我院34例不良事件发生原因分析与对策

Causes analysis and countermeasures of 34 cases of adverse events in our hospital

目的探讨不良事件发生的原因与对策。方法分析我院2007年12月至2009年12月34例不良事件发生的原因。结果跌倒/坠床、烫伤、意外拔管发生率最高,占不良事件发生率总数的67.65%。不良事件的发生与患者的年龄、疾病因素、身体机能状况以及护理人员防范意识欠缺、护理措施不到位等有关。结论采取创建安全文化、建立相关制度和防范措施、改善医院环境设施等干预措施,防范不良事件的发生。

Objective To explore the causes and countermeasures of adverse. Method Thirty - four cases of adverse events in our hospital from December 2007 to December 2009 were analyzed. Results Falling out of beds,burns,and accidental extubation were the highest incidence of events, accounting for 67.65% of the total. The related factors of adverse events included the age, diseases, and physical function status of patients, lack of prevention awareness of nurses, nursing measures not in place,and so on. Conclusion Hospitals should take the intervention measures,including creating a safety culture,establishing related systems and preventive measures, and improving the environment and facilities of the hospital, and so on, to prevent adverse events.