Request and report system
When major operations such as organ removal, transplantation and amputation are carried out for the wounded and sick, and important new business and technology are carried out for the first time, the department shall report to the medical department (department) for approval by the leaders of the hospital, and apply for the consent of the leaders of the unit where the wounded and sick and their families belong (except in special circumstances) to perform the signing procedures.
When receiving a large number of trauma, poisoning and infectious patients in the emergency treatment of sudden disasters, it shall report to the leaders of the medical department (department) and the hospital in time; When the treatment of the wounded and sick involves legal issues, it should also report to the political department (department); The medical treatment and hospitalization of foreign patients should be reported according to the regulations of the foreign affairs department of large units.
Cadres at or above the division level should report to the medical department (department) and hospital leaders when they are hospitalized. Cadres at or above the corps level shall be reported to the Ministry of Health of large units or the office of the leading group for health care, and cadres at or above the district level shall be reported to the office of the leading group for health care of the whole army.
When patients with infectious diseases (including sexually transmitted diseases) managed by the state are found in outpatients and wards, they should be strictly managed in accordance with the Law of People's Republic of China (PRC) on the Prevention and Control of Infectious Diseases and the Regulations of the Chinese People's Liberation Army on the Prevention and Control of Infectious Diseases, make a good report on the epidemic situation, and notify the health authorities of the troops where the patients belong.
When special infections such as infectious diseases, tetanus and gas gangrene occur in general wards, measures should be taken immediately and reported to the leaders of the medical department and the hospital.
Medical accidents, medical disputes or serious medical care errors should be reported in a timely manner according to regulations. Valuable medical equipment is damaged or stolen, valuable drugs are lost or a batch of drugs are found to be deteriorated, and it should be reported to the medical department (department) and hospital leaders in time.
When the sick and wounded are in critical condition, the department should fill in the "notice of critical illness" and send it to the medical department (department) and outpatient department, and the outpatient department will inform the unit or family members where the sick and wounded are located. When leading cadres at or above the corps level are seriously ill or in emergency rescue, the hospital should report to the Ministry of Health of each major unit or the office of the leading group for health care, and report to the office of the leading group for health care of the whole army at the same time.
After the death of the wounded and sick, the department should fill in the "Death Notice" and send it to the medical department (department), hospital affairs department (department) and outpatient department. When military cadres die, they should be sent to the political department (department) at the same time, and the outpatient department should inform the unit or family members of the wounded and sick. The death of military cadres at or above the division level shall be reported to the hospital leaders in a timely manner; The death of cadres at or above the corps level shall be reported by the hospital to the Ministry of Health or the health care group office of major units and the health care leading group office of the whole army in time. The Death Report of the Sick and Wounded shall be submitted to the Medical Department (room) within 10 days after the death of the sick and wounded, and shall be classified into medical records after being signed by the medical department (room) and hospital leaders.
The department reports to the hospital leaders every quarter 1 time; The hospital reports medical work 1 time to the higher health authorities every six months.
Responsibility and inheritance system
Nurses on duty day and night are set up in each department (the clinical department will increase the staff on duty on holidays). Nurses on duty must stick to their posts, perform their duties, ensure uninterrupted nursing work, and fill in the Duty Record carefully.
When the nurse on duty really needs to leave her post, she must report to the head nurse, who will appoint someone to replace her.
Nurses on duty should closely observe the changes of undergraduate patients' condition and finish the treatment and nursing work on time; Responsible for receiving new hospitalized patients; Check and guide the work of health workers (nurses).
The nurse on duty should do a good job in ward management during the duty time, and report to the superior for instructions in time in case of major problems.
Each department regularly shifts after work in the morning, presided over by the department director and attended by the whole class. The nurse on duty reports the patient's flow and condition changes, such as new admission, critical illness, pre-and post-operation and special examination. And lead the speech, arrange the work of the day, and convey the spirit of the hospital weekly meeting. Shift changes generally do not exceed 15 minutes.
Special examination, critically ill patients should be handed over by the bedside, and special cases should be handed over individually. Narcotic drugs, psychotropic drugs, toxic drugs for medical use and medical devices that need to be handed in shall be handed in face to face.
