基于帕累托原理持续改进手术安全管理的评价

Continuously Improve Surgical Safety Management Based on Pareto Principle

目的分析手术病案主要缺陷类型和缺陷表现,寻找提高手术安全管理的方法。方法运用帕累托方法,总结分析2017年1月5日-2018年12月20日存在缺陷的192例手术病案中出现的主要缺陷类型,针对主要缺陷类型找出缺陷表现。结果10类缺陷类型中检查检验报告单未及时粘贴、手术病案打印及审签字不全、三四级手术科主任未审批、手术知情同意书缺陷4类缺陷累积百分比为76.39%;造成4类主要缺陷类型的表现有10个,其中医学检验报告单未及时粘贴和三四级手术术前小结无科主任审批签字发生率相对较高,分别为25.60%和18.84%。结论手术文书存在多种缺陷,反映出医院手术管理存在问题,应加强培训提高防范认识,发挥科室质控小组的作用,多方参与,齐抓共管,压实责任,健全奖惩机制等方面入手,持续加强手术安全管理。

Objectives To analyze the main types and manifestations of defects in surgical medical records and find out the methods to improve the safe management of surgery.Methods By using Vilfredo Pareto method,192 patients with surgical defects who visited the operating room from January 5 th 2017 to December 20 th 2018 were analyzed,and the main defect types were found out,and the defect manifestations were found according to the main defect types.Results Among the 10 types of defects,the cumulative percentage of the defects of the four types of defects was 76.39%.The performance of the four major types of defects was 10,of which the incidence of non-timely pasting of medical test reports and the non-approval of signatures by the chief of the pre-operative summary of Level III surgery was relatively high,with 25.60%and 18.84%respectively.Conclusions We should strengthen the management of operation safety from the aspects of strengthening training,raising the awareness of prevention,giving full play to the role of the quality control team of the department,participating in many parties,holding together the management,compacting the responsibility,and continued strengthening of surgical safety management.