Since the establishment of the Department of Anesthesiology in our hospital in 1987, the Department of Anesthesiology has made great development, and there are five nurse anesthetists, who have played an important role in their respective positions. However, with the deepening of China's reform and opening up, the progress of medical science and technology and the development of domestic and international exchanges, there is a growing demand for international integration. Combined with the actual situation of our hospital, the Department of Anesthesiology urgently needs to recruit anesthesia nurses a few suggestions for the reference and discussion of fellow anesthesiologists.
Anesthesiology as a secondary discipline, the establishment of the first clinical department determines the status of anesthesiologists in the clinical treatment, monitoring and emergency. According to the requirements of the development of the discipline, as a clinical department with other specialties, must be equipped with skilled nurse anesthetists. For example, the ratio of nurse anesthetists to operating tables in U.S. hospitals is 1 to 1~1.5, including the PACU, and the corresponding Association of Registered Nurse Anesthetists and professional journals of nurse anesthetists, International Federation of Nurse Anesthetists, American Academy of Anesthesiologist Assistants, have been established. International Federation of Nurse Anesthetists, American Academy of Anesthesiologist Assistants, American Association of Nurse Anesthetists (AANA), American Society of Perianesthesia Nurses, J ournal of PeriAnesthesia Nursing. American Association of Nurse Anesthetists (AANA), American Society of Perianesthesia Nurses, J ournal of PeriAnesthesia Nursing, and in Taiwan Province of China, the Association of Nurse Anesthetists (ANA) was established in 1988 and the professional journal of nurse anesthetists, Taiwan Association of Nurse Anesthetists, was published in 1992. Nurse anesthetists work in various departments such as clinical anesthesia, AICU, PACU, pain management, etc., and have formed a unified anesthesiology system, which is an experience worth learning from.
Although China's medical career is developing rapidly, the anesthesiology operation mechanism, operation mode and management mode of the past few decades ago still exist in domestic tertiary hospitals at present. Anesthesiologists spend a lot of time and energy to manage instruments and equipment, medicines, both to prepare the equipment (our hospital, including maintenance of nearly 80 units), and to prepare medicines (anesthesia-related commonly used medicines nearly a hundred kinds), at the same time to anesthesia operation and monitoring and treatment of the patient, etc., which inevitably make anesthesiologists and doctors as well as nurses and skilled workers, which seriously interferes with the efficiency and quality of the treatment of anesthesia period, affecting the perioperative safety of the patient This seriously interferes with the efficiency and quality of anesthesia treatment and affects the perioperative safety of patients. At present, a large number of anesthesia machines, monitors, resuscitation equipments and new anesthesia drugs and resuscitation medicines are emerging in an endless stream, which is a drastic change compared with that of two or three decades ago. Therefore, the current anesthesiologists as a "commander in chief" situation is seriously not adapt to the new situation of the rapidly changing anesthesiology and modern surgical development requirements. New surgical techniques, new projects, new surgical methods, medical reforms and aging society often bring patients with critical, complex and variable, which requires anesthesiologists to have a high level of professional and technical skills. The old experts in anesthesiology in China have put forward five basic qualities of anesthesiologists: good medical ethics; solid basic theory; skilled technical operation; ability to respond to emergencies; and good interpersonal relationship. 1993 Edinburgh Conference put forward the requirements of "five-star" doctors, i.e., health care providers; decision makers; and health care professionals. The Edinburgh Conference in 1993 proposed the requirements of "five-star" doctors, namely, health care provider; decision maker; health educator; community leader; service manager. The quality, knowledge and ability of anesthesiologists have higher requirements ------ elite education and training.
Anesthesiologists in anesthesia, first aid and resuscitation both to monitor and pump their own drugs, but also to think about how to rescue the patient, it is clear that this interferes with the efficiency of the rescue of the patient and reduces the coefficient of safety, imagine if the surgeon and the internist does not have a nurse, will be how efficient and how the medical. At present, the operating room nurses have a clear division of labor, instrument nurses and visiting nurses are mainly responsible for the cooperation of surgical procedures, the anesthesiologist's cooperation is very little, a major rescue and emergency, it is difficult to adapt to anesthesia first aid and resuscitation work.
