住院医师规范化培训带教过程中发现的问题.doc

 PAGE 8  PAGE 9 作者单位：200025 上海交通大学医学院附属瑞金医院麻醉科(范秋维, 于布为)；Gloucestershire Royal Hospital, Gloucestershire GL1 3NN, United Kingdom (Roger Eltringham) 通讯作者：范秋维，电子邮箱为 f630906@ 作者单位：200025 上海交通大学医学院附属瑞金医院麻醉科(范秋维, 于布为)；Gloucestershire Royal Hospital, Gloucestershire GL1 3NN, United Kingdom (Roger Eltringham) 通讯作者：范秋维，电子邮箱为 f630906@ 成功源于注意细节 ——住院医师麻醉培训时注意细节是带教的非常重要部分 范秋维 于布为 Roger Eltringham 【摘要】 目的 调查在麻醉实施过程中发生的一系列细节问题，针对问题提出解决对策，保证围术期病人安全，由此改进住院医师培训质量。方法 上海交通大学医学院附属瑞金医院的所有住院医师在麻醉科接受培训参加此项研究，作者调查在上级医师指导住院医师工作中发生的一系列细节问题，所有问题及时记录并随后作分析。结果 研究显示围术期有许多问题发生，这些问题涉及各项医疗活动，包括病史缮写问题、各种麻醉操作问题、临床观察、监测和药物使用，和人文关怀问题，针对问题提出一系列解决对策，包括与患者建立良好的沟通，采集病史，体检，解释有关麻醉过程和术后安排；病历书写应准确、完整和清晰；术前麻醉知情同意书应有患者本人，或委托的家属，或监护人，或关怀者签字；上级医师和住院医师在围术期必须密切关注病人，实施规范的麻醉操作，观察和处理，注意人文关怀。结论 注意细节非常重要，不注意细节可导致危及生命的灾难和严重的医疗事故发生，上级医师应拓宽知识和提高医疗技术、注重医德和人文关怀，并有责任对住院医师进行规范化的带教培训，消除不该发生的危险，成功源于注意细节。 【关键词】注意细节；成功；住院医师；规范化培训；病人安全 Success follows attention to detail. ????Attention to detail is a very important part of teaching during an anaesthesia residency program. FAN Qiuwei, YU Buwei. Department of Anaesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China; Roger ELTRINGHAM. Department of Anaesthesia, Gloucestershire Royal Hospital, Gloucestershire GL1 3NN, United Kingdom 【Abstract】 Objective To investigate a series of minor problems that occurred during administration of anaesthesia, to plan strategies for maintaining patient safety in peri-operative period, and thereby to improve medical residency training. Methods All of the resident doctors taking part in the study were trainees at the department of anaesthesia of Rui Jin hospital affiliated to Medical School of Shanghai Jiao Tong University. The authors investigated a series of minor problems which occurred while senior anaesthetists were supervising residents. All problems were recorded and subsequently analysed. Results The study revealed numerous problems during the peri-operative period. They involved a w