Strictly implement the handover inspection system, requiring four inspections, five inspections and three inspections.
The fourth look: see whether the doctor's advice is copied, whether it is correctly implemented, whether the three hooks are complete, and whether there is any doctor's advice to be implemented; The doctor's office reports the patient flow throughout the day, the key situation of new, dangerous, surgical and special patients, whether the medical and nursing measures given by each shift are recorded correctly and whether there are any omissions; See whether the body temperature is measured as required, and whether there are patients with high fever or sudden fever; See whether the nursing records are accurate, whether the records of the amount of entry and exit are accurate, and whether there are omissions and errors.
Fifth check: check whether the initial treatment of newly admitted patients is perfect, and whether those with special changes in their condition are treated in time; Check whether the patient's preparation is perfect and whether all kinds of items to be taken to the operating room are ready; Check whether the acute, severe and paralyzed patients turn over on time, whether the bed is flat and free of sundries, and whether the patients have bedsores; Check whether patients with incontinence are properly treated and whether their skin and clothes are clean and dry; Check whether there is bleeding in the wound after major surgery, whether the dressing is appropriate, whether the drainage tube is unobstructed, and whether the treatment is proper, timely and safe.
Patrol: For patients with critical illness, major surgery and special changes in their condition, the shift attendants should * * * patrol with them and carry out bedside shift. In addition to inspecting the illness, the successor also needs to know the patients in the ward, their position and whereabouts, and pay attention to the environmental safety of the ward.
Disinfection isolation system
All consultation rooms, treatment rooms, dressing rooms, dispensing rooms, rescue rooms, intensive care units, operating rooms, preparation rooms, germ rooms, delivery rooms, neonatal rooms, neonatal wards, blood banks, blood purification rooms, aseptic equipment accessory rooms, infusion (blood) equipment cleaning and packaging rooms, isolation observation rooms, infected areas, etc. It should be cleaned regularly and disinfected at any time if necessary.
Medical staff attending classes must wear work clothes and hats, and dress neatly. Wash your hands before and after treatment, or soak in disinfectant. During aseptic operation, you should wear a mask and strictly abide by aseptic operation procedures.
Sterile containers, instruments and dressings should be disinfected and replaced regularly. Medicine cups should be used regularly, cleaned and disinfected. Soak the thermometer in disinfectant after each use. Dental drills and mouthwash cups should be thoroughly disinfected after each use. Sputum cups and toilets should be cleaned and disinfected after use.
Intravenous infusion of sterile liquid must indicate the date, time and specific purpose, and shall not be used after more than 2 hours; All kinds of solvents shall not be used for more than 24 hours after being unsealed and dried.
The treatment room should clearly distinguish between sterile area, clean area and relatively polluted area, and the disinfection items must be marked with disinfection date and duration.
When infectious diseases are suspected, an isolation system should be established in the observation room. When infectious diseases are detected by non-infectious diseases department, they should be consulted in time and transferred to other departments.
Infectious patients should be treated in isolation according to the disease and condition, and they should be active within the prescribed scope, and should not cross wards and go out. When infecting patients to other departments for treatment, isolation and disinfection should be done well; After discharge, transfer, transfer and death, terminal disinfection shall be carried out in accordance with the relevant provisions of the Regulations of the People's Liberation Army on the Prevention and Control of Infectious Diseases.
Workers of infectious diseases should wear isolation gown, shoes and masks when entering polluted areas; People who are exposed to different diseases should change to isolation gown and wash their hands; When leaving the polluted area, you should take off isolation gown and shoes and wash your hands.
The excreta and used articles that infect patients shall be disinfected in accordance with the Regulations of the People's Liberation Army on the Prevention and Control of Infectious Diseases. Disinfected articles shall not be taken out of the infectious disease area or used by others. The old clothes of infected patients should be disinfected before cleaning. Hospital sewage can only be discharged after disinfection.
Patients with special infections such as anaerobic bacteria and Pseudomonas aeruginosa should be closely isolated; Used equipment, clothes and rooms should be thoroughly disinfected; Used dressings and cotton balls should be collected separately and burned.
