ICU质量控制——安全性策略（课件）幻灯片.ppt

ICU质量控制 —安全性策略 解放军总医院第二附属医院ICU 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 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 “To Err Is Human” Errors caused Deaths In US: 44000-98000 /Year Kohn, Institute of Medicine 1999 In China: 12900/year ??? Adopted from CAC 1999 Errors Happened in ICU Critical Care Safety Study 391 patients (1 year) 1490 patient-days 277 errors 11% Life-threatening Jeffrey M CCM 2005 ICU与普通病房区别 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 不仅只有病人紧张 ICU环境增加院内感染 HAP 普通病房：5% ICU: 15~20% Medical errors in relation to staff work hours in ICU Hospital mortality in relation to staff workload: a 4-year study in ICU Optimal Nurse Need/Patient ICU理想的护士比例 放弃抢救 经济原因 错在家属 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 Patient Safety System 2. Reporting system ? Survey Mission ? Automatic reporting ? Close reporting Error Reporting System Sharply Cuts ICU Mortality Jan. 30, 2003 (San Antonio) — Johns Hopkins University researchers have devised the first-ever error reporting system for the intensive care unit (ICU),