血透室规章制度.docxVIP

血透室规章制度

目录

一、总则....................................................2

二、人员管理................................................2

2.1医护人员资质要求.....................................4

2.2患者及陪护人员须知...................................4

2.3员工行为规范.........................................5

三、设备与物品管理..........................................6

3.1设备维护与保养.......................................6

3.2物品采购与存储.......................................7

3.3设备与物品使用规定...................................8

四、操作规程................................................8

4.1血液透析操作流程.....................................9

4.2康复治疗操作规范....................................10

4.3危急情况处理流程....................................11

五、感染控制...............................................11

5.1个人防护措施........................................12

5.2空气净化与消毒......................................13

5.3感染监测与报告......................................14

六、护理质量管理...........................................15

6.1患者评估与护理计划..................................16

6.2护理服务质量监控....................................17

6.3患者满意度调查与反馈................................18

七、应急处理与报告制度.....................................18

7.1应急预案与处置流程..................................19

7.2报告程序与时限要求..................................21

7.3责任追究与奖惩机制..................................21

八、培训与考核.............................................22

8.1员工定期培训计划....................................23

8.2考核标准与方法......................................24

8.3培训效果评估与改进..................................25

九、患者隐私保护...........................................27

9.1患者信息保密制度....................................28

9.2个人信息查询与使用规定..............................28

9.3患者隐私权维权途径..................................29

十、附则...................................................30

10.1制定与修订说明.....................................32

10.2解释权归属.........................................32

10.3生效日期...........................................33

一、总