After discharge, patients should replace quilt cover and pillowcase, bedside table, bedstead and bedside table, and scrub and disinfect with 0. 1% peracetic acid. After the patient is discharged from the hospital after death or infection, the bedding and pillow core in the ward must be disinfected by ultraviolet rays, exposed to sunlight or sealed.
Inspection system
Clinical department
The name, sex, age, bed number and medical record number of the wounded and sick shall be checked when issuing medical advice, prescription or medical treatment.
The implementation of medical orders should be "three checks and seven pairs": check after dispensing: check before taking medicine, injection and disposal: check after taking medicine, injection and disposal. Check the bed number, name, drug name, dosage, concentration, time and usage.
Quality, label, expiration date and batch number should be checked before drug inventory and use. Do not meet the use requirements, shall not be used.
Before taking medicine, you should ask if you have a history of drug allergy. When using narcotic drugs, psychotropic drugs and toxic drugs in medical treatment, it should be checked repeatedly. Intravenous administration, check whether there is deterioration, and pay attention to the incompatibility when using multiple drugs.
Intravenous infusion should pay attention to check: ① whether the infusion bottle, hose and Murphy's dropper are clean and whether there are foreign bodies; Whether the disposable medical infusion set has expired, and whether the packaging bag is damaged or leaked; (2) Check the name and validity of the liquid; (3) Whether the glass bottle is cracked and the bottle cap is loose; ④ Whether the liquid is discolored, turbid or precipitated.
Before blood transfusion, it must be checked by two people before input; Blood transfusion should be closely observed to ensure safety; After blood transfusion, the remaining blood in the bottle is kept for 24 hours and handled by the department.
operating room
When receiving the wounded, check the patient, bed number, name, gender, diagnosis, operation name and preoperative medication.
Check the name, sex, diagnosis and surgical site before operation.
For body cavity or deep tissue surgery, the number of gauze, gauze pad, gauze (cotton) ball, instrument, sewing needle and bobbin should be counted before surgery and suture; After the operation, check it again.
The specimens taken out during the operation should be registered in time, and the subjects, names, positions and specimen names should be checked.
Drug use and blood transfusion should be checked according to the requirements of clinical departments. Narcotic drugs, psychotropic drugs and toxic drugs for medical use must be checked by two people before use.
Attachment: Blood transfusion examination system
Strengthen the education and management of blood transfusion norms, and strictly supervise the implementation of the "three checks and seven pairs" system.
When the blood transfusion department sends blood, it should check the patient, medical record number, bed number, name, blood type, cross-matching test results, blood bottle number, blood collection date, blood quality, blood volume and blood type with the blood collector, and they can be taken away after being signed by both parties.
After the blood is sent out, the blood sample of the recipient should be kept for 24 hours for future reference.
The nurse or doctor takes blood from the blood bank with the blood collection slip, and signs it after checking with the blood collector. Vibration should be avoided when taking blood to prevent the red blood ball from breaking.
Before blood transfusion, two medical staff should check the cross matching report, blood type test sheet, blood bag label, etc., and check whether the blood bag is damaged or leaked, whether the blood color is normal, and whether the plasma is turbid. If in doubt, you should contact the blood bank immediately.
During blood transfusion, two or more executors should go to the bedside to check the patient's name, gender, age, medical record number, bed number, blood type, etc. And confirm that it is consistent with the blood matching report. After the blood test again, under the strict aseptic operation, the standard blood transfusion device was used for blood transfusion.
Before and after blood transfusion, use intravenous saline to flush the blood transfusion pipeline. When the blood of different donors is continuously input, the blood transfusion device in the middle is washed with intravenous saline.
Blood transfusion must be performed within 30 minutes after bleeding, and blood transfusion should be completed within 3 ~ 4 hours (200~300ml).
Blood transfusion card or blood transfusion registration form should be filled in after blood transfusion, and blood bags should be kept for 2 ~ 4 hours to prevent delayed blood transfusion reaction.
Nurse station management system
The nurse station is the nurse's office, so keep the room quiet and no smoking.
