基层医院无惩罚性护理不良事件管理系统的构建与应用

Construction and application of non-punitive nursing adverse event management system in primary hospital

目的构建无惩罚性护理不良事件管理系统,探讨该系统在基层医院护理不良事件管理中的应用效果。方法采用便利抽样法,选取2015年1月—2016年12月启用不良事件直报系统前2年住院的71967例患者为对照组,采用护理部统一不良事件表经医院OA系统发送将护理不良事件上报护理部。以2017年1月—2018年12月启用直报系统后住院的73002例患者为试验组。比较直报系统应用前后护理不良事件上报率、不良事件分级、类别及跌倒/坠床伤害率。结果试验组共上报811例不良事件,高于对照组的715例,两组比较差异有统计学意义(χ^2=5.685,P=0.017);试验组与对照组不良事件级别发生率比较差异有统计学意义(P<0.05)。试验组药物外渗、标本相关事件的例数增加,针刺伤、烫伤事件的例数减少,两组比较差异具有统计学意义(P<0.05)。试验组跌倒/坠床Ⅲ级损伤发生率3.1%(5/159),低于对照组的11.6%(15/129),两组比较差异具有统计学意义(P<0.05)。结论无惩罚性直报系统有利于营造医院护理安全文化氛围,提高不良事件的主动上报率,降低不良事件的级别及伤害率,改变不良事件的构成比,从而提高护理管理效能,持续改进护理质量。

Objective To construct a non-punitive nursing adverse event management system and explore the effects of the system in the management of adverse events in primary hospitals.Methods By convenient sampling,71967 patients who were hospitalized in the first 2 years of the introduction of the adverse event reporting system from January 2015 to December 2016 were selected as the control group,the Department of Nursing unified adverse event table was sent to the hospital OA system,adverse events are reported to the Department of Nursing;a total of 73002 patients hospitalized after the direct reporting system was enabled from January 2017 to December 2018 were the experimental group.Comparing the reported rate of adverse events,adverse event grading,categories,and fall/falling injury rates between the two groups.Results A total of 811 adverse events were reported in the experimental group,which was higher than 715 in the control group,the difference between the two groups was statistically significant(χ^2=5.685,P=0.017).There was a statistically significant difference in the levels of adverse events incidence between the experimental group and the control group(P<0.05).The number of cases of drug extravasation and specimen-related events increased in the experimental group,and the number of needlestick and scald events decreased,the difference between the two groups were statistically significant(P<0.05).The incidence of GradeⅢinjury in the fall/fall of the test group was 3.1%(5/159),which was lower than that of the control group(11.6%,15/129),the difference between the two groups was statistically significant(P<0.05).Conclusions The non-punitive direct reporting system is conducive to creating a safe culture atmosphere for hospital care,increasing the active reporting rate of adverse events,reducing the level of adverse events and injury,changing the composition ratio of adverse events,thereby improving the efficiency of nursing management and continuously improving the quality of care.