With decades ago than, nurses to do anesthesiologists in the era of tertiary hospitals have long been over, the past some people worry about the emergence of nurse anesthesia will not go the original old road? The authors believe that the times are different and not the same. (1) there are mature experience in Western developed countries, (2) nurse anesthesia is mainly engaged in perioperative monitoring, anesthesia equipment maintenance, drug preparation, that is, responsible for preoperative, intraoperative and postoperative anesthesiologists with nursing care, never engaged in anesthesia technology and diagnosis and treatment, or it is illegal. They must carry out the medical instructions, just like ward and ICU nurses, responsible for perioperative nursing and daily nursing (see Annex 1 Duties of nurse anesthetists in Nanjing First Hospital). The key is how to manage and employ them. Nurse anesthesia belongs to nurses, and should be under the management of professional nurse anesthetist (under the leadership of nurse anesthesiologist and nursing department). Nurse anesthesia training needs a certain period of time, in the United States there are registered nurse anesthesia (RNA), it can be said that the nurse anesthesia should have a high professional standard, both anesthesia care and know first aid and resuscitation. Nurse anesthesia training should have an overall planning and identification of professional nursing roles, so that nurse anesthesia training courses can be consistent, and thus enhance the professional standard and knowledge of anesthesia nursing. It is our ultimate goal to move towards an anesthesia system with Chinese characteristics, and the quality requirements and training programs for nurse anesthetists should be formulated separately. As a professional nursing role, nurse anesthesia is a new thing in China and needs to be improved and innovated in clinical work, teaching and reform. (See the work quality assessment form for nurse anesthetists in the Department of Anesthesiology, Nanjing First Hospital).
Nurse anesthesia has not attracted enough attention in China. Foreign experience tells us that good preoperative preparation, intraoperative cooperation and postoperative recovery room care by nurse anesthetists can greatly reduce the mortality rate of patients, and without nurse anesthetists, anesthesiologists would not be able to deal with patients in an efficient and high-quality manner. If the division of labor is not clear, anesthesiologists have become the all-knowing anesthesiologists, nurses, and workers, the current situation is like the past "medical and nursing one-stop", which is obviously contrary to the law of development of the modern medicine more and more division of labor specialization. In the cost-benefit analysis of the market economy, nurse anesthetists and anesthesiologists *** survival in line with the laws of the market economy.
I believe that the continuous enrichment of the anesthesia department by professional nurse anesthetists will bring a new revolution to the discipline of anesthesia, making the discipline of anesthesia a first-class clinical department in the true sense of the word, so that the department and anesthesiologists will be able to enhance the status of the department and the improvement of the efficiency of the work, the increase in the safety of the patients, the standardization of the anesthesia management, and the time for scientific research and teaching is more.......
Therefore, I suggest that the anesthesia community call for a solution to the problem of nurse anesthetists as soon as possible, for the development of anesthesiology, to improve work efficiency and patient safety considerations, all of us *** the same goal is to improve the safety and quality of our anesthesia.
Attachment:
Nanjing First Hospital Nurse Anesthesia Management Standards
(2004 Edition)
Adopting the concept of "humanized care". Humanized nursing is a unique view of "people, health, environment and nursing". It requires nursing staff to pay attention to individual differences in patients' physical, mental, social, spiritual, and cultural aspects, to understand patients' mentality, to know patients' needs and concerns, and to make efforts from the smallest detail to give patients full respect, understanding, trust, consideration, and care in overall nursing care and post-discharge continuity services. It includes creating a relaxed, free and harmonious environment for patients to recuperate, nursing staff with a strong ideological style, solid professional skills, and good communication with patients, good at peeping through the patient's psychology, instant targeted guidance, to provide help, while planned and systematic special health knowledge education, to fill the gaps in the patient's knowledge of the disease, and can be hungry to explore new knowledge, update new skills.
