ICU护理实习生静脉药疗安全问题分析与管理对策

目的:中国ICU药疗的执行者是护士。在实习期间开始进行静脉药疗相关训练是培训大纲要求的内容之一。但相关安全性问题无报道。本研究拟通过对ICU护理实习生(简称:护生)进行问卷调查,了解其在ICU实习期间是否发生药疗安全情况,并分析相关影响因素。方法:采用方便性抽样、自行设计问卷,于2014年9月~2016年9月对进入我院ICU实习的156名护生在实习结束时就药疗安全情况进行调查,并对结果进行独立统计学分析。结果:所有156份问卷均收回、且为有效问卷。调查结果显示,承认发生过用药安全问题的人数为95人(60.1%)。错误类型按发生率高低依次为:给药途径错误(71.2%,68/95)、给药剂量错误(57.9%,55/95)、延迟给药(40.0%,38/95)以及遗漏给药(11.6%,11/95)。护生自述发生用药安全问题的原因中工作忙而忽视药疗“三查七对”比例最高(67.4%,64/95),其次是带教护理教员不严格(44.2%,42/95),缺乏对药物的认识最低(17.9%,17/95)。此外,还发现在为期1年的实习期间,实习初期(前3个月)和实习后期(后3个月)来ICU的护生发生药疗问题比例较高,分别为85.4%(35/41)和68.4%(26/38),而实习中期相对较低,分别为40.5%(第4~6个月,15/37)和47.5%(第7~9个月,19/40)。上述药疗错误多发生在白班和前夜班工作期间(85.3%,76.8%,多选),后夜班相对较好(48.4%,多选)。结论:ICU护生临床实习期间存在严重的静脉药疗安全问题,其能力不能适应ICU高强度护理工作特性以及不能胜任复杂的静脉药疗技术是主要原因,而缺乏规范的药疗培训和操作监管是发生问题的关键。

Objective:Nurses were the medication executors in Chinese ICU.Carry out medication related training was one of the training program content.during the internship period.However,the relevant security issues were not reported.This study through a questionnaire survey to ICU nursing interns(abbreviation:probationer nurses;),understanding whether the medication safety has happened during their internship period in ICU,and analyzing the related factors.Methods:Medication safety were investigated at the end of the internship by convenient sampling and a self-designed questionnaire to 156 probationer nurses entering the hospital ICU internship from January 2014 to January 2016 in our hospital ICU,and the results were statistically independent.Results:156 questionnaires were all recovered,and the effective questionnaire results showed that the number was 95 people(60.1%)which admitted medication safety issues happened.The error type incidence level were as follows from high to low:wrong route of administration(71.2%,68/95),the dosage error(57.9%,55/95),delayed administration(40%,38/95)and the omission of Administration(11.6%,11/95).Busy work and ignore the medication“three inspections and seven verifications”were the highest proportion(67.4%,64/95),following that the teaching of nursing faculty was not strict(44.2%,42/95),and the lack of drug understanding was the lowest(17.9%,17/95)in probationer nurses reported the reasons of drug safety problems.In addition,it found that ICU probationer nurses had higher proportion of medication at early practice(3 months ago)and lately practice(after 3 months)during the internship period of 1 years,which were 85.4%(35/41)and 68.4%(26/38),however mid-term relatively low were 40.5%(4-6 month,15/37)and 47.5%(7-9 months,19/40).The medication errors occurred at the day and before the night shift(85.3%,76.8%,multiselect),and after the night shift was relatively good(48.4%,multiselect).Conclusion:The security problems of intravenous medication has seriously happened during the ICU probationer nurses clinical practice,which not adapt to work characteristics of ICU high strength and not qualified for complex intravenous medication technology are the main reason.However,the lack of standardized medication training and operation supervision is the key problem.