基于瑞士奶酪模型的护理管理模式在日间病房化学治疗患者安全用药中的应用

Application of nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards

目的 探讨基于瑞士奶酪模型的护理管理模式在日间病房化学治疗(化疗)患者安全用药中的应用效果。方法 纳入2023年2月-3月(改进前)及2023年6月-7月(改进后)天津医科大学肿瘤医院日间病房化疗患者为研究对象。改进前采用常规护理管理模式,改进后采用基于瑞士奶酪模型的护理管理模式。比较改进前后护士用药安全能力、用药不良事件情况以及患者护理满意度。结果 改进前后各纳入患者150例。两组患者的年龄、性别、文化程度、家庭人均月收入、肿瘤分期、疾病诊断差异无统计学意义(P>0.05)。改进后患者护理满意度总分高于改进前[(22.99±1.52)vs.(20.45±2.14)分,P<0.05],但在治疗环境、服务态度维度,差异无统计学意义(P>0.05)。改进前后护理人员无变动,共纳入日间病房护士34名。改进后护士用药安全能力总分高于改进前[162.00(160.75,166.25)vs. 136.00(135.00,138.00)分,P<0.05],但在改善用药安全问题、多学科协作能力、护理职业责任维度差异无统计学意义(P>0.05)。改进后日间化疗用药不良事件发生率低于改进前(P<0.05)。结论 基于瑞士奶酪模型的护理管理模式可提高护士安全用药能力,减少日间病房化疗用药不良事件,提升患者满意度,可在临床推广。

Objective To explore the application effect of a nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards.Methods The study included chemotherapy patients in the Department of Day Care Ward of Tianjin Medical University Cancer Institute&Hospital between February and March 2023(before improvement)and between June and July 2023(after improvement).Before the improvement,a conventional nursing management mode was adopted,and after the improvement,a nursing management mode based on the Swiss cheese model was adopted.The medication safety ability of nurses,adverse drug events,and patients’satisfaction of nursing before and after improvement were compared.Results Finally 150 patients were included before and after improvement,respectively.There was no statistically significant difference in age,gender,educational level,per capita monthly household income,tumor staging,and disease diagnosis between the two groups of patients(P>0.05).The total score of patients’satisfaction of nursing after improvement was higher than before improvement(22.99±1.52 vs.20.45±2.14,P<0.05),but there was no statistically significant difference in the dimensions of treatment environment and service attitude(P>0.05).There was no change in the nursing staff before and after the improvement,and a total of 34 nurses were included in the Department of Day Care Ward.The total score of the nurses’medication safety ability was higher than before improvement[162.00(160.75,166.25)vs.136.00(135.00,138.00),P<0.05],but there was no statistically significant difference in the dimensions of improving medication safety issues,multidisciplinary collaboration ability,and nursing professional responsibility(P>0.05).The incidences of adverse events during daytime chemotherapy after improvement were lower than before improvement(P<0.05).Conclusion The nursing management mode based on Swiss cheese model can improve the safety medication ability of nurses,reduce adverse events of chemotherapy medication in daytime wards,and improve patient satisfaction,which can be promoted in clinical practice.