Responsibilities of Nurse Anesthesia
1, cooperate with anesthesiologists to complete daily anesthesia monitoring and treatment (including PACU).
2, responsible for drugs, medical equipment, medical forms, daily necessities of the collection of registration.
3, anesthesiology all the instruments and equipment maintenance and maintenance work, the use of instruments and equipment, lines are standardized placement, the power to the minimum after the shutdown, precision instruments sent back to the precision instrument room.
4, fully responsible for the anesthesia before, during and after the preparation work, including anesthesia machine, monitoring instruments, drugs.
5, fully responsible for sterilization.
6, participate in a variety of duty and critical patient resuscitation.
7, anesthesia should be carefully checked before anesthesia, anesthesia drugs, instruments are complete, strict implementation of technical operation routines and checking system to ensure safety. In anesthesia, often check the blood transfusion, infusion and medication.
8, during anesthesia, you should stick to your post, observe closely and record carefully. If there is any abnormality, they should contact the anesthesiologist in time and cooperate with the anesthesiologist to deal with it appropriately. For interns and trainees, they should be strictly required and specifically instructed.
9, strict implementation of the rules and regulations and technical operation routine, to prevent errors and accidents. After surgery, the critical and general anesthesia patients and anesthesiologists escort, and to the ward nurse to explain the condition and postoperative precautions.
10, post-operative follow-up, the situation will be recorded in the anesthesia nursing record sheet.
11, actively carry out research on anesthesia nursing, participate in scientific research and teaching, and do a good job of training for advanced students and interns.
Anesthesia nursing (head nurse) team leader's duties
1, under the leadership of the department director, department head nurse, anesthesiologists under the guidance of the work.
2, responsible for nursing business learning, research, teaching, indoor management and internal and external contacts.
3, planned arrangements for key work, to achieve the daily schedule, weekly schedule, to ensure the implementation of the implementation of the routine system.
4, often understand and check the nurses of each shift to implement the medical advice and clinical nursing work, found that the problem is dealt with in a timely manner, in order to prevent errors and accidents.
5, participate in and organize the rescue of critically ill patients, accompany the anesthesiologist to check the room, participate in case discussions, in-depth understanding of the requirements of nursing.
6, organization and leadership of nursing checkups, checking the level of nursing care and the quality of teaching, and regularly organize the assessment.
7, responsible for drugs, medical equipment, medical forms, daily necessities to receive registration inspection and maintenance work, responsibility to the individual.
8, regularly report to the director of the department and the head nurse, listening to colleagues on medical care, management and other aspects of the suggestions and comments, and constantly improve the work.
9, supervise and inspect the work of nursing staff, keep the environment clean, quiet and safe.
10, timely checking and proofreading of various forms to use, writing, etc. whether to meet the requirements.
In the OR nurse anesthesia routine work
1. Responsible for the operating room anesthesia machines, monitors, mechanical pumps and other instruments and connecting wires maintenance clean.
2. Responsible for cleaning inside and outside of anesthesia cart and pressurized bags.
3. Used masks, connectors, laryngoscopes are retrieved on the same day and returned to the position on the next day.
4. Replace sodium lime in the anesthesia machine every day, retrieve and sterilize and replace threaded tubes on 1, 2, and 3 units. Clean the first aid kit every morning. Retrieve and sterilize 5,6,7,8,9,10,11,12 tables of interoperative threaded tubing every Friday and return to position the following Monday. (Special patients are treated as disposable.)
5. Check the routine supplies in the anesthesia cart drawer every day (number of sputum tubes #14 and #8, medication refillers, masks, and respiratory bladders.)
6. Tuesday and Friday, take the time to go to the cardiac research institute, replenish the items, drug base and responsible for the maintenance of the operating room instrumentation (work the same as the first and the second point), replacement of threaded tubes, masks, connectors and disinfection.