The articles in the nurses' station shall be placed neatly and positioned orderly, and the desktop and floor shall be kept clean.
During working hours, employees must dress neatly and dignified.
Staff are not allowed to chat in the nurse station, and non-staff are not allowed to enter the nurse station.
All working hours should be in Mandarin, using civilized language, and no personal calls are allowed without special circumstances.
When you hear the patient's call signal, you should be on call.
Fill in and replace the patient's hospitalization card in time to maintain the accuracy of the number of inpatients, patient information and nursing level.
Ward management system
The head nurse is responsible for ward management, and ward staff and patients actively assist.
Keep the ward quiet, so as to walk lightly, talk lightly, open and close the door lightly and operate lightly.
Ward unit furnishings and other items should be placed in a unified position, and should not be moved without the consent of the head nurse. Inpatients should wear hospital gown and change it 1~2 times a week; The quilt cover, bed sheet and pillowcase in the sickbed unit should be washed 1 time every 0 ~ 2 weeks to keep it clean and hygienic.
Insist on cleaning on time every day, keep the ward clean and pay attention to ventilation. Smoking is prohibited in the ward.
Medical staff attending classes must wear work clothes and hats, and dress neatly. You must wear a mask for aseptic operation.
Strengthen the management of camping equipment and sanitary clothing, establish account books, keep them by special personnel and check them regularly. When the management personnel change, they should go through the handover procedures.
After the sick and wounded leave the hospital, wipe the bed unit with disinfectant in time, change clothes, and disinfect drinking cups, washbasins and sputum cans.
Establish organizations for the sick and wounded, assist in the ideological and life management of the sick and wounded, regularly organize the sick and wounded to learn political, current affairs and health science knowledge, and urge the sick and wounded to consciously abide by the Hospitalization Rules. Do not enter the infirmary without the permission of the medical staff.
Medical personnel are not allowed to chat, laugh and play cards in the infirmary during their duty. They are not allowed to make personal calls, do private things or read non-medical books, newspapers and magazines without special circumstances. Personal belongings are not allowed in the refrigerator of the ward.
Do a good job in the management of escorts and strictly control the number of escorts.
Graded nursing system
After the patient is admitted to the hospital, the doctor decides the nursing level according to the condition and gives the doctor's advice. Nursing grades are divided into special care and primary, secondary and tertiary care, and unified signs are set up respectively, which are displayed on the patient list and bedside cards. During hospitalization, the nursing level should be changed in time according to the change of illness.
Intensive care: patients who may have accidents at any time after critical illness or major surgery. Designate a special person to guard around the clock, make a nursing plan, closely observe the change of illness, prevent complications, prepare all kinds of monitoring instruments, first aid equipment and medicines, prepare for first aid at any time, fill in the "Special Care Record" timely and accurately, and make a summary and induction according to the specified time. The special care sign is a red triangle.
First-class care: patients who need strict bed rest or consciousness disorder after severe or major surgery. Give careful care in life, make nursing plans when necessary, and make nursing records; Closely observe the changes of the disease, and patrol 1 time within 5 ~ 30 minutes; Conscientiously do morning and evening care; Change body position, take a bath and wash your hair regularly according to your illness to prevent complications. The first-class nursing sign is a red vertical bar.
Secondary care: the sick and wounded who are seriously ill or recovering from serious illness and cannot take care of themselves completely. Conduct indoor activities properly and give necessary life help; Pay attention to the change of the disease, and patrol every 1~2 hours 1 time. The secondary nursing sign is a blue vertical line.
Tertiary care: patients with minor illness or convalescence. Take care of yourself under the guidance of medical staff, pay attention to observe the condition, and patrol every 3~4 hours; Take part in some indoor and outdoor activities according to your illness. Do a good job in health and health guidance before discharge.
Critical patient rescue system
For the rescue of critically ill patients, we must clearly define the division of labor, closely cooperate, actively treat, closely observe and record in detail. After the rescue, we should conscientiously sum up our experience.
The rescue of critically ill patients in the department is organized and implemented by the department director, chief physician (deputy) or attending physician, and reported to the medical department (department).
