ICU质量控制——安全性策略（课件）演示幻灯片.pptVIP

管理者对错误的认识 Medicines tendency to view errors as failings that deserve blame Nurse training that emphasizes rules vs medicines emphasis on knowledge Corrective actions that focus on the individual vs the system. 个人态度 “no blood, no foul” Solving through individual power Disaster for their career Patient Safety System 1. Medical error organization Analyzing the causes of errors System vs Individual Responsibility vs Knowledge ICU质量控制 —安全性策略 解放军总医院第二附属医院ICU 马朋林 提 纲 ICU 安全性现状 不安全因素分析 提高安全性对策 一、ICU 安全性现状 6 SIGMA 管理 PPM=3.4 百万次操作 错误发生 3.4次 ICU质量评定 操作次数： 1000—3000次/病人/天 观察、处理报警、监测、治疗 可预防错误：36个/1000病人.天 PPM=12-36 威胁病人生命错误：占13% =4.7个/1000病人.天。 PPM=1.5-4.7 Data from Jeffrey CCM 2005 ICU 百万分安全？ 工业产品=生命？ ICU质量控制目标 医疗错误相关死亡率 PPM=0 How Hazardous Is Health Care? Lakshmi Halasyamani, MD, Michigan ICU与普通病房区别 Simchen E et al. Crit Care Med 2004; 32:1654-1661 159 cases 二、不安全因素分析 ICU不安全因素 ICU环境因素 人力资源短缺 病人因素 管理因素 ICU环境引起病人心理状态改变 Author Cited from Patient Type Anxiety Jones C CCM 2001 ICU 33/45 (73%) Rotondi CCM 2002 ICU,MV 100/150 (67%) Swaiss MEJA 2004 ICU,MV 37/55 (68%) Sharon AJCC 2004 31 ICUs 73/106 (69%) Leur Crt Care 04 ICU,MV 66/123 (54%) Hsiao AATW2006 ICU,MV Serious 不仅只有病人紧张 Burnout in intensive care unit Minerva Anesthesiol 2007 Apr;73(4):195-200 Am J Respir Crit Care Med. 2007 ;175(7):698-704. Intensive care med;2008 Jan;34(1):152-6 Burnout contagion among intensive care nurses J Adv Nurs. 2005 Aug;51(3):276-87. 是医疗错误的重要原因之一 HAP 普通病房：5% ICU: 15~20% ICU环境增加院内感染 人力资源短缺是医疗错误发生的独立高危因素 Medical errors in relation to staff work hours in ICU NEJM, 2004 Ⅰ级人力要求 Ⅱ级人力要求 Ⅲ级人力要求 Ⅳ级人力要求 护士短缺 百分率 发生错误病人百分率 护士人力资源短缺与ICU错误 Hospital mortality in relation to staff workload: a 4-year study in ICU Lancet 2000; 356: 185–89 Optimal Nurse Need/Patient Calculation 0.5 Stable, Without Vasopressor, MV, CRRT,IABP etc 1