7. 1, 2, 3 tables and first aid kit are under the responsibility of one person. 5, 6, 7, 8 table one person is responsible for. 9,10,11,12 table one person is responsible for. Four weeks a change. When it is your turn to be in charge of stations 5, 6, 7 and 8, you will also be responsible for the regular work of the Heart Institute.
January Highlights:
Monthly check of expiration dates of disposable items and medications in the anesthesia cart. Scheduled to be checked on the third week.
Note: Masks, connectors, and threaded tubing are sterilized with acidified water. Laryngoscopes were disinfected with formalin fumigation.
Surgical anesthesia patients pre-operative, post-operative visit system
1, according to the next day's notice of surgery arrangements, one day before the operation, anesthesia nurses, circuit and hand-washing nurses to the ward to visit the patient, major surgery, special surgery, three days after the operation of the patient for a follow-up, and recorded in the "anesthesia patient care record sheet", "anesthesia patient care record sheet. "Surgical patient care record sheet".
2, through the medical record to understand the patient's condition and general situation, including: blood type, skin test, biochemical examination, past medical history, family history, etc..
3. Introduce anesthesia and surgical precautions and the environment of the operating room to the patient and his family, the general conditions of the anesthesiologists and nurses who participated in the surgery, and answer all kinds of questions raised by the patient to alleviate the patient's anxiety and to do a good job in the psychological care of the patient.
4, visit the patient to use medical terminology, to improve legal awareness, language, behavior should be polite and standardized.
5, major surgery, preoperative nurses and anesthesiologists are required to participate in the preoperative discussion of the ward together, to understand the special needs and make good preoperative preparation.
Anesthesia sterile goods storage room work system
Sterile goods storage room is a more demanding part of the supply room. The staff of this room should have a strict concept of sterility, skillful aseptic operation techniques, and should be serious and meticulous in the execution of their work.
(a) into the sterile goods storage room must wear masks, hats, shoes, non-room staff are not allowed to enter.
(b) the room is designed for the storage of sterile goods, all unsterilized goods, shall not be stored.
(c) Sterile items should be classified and placed, and all sterilized items should be marked or dated with an expiration date of 1 week.
(d) hold to take the sterile goods, must use sterile forceps, open the lid of the sterile tray and bottle stopper must be placed on the cover of the tilt, and pay attention to the operation shall not cross the sterile zone, immediately after use, cover tightly.
(E) All the items issued by the room should be checked for the date of sterilization, the name of the item, signature, if the label is fuzzy or no label can not be issued.
(F) the room must be kept clean, the air must be sterilized twice a day with ultraviolet light, air colony measurement once a month.
Working system of nurse anesthesia in PACU
1. The room admits patients after anesthesia surgery, and non-room personnel are prohibited from entering the room for non-work needs. If the staff from outside the hospital need to enter the room, they need to be approved by the Medical Education Department. Family members of patients are not allowed to enter the room to visit.
2. Shoes and clothes must be changed in the work area, and masks and hats must be worn in the room to prevent cross-infection, and air disinfection is often carried out.
3, to maintain indoor cleanliness, hygiene, quiet, no loud noise, smoking is prohibited.
4, the room staff to adhere to their posts, do not leave their posts without authorization, something to go out should be informed of the direction of the duty officer.
5, the work attitude should be serious, strict compliance with the rules and regulations and a variety of technical procedures to prevent errors and accidents.
6, guardianship staff should closely observe the condition, according to the condition of the timely revision of guardianship and rescue plan.
7, the guardian should have a wide range of basic medical knowledge, clinical knowledge and basic knowledge of electrocardiography and electronic technology, and skilled in rescue and resuscitation techniques, combined with the condition of the correct analysis of the monitoring data, according to the need to make the appropriate emergency measures.
8, the room personnel should be familiar with the performance of various indoor instruments and operating procedures, strictly in accordance with the operating procedures for work. Instruments should be responsible for the custody of a person, maintenance and registration, regular inspection, found damaged, failure should be reported in a timely manner.
9, monitoring records and information should be properly preserved.
