精细化管理在手术室骨科外来器械管理中的应用

Application of fine management in the management of orthopedic external surgical instruments in orthopedics

目的探讨精细化管理在手术室骨科外来器械管理中的应用。方法回顾性选择2017年1~6月期间使用外来手术器械进行手术的670例患者作为实施前组,选择2017年7月~2018年3月期间使用外来手术器械进行手术的1075例患者作为实施后组,实施前组应用传统手术室骨科外来器械管理,实施后组应用精细化手术室骨科外来器械管理,分析精细化管理模式实施前使用骨科外来器械手术中准备不完善情况,并比较精细化管理模式实施前后的手术室骨科外来器械准备完善率、器械相关问题发生率及护理差错发生率。结果在精细化管理模式实施前,应用外来手术器械进行手术的670例患者中,有106例(15.82%)发生准备不完善情况,其中准备不完善情况发生比例最高的为术前管理不到位(32例,30.19%),其次由高到低依次为术后管理不到位(26例,24.53%)、术中管理不到位(23例,21.70%)、器械准入接受有误(17例,16.04%)、清洗灭菌不到位(8例,7.55%)。实施精细化管理模式后,骨科外来器械准备完善率(95.07%)、器械相关问题发生率(0.93%)及护理差错发生率(4.00%)与实施前(84.18%、5.07%、10.75%)相比,差异均具有统计学意义(P<0.05)。结论精细化管理对提高骨科外来器械使用中的手术效果和工作效率、保证患者手术安全具有效有重要意义。

Objective To explore the application of fine management in the management of orthopedic external surgical instruments in operating room. Methods 670 patients who underwent surgery using external surgical instruments from January to June 2017 were selected as pre-implementation group. 1075 patients who underwent surgery using external surgical instruments from July 2017 to March 2018 were selected as post-implementation group. The pre-implementation group was treated with the traditional operating room orthopedic external device management, and the post-implementation group was treated with the fine operation room orthopedic external device management. The imperfect preparation during the surgery by using orthopedic external instruments before the fine management mode was analyzed. The operating room orthopedics preparation perfect rate of the external surgical instruments, the incidence of device-related problems and the incidence of nursing errors before and after the implementation of the fine management model were compared. Results Before the implementation of the refined management model, 106(15.82%) of the 670 patients who underwent surgery with foreign surgical instruments were not well prepared. Among them, the highest proportion of imperfect preoperative management was inadequate(32 cases, 30.19%), followed by inadequate post-operative management(26 cases, 24.53%), inadequate intraoperative management(23 cases, 21.70%), inadequate access to equipment(17 cases,16.04%)and inadequate cleaning and sterilization(8 cases, 7.55%). After the implementation of the refined management model, there were significant differences in the preparation rate of external instruments(95.07%), the incidence of equipment-related problems(0.93%) and the incidence of nursing errors(4.00%) compared with those before the implementation(84.18%, 5.07%, 10.75%)(P<0.05). Conclusion Fine management is of great significance to improve the surgical effect and work efficiency of the use of external surgical instruments in orthopedics and to ensure the safety and safety of patients.