First, the nursing of critically ill patients with high risk factors
1. The patient's condition is not carefully observed, and the foresight is not strong: because the critically ill patient's condition is critical, complicated and changing rapidly, young nurses lack professional knowledge and have no foresight, and it is easy to lose the best rescue opportunity, resulting in medical disputes.
2. Socio-psychological factors: Due to the irreversible development of the disease, patients die, and relatives often pay great attention to every detail that leads to the death of patients. This strong emotion may further deepen the misunderstanding between medical staff and relatives, and lead to medical and nursing disputes.
3. Risks caused by poor communication between nurses and patients: Because patients are in critical condition, they pay too much attention to the treatment and nursing of medical staff, and a little carelessness in their work will cause misunderstanding and dissatisfaction among their families. At the same time, the natural process of the patient's illness or the risk of treatment and examination may make the patient's condition repeated or aggravated.
4. Human error
(1) did not strictly implement the rules and regulations, and did not strictly follow the medical care operation procedures. If the commonly used rescue equipment is not tested regularly, when the patient's condition changes, the rescue equipment and machinery suddenly fail.
(2) The writing of nursing documents is not standardized. Nursing records must be true, complete, timely and accurate. It is the original record reflecting the patient's condition change, the process of disease treatment and nursing and its treatment effect.
Second, the safety nursing system
1. Formulate and improve medical and nursing rules and regulations.
(1) The nursing grade system must meet the requirements of nursing grade, and critically ill patients should make 1 rounds within 15 minutes to 30 minutes, so as to know the change of their condition.
(2) A special management team should be set up in the emergency room working system, including the management, use, maintenance and supply of first-aid articles, so that the intact rate of emergency room equipment and medicines can reach 100%, and the emergency room can master the use of various first-aid equipment skillfully.
(3) We must implement the system of "three checks and eight pairs" accurately and timely, and be familiar with and master the nature, usage, dosage and incompatibility of drugs. Oral medical advice should be repeated twice during rescue, and it can only be carried out after verification. After that, the doctor should be urged to fill in the doctor's order in time and sign the exact execution time and full name.
(4) Strict disinfection and isolation system Invasive operation must adhere to the principle of aseptic operation, and it is necessary to explain clearly to patients or their families in advance, so that patients or their families can understand and sign informed consent forms. For patients with low immune function and infection, isolation measures should be implemented according to isolation types.
2. To standardize the writing of nursing documents, we must take them seriously from the legal point of view and write all kinds of nursing documents truthfully and objectively. The data in nursing records should be accurate, and the medical records should be consistent with the nursing records, so as to avoid delaying the illness and causing medical disputes.
3. Strengthen the communication between nurses and patients, emphasizing that the service attitude of critically ill patients is complicated, there are many rescues, the staff are nervous and anxious, and their families are worried. Reasonably meet the emotional and psychological needs of patients and their families and reduce disputes.
Third, safety nursing measures
1. Strengthen the training of nursing staff, strictly implement the system of duty, succession, graded nursing, ward management and nursing safety management, strengthen the observation of patients' condition, and take timely treatment measures.
2. Patients with disturbance of consciousness and restlessness in bed should avoid using bed railings, check whether the bed railings are in good condition, and use restraint belts when necessary. Nursing staff should be present when transporting patients, accompanied by nursing staff when transporting critically ill patients, and rescue materials should be available.
3. Avoid aspiration, the patient will suffocate when vomiting, and his head will lean to one side. Clean up the vomit in time, and prepare the aspirator and attractant at the bedside. Patients with tracheal intubation and tracheotomy should fully moisten the airway to prevent sputum from scabbing, and knock on the back when turning over to make the sputum loose and easy to suck out.
4. Avoid accidental extubation. Properly fix the intubation and drainage tube for patients with restlessness and unconsciousness, increase protective constraints, closely observe the patient's restlessness, and take timely countermeasures, such as proper sedation.
5. Prevent patients with pressure ulcers from being evaluated for their skin condition when they are admitted to the hospital. Patients who stay in bed for a long time may easily feel oppressive.
Patients with sores should turn over regularly and give an air cushion bed to keep the bed and clothes clean and flat. Patients with urinary incontinence should keep their skin clean and dry. Patients and nursing staff should trim their nails, and users of restraint belts should pay attention to local skin conditions. Strengthen nutrition and ensure the needs of the body.
6. Strengthen the detailed management of critically ill patients. Educate nurses to have meticulous "cautious independence" spirit, organize nurses to analyze and discuss the causes of nursing adverse events, pay attention to details, strictly implement nursing operation norms, and implement safety management rules and regulations.