All clinical departments should set up emergency rooms and intensive care units, and drugs and equipment should be located and kept by special personnel, checked regularly and kept in good condition.
Emergency room or monitoring room should have a rescue plan for common critical diseases, and medical personnel should be familiar with the use of common rescue techniques and instruments.
Nursing ward round system
The nursing department makes rounds, mainly in nursing administrative rounds (routine evaluation rounds) or quality rounds (clinical professional rounds) every month, and arranges 1 teaching rounds every quarter.
The head nurse gives priority to routine evaluation rounds or clinical operation rounds every week, and arranges 1 teaching rounds every month.
The head nurse in the ward focuses on clinical professional rounds every day, and arranges/kloc-0 rounds of teaching guidance or routine evaluation rounds every week.
The professional team leader mainly conducts routine evaluation rounds or clinical rounds every day.
Personnel at all levels should strengthen the inspection of patients who are newly admitted to hospital, critically ill, before and after major surgery and after special examination and treatment, keep abreast of the changes in their condition, observe the nursing effect, and report and handle the situation in time.
When teaching rounds, if necessary, please ask the director, director (deputy) or attending physician for guidance, check the quality of nursing, and study and solve nursing problems.
The time of rounds is generally less than 30 minutes.
Nursing rounds at all levels should correctly use the steps of nursing procedures, and should be registered and recorded. Department rounds and nursing rounds should be summarized and recorded in the nursing process or rounds book.
Medical execution system
All kinds of drugs, examinations and surgical items used for the sick and wounded should be prescribed by doctors and recorded on the "medical advice record sheet". Copying and sorting out doctor's advice must be accurate and may not be altered.
After the doctor gives the doctor's order, the nurse copies the "doctor's order record form" and each execution form (card) respectively, and should find out the suspicious doctor's order before execution. Except for first aid, verbal orders shall not be executed. When issuing an oral will, the nurse should repeat it and check it by the doctor before implementation. Afterwards, the doctor should make up the doctor's advice in time.
After the doctor sends the doctor's order on the computer, the nurse should carefully check the name, usage, execution time, pricing attribute and execution department of the doctor's order. In particular, check the bed number, name, drug name, dosage, concentration, time, usage and drug specifications, check the execution frequency of treatment or disposal orders, and check the bed number, nursing level and system settings of nursing orders before saving, proofreading and correcting them.
Temporary medical orders must be executed within the specified time of 15 minutes. It is required to dispose of it first, then sign and sign the time. After carrying out the doctor's advice, determine the medication time according to the treatment needs, edit and print out all kinds of treatment sheets and nursing sheets for each patient.
Accumulate fees according to the doctor's advice and the charging standards for various disposal contents. Check the medical expenses of inpatients at any time, supplement the fees in time, and classify them according to the charging subjects, items and dates.
After the doctor's advice is executed, the nurses in each class must check the doctor's advice executed in the previous class and sign it; Night nurses should check the doctor's orders, medication orders, infusion orders, injection orders and minor treatment orders on the same day; The head nurse should check all the doctor's orders once a week and sign them.
Nurses should check the doctor's advice in each shift, and check whether the doctor's advice in the previous shift is handled properly after taking over; Enter the workbench at any time during the duty to see if there are any new doctor's orders.
After operation, delivery, changing major, discharge or death, the previous doctor's advice should be stopped. For patients who have been hospitalized for a long time, if there are too many pages in the doctor's advice record, the doctor's advice should be rearranged.
All temporary orders that need to be executed by the next nurse should be clearly explained and recorded.
Working system of treatment room
Treatment nurses must wear work clothes, work caps and masks. Wash your hands and wear a mask before operation, and strictly implement aseptic operation procedures, so that one person can have one needle and one tube.
When carrying out various therapeutic operations, the operating procedures and inspection system should be strictly implemented, and the allergic history should be asked before injecting penicillin, animal serum, iodine and other drugs. Do an allergy test as required.
Instruments and drugs should be classified and positioned, with obvious labels and clear handwriting. Narcotic drugs, toxic drugs for medical use and precious drugs should be locked and kept by special personnel, and carefully counted and registered during handover.