10, the patient in and out of the ward, the items, the condition of face-to-face shift, and the establishment of pick-up and drop-off shift book.
In the PACU nurse anesthesia handover system
1, when the patient enters the PACU, the PACU doctor and nurse anesthesia must be with the anesthesiologist *** with the handover of the patient.
2. The patient's name of surgery, anesthesia method, intraoperative medication and vital signs should be explained in detail.
3, the receiver should listen carefully to the anesthesiologist's shift, and ask about anything that is not clear, and count all the supplies that the patient brings back from the operating room.
4, timely and accurate monitoring of the patient's vital signs, the patient's vital signs are stable before the anesthesiologist can leave.
5. The treatment and care of the patient during the PACU period should be based on the implementation of the PACU doctor's orders.
Responsibilities of nurse anesthetist in PACU
1, understand the patient's medical history, pre- and post-operative diagnosis, intra-operative process and whether there are any accidents, postoperative special precautions, the current main problems, treatment principles, monitoring indicators and nursing requirements.
2. Keep all kinds of tubes smooth and all kinds of wires connected and used normally, including endotracheal intubation or tracheotomy, ventilator tubes, arterial manometry tubes, intravenous tubes, floating catheters, all kinds of drainage tubes, electrocardiographic monitoring, pulse oximetry monitoring and so on.
3, the use of a variety of monitoring conditions in a timely manner to detect subtle changes in the patient's condition, timely report to the doctor.
4, conscientiously do a good job of nursing records, timely and accurate implementation of medical advice, found that the loopholes or have doubts, immediately ask for instructions and report to the doctor to verify.
5, familiar with the use of various commonly used instruments operating procedures. Note, common faults and troubleshooting methods.
6, keep the work unit clean, neat and quiet. Timely replenishment of all required items and medicines.
7, to ensure quality service, enhance the confidence of patients, the patient's attitude and kind and patient, considerate and thoughtful.
8, abide by the work discipline, do not go AWOL.
9, comply with the protective medical system, in order to avoid medical disputes, the nurse does not explain the condition.
10, strict implementation of the anesthesiologist's medical advice (written and oral), oral medical advice should be recorded in a timely manner.
11, with the operation of the circuit nurse should be with the nurse anesthesia *** with good nursing care, until the patient out of the PACU.
12, responsible for the admission of the patient's registration and bookkeeping.
Sterilization and isolation system
1, 10 minutes ahead of time into the PACU cleaning every day.
2. Those who enter the PACU should wear a working cap, isolation clothes and pants, and change working shoes.
3, in the patient to carry out all kinds of treatment and nursing operations to wash hands first, wear a mask, and then operate.
4, where contact with the patient's blood, body fluids and all other materials should be given to the disinfection of disposal.
5, the patient contact monitor various wires should be given disinfectant wipe.
6, patients with infectious diseases in contact with the material should be soaked in disinfectant before incineration.
7, each patient's supplies should be dedicated to the exclusive use of goods, to eliminate the cross use of a thing to avoid cross-infection.
8, patients should be properly disinfected when leaving the PACU.
Blood transfusion checking system
1, check the date of blood collection, blood clot or hemolysis.
2. Check whether the name, blood type and blood bag number on the transfusion order and the label on the blood bag are consistent, and whether there is any coagulation on the mating report.
3. Check the patient's bed number, name, hospitalization number, blood type, blood bag number, and blood volume.
4, blood transfusion before the mating report must be checked by two people before implementation.
5. After blood transfusion, the blood bag should be retained for sending for testing when necessary.
Anesthesia care in the PACU a week of work priorities
1, once a day to replace the disinfectant soaking the patient's belongings.
2. Change all kinds of sterilization kits and jars on Monday.
3, Tuesday check the performance of various monitors and wipe monitors and various wires with disinfectant.
4, Wednesday organizing the rescue cart and rescue drugs and supplies.
5, Thursday count the medicine cabinet drug base.
6, Friday to do the PACU hygiene cleaning.
Note: UV irradiation twice daily.
Air culture once a month.
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