Case 2: A 76-year-old patient was hospitalized for 2 months due to cough, asphyxia and fever. The initial diagnosis was chronic bronchitis complicated with infection, pulmonary heart disease and emphysema. After admission, the nurse gave him intravenous infusion. Put a tourniquet on the elbow of the patient's right arm 3 cm away. When the needle was fixed by venipuncture, the nurse forgot to take off the tourniquet because the patient's sleeve slipped and covered it, and then connected the infusion tube to replenish fluid. In the process of infusion, patients repeatedly put forward "arm pain, slow dripping speed" and so on. After 500 ml of liquid was transfused, the infusion needle was pulled out and local slight swelling was found, which was thought to be caused by a small amount of liquid extravasation and was not treated. Nine and a half hours after venipuncture, when the patient was applying hot compress due to local pain, the family members found that the tourniquet was still tied, and immediately took it off and reported it to the nurse. The nurse asked for hot compress after the examination, but did not report to the doctor. Four hours after the tourniquet was loosened, two 2*2 cm blisters were found in the palm of the patient's right forearm, which were mistaken for hot compress burns and have not been reported for treatment. After another 6 hours, the right forearm was swollen, the blisters were enlarged, and the back of the hand was purple. The nurse reported to the doctor and the dean. Although treated by amputation, the patient died of heart and kidney failure due to old age and weakness, poisoning and infection, and was later identified as a medical accident. As can be seen from this case, the nurse in this case seriously violated the operating rules of intravenous infusion technology and failed to loosen the tourniquet in time after completing intravenous puncture, which was the main cause of limb necrosis and systemic poisoning and infection.
The so-called nursing norms and routines are based on the principle of safeguarding citizens' health rights, and on the basis of summarizing the scientific and technological achievements of predecessors, they define the nursing process and apply the norms or guidelines of technology. Usually divided into broad sense and narrow sense. Broadly speaking, nursing norms and routines refer to all kinds of standards, procedures, norms and systems formulated by health administrative departments and national trade associations (societies) according to the characteristics of the industry. This specification is technical, prescriptive and operable after being formulated and promulgated by the administrative department of health and the national trade association (Association for Science and Technology), which guides and regulates nursing behavior, and nurses must strictly abide by it and conscientiously implement it in their practice activities. Narrow nursing norms and routines refer to the working methods and steps that medical staff in this institution should follow in nursing and other work. The narrow sense of diagnosis and treatment nursing norms and routines covers the second and third professional disciplines of clinical medicine and the auxiliary professions of clinical diagnosis and treatment, including general clinical problems, specialized diseases, different levels of nursing norms and so on. Nursing operation rules are an important part of nursing technical standards, an important basis for standardizing nursing technical operation behavior and ensuring accurate and safe nursing technical operation, and also a code of conduct that nursing workers must follow in clinical work.
From the medical practice, when determining the legal responsibilities of medical institutions and nursing staff, whether the nursing staff violated the operating rules in the medical process is the key condition to confirm the fault of medical institutions and nursing staff. The most common and direct thing is that relevant departments formulate regulations, nursing norms and routines for medical institutions and medical behavior management to guide specific operations. Whoever violates them is bound to have an accident. This is the best criterion to judge whether there is a medical accident. In addition, we should pay attention to the indications, contraindications, patient preparation, operation steps and methods stipulated in nursing norms and routines.
It should also be pointed out that if you don't follow the nursing norms and routine operations in an emergency, is it a medical accident when patients have adverse consequences? This also stipulates the exemption exception in medical work in relevant laws. In the case of possible violation of the norms and routine of diagnosis and treatment, it should be carried out within the scope of exemption allowed by relevant national laws and regulations, otherwise it is very likely to lead to medical accidents and bear corresponding legal responsibilities.