Indoor areas should be divided into clean areas and polluted areas. Sterile articles and non-sterile articles should be placed in fixed positions respectively. After treatment, clean up the used items and put them in the designated place. Disinfect the instruments and dressings used by infected patients in time. Disposable therapeutic articles should be destroyed and disinfected as required after use.
Sterile holding forceps (tweezers) and their soaking solution and containers, dressing cans, iodine and alcohol bottles are autoclaved every week. The disinfectant plane for soaking sterile forceps should be kept 2~3cm above the sterile shaft joint. Used syringes and infusion sets should be replaced regularly, and then replaced with the disinfection supply room after soaking with disinfectant.
Regularly check the validity period of various treatment kits and sterile items, and disinfect and sterilize them again after expiration.
Keep the room clean and tidy. Wet cleaning and ventilation are carried out every day. Irradiate the surface and air with electronic germicidal lamp or ultraviolet ray for 30 minutes every day and register your signature. Thoroughly disinfect every week 1 time. Conduct air bacteria culture every month and keep the report form for future reference.
Articles in the treatment room are generally not lent out. Under special circumstances, with the consent of the head nurse, the borrowing formalities should be handled in time and retrieved.
Working system of intensive care unit
All critically ill patients who need to live in the intensive care unit shall be determined by the attending physician, strictly implement the graded diagnosis of the attending physician, attending physician, chief physician (deputy) and department director, and formulate the monitoring and rescue plan. Nurses work in three shifts and take care of them 24 hours a day. No guardians or visitors.
Medical personnel engaged in monitoring work must undergo relevant professional knowledge training before taking up their posts, and master the first-aid technology and the performance and use of indoor first-aid equipment.
The medical staff on duty should stick to their posts, closely observe the condition, accurately monitor vital signs and record them in time. If the condition changes, it should be dealt with in time.
Keep the room quiet and tidy. People entering the room should dress according to the regulations. Strictly implement aseptic technical operation procedures. Sterile containers, instruments and dressings are disinfected regularly, and disinfectants are replaced regularly. Indoor regular air disinfection and air bacteria culture, and save the report for future reference.
Valuable medical instruments and equipment should be managed by special personnel, files should be established, and regular inspection and maintenance should be carried out. All kinds of instruments and medicines should be kept by special personnel, positioned and quantified, replenished in time after use and kept in good condition.
Principles of disinfection and sterilization
Medical supplies entering human tissues or sterile organs must be disinfected.
Instruments and articles in contact with skin and mucous membranes must be disinfected.
Used medical instruments and articles should be thoroughly cleaned before disinfection or sterilization; Among them, medical instruments and articles used by patients with infectious diseases should be disinfected first, and then disinfected or sterilized after thorough cleaning.
All medical devices should be disinfected or sterilized before maintenance.
According to the performance of the goods, choose the disinfection or sterilization method. For example:
Physical sterilization is the first choice for sterilization of heat-resistant articles. Such as surgical instruments, various puncture needles, syringes and the like. Pressure steam sterilization is the first choice; Dry heat sterilization is the first choice for oil, powder and paste.
Chemical disinfection can be used for heat-resistant articles. Such as various catheters, precision instruments, endoscopes, artificial implants and the like. , choose ethylene oxide sterilization method or 2% glutaraldehyde immersion sterilization method.
The principles of chemical disinfection and sterilization are as follows:
Reasonable selection of high-efficiency, medium-efficiency and low-efficiency disinfectants according to different situations;
When using chemical disinfectants, we must master their performance, function, application method and factors affecting disinfection effect. For example, formaldehyde cannot be used for air disinfection. Formaldehyde fumigation box can be used for surface disinfection of heat-resistant and moisture-proof articles, but not for sterilization; Heating or adding catalyst should be used in disinfection, and natural volatilization fumigation cannot be used.
When preparing chemical disinfectants, the effective concentration must be detected and monitored regularly;
The containers used for soaking disinfection and sterilization articles must be disinfected and sterilized when the disinfection and sterilization agent is replaced.