追踪方法学在院前急救护理安全管理中的应用

Application of tracer methodology on the nursing safety management in prehospital emergency

目的探讨追踪方法学在护理安全管理中的应用效果。方法 2010年昆山市急救中心将追踪方法应用到护理安全管理中,成立护理安全追踪检查小组,追踪院前急救患者的急救经历,对其从接受急救到转运至院内的过程进行连续追踪,个案追踪中发现问题后转入系统追踪,以寻求出现问题的环节和原因,然后进行专项调查并采取相应整改措施。结果 2010年追踪方法学应用后,护士查对制度执行中的缺项率(26.67%)与2009年(13.33%)相比,差异无统计学意义;护士对急救药品知识掌握以及职业暴露处理流程掌握缺项率由2009年管理前的80%和77.33%,下降到2010年管理后的13.33%和20%直至零缺项,差异有统计学意义(χ2=41.143,P﹤0.001;χ2=36.013,P﹤0.001);护士开展静脉留置针评估和转运患者安全评估2项内容的考核指标有明显改善(χ2=26.023,P﹤0.001;χ2=12.833,P=0.006)。结论追踪方法学的应用有效降低了院前急救患者在各环节存在的护理风险,确保了护理安全。

Objective To explore the effect of applying tracer methodology in nursing safety management. Methods With the application of tracer methodology to nursing safety management in Kunshan Emergency Center 2010, tracer inspection group for nursing safety was set up, first aid experience of patients in pre-hospital emergency were traced; the patients＇ emergency process of being transferred to the hospital was traced continuously. The problem was found in patient tracer, and then it would be shifted into system tracer for seeking the stumbling links and reasons. Subsequently a special investigation was conducted and appropriate corrective actions were taken. Results After the application of tracer methodology in 2010, the rate of the uncompleted in the nurses＇ implementation of cheek system was 26.67%, and that of 2009 was 13.33%, the difference was not statistically significant（P0.05）; the rate of the uncompleted in nurses＇ mastery of emergency medicine knowledge and occupational exposure processing was declined from 80% and 77.33% before the management in 2009 to those of 13.33% and 20% in 2010, the difference was statistically significant（χ2=41.143,P﹤0.001;χ2=36.013,P﹤0.001）. Assessment indicators of nurses＇ operating venous indwelling needle and safety assessment of transporting patient were improved significantly（χ2=26.023,P﹤0.001;χ2=12.833,P=0.006）. Conclusions Application of tracer methodology effectively reduces nursing risk exist in every link of saving patients in prehospital emergency, and ensures the safety of nursing.