and heat protection dishes.
(3) Key points of operation
1. Putting a big sheet on one side is the same as using a bed. Align the single piece and the single piece of rubber with the center line of the bed, with the upper edge 45-50 cm away from the bed head, and lay the single piece and the single piece of another rubber at the required position as required. In the same way, lay the big board on the other side, single piece and single piece in rubber.
2. Place the quilt cover on the bedside, with the end of the bed folded outward, the edge of the bed folded inward, and the bedspread folded fan-shaped on the opposite side of the bed.
Put the pillowcase across the bed with the back door open.
4. Move back to the bedside table, chair, square and quilt.
5. Put the anesthesia nursing tray on the bedside table, and put the infusion stand at the end of the bed.
(4) Precautions
1. The anesthesia bed should be covered with clean sheets to ensure the postoperative comfort of patients.
2, depending on the condition required items, such as anesthesia nursing tray, etc.
(V) Operation evaluation
With the spare bed, the patient's care items are complete, and the patient can get timely rescue and care.
Nursing Department March 25, 2005
2. Access record method
1. Daily drinking water: including drinking water, food water content, blood transfusion and blood transfusion. The unit quantity of all solid foods should be recorded, such as 2 steamed buns, 1 bowl of rice and 4 biscuits, and the water content should also be recorded.
2. Daily output: including feces, urine, gastrointestinal decompression fluid, hydrothorax and ascites, vomit, discharged bile, etc.