目的:探讨实行双护士值班模式对提高护理安全质量的意义,提出管理对策,完善值班制度。方法:对实行双护士值班模式前、后的护理投诉、纠纷、不良事件、满意度、职业伤害次数、严重程度、发生时间及男、女病区实施双护士模式后前6个月与后...目的:探讨实行双护士值班模式对提高护理安全质量的意义,提出管理对策,完善值班制度。方法:对实行双护士值班模式前、后的护理投诉、纠纷、不良事件、满意度、职业伤害次数、严重程度、发生时间及男、女病区实施双护士模式后前6个月与后6个月护理人员受伤害例数进行比较。结果:实行双护士值班制度后护理投诉、纠纷减少,护理不良事件发生率降低,护理满意度提高,护理人员受伤害严重程度下降;护理人员受伤害次数增加,年轻护士、夜间伤害发生率增多。结论:双护士值班模式在精神科病房的开展,在提高护理质量上比单护士模式有明显的优势,但在护理人员的人身安全和心理健康方面存在缺陷;管理者必须重视存在问题的改进,使制度不断完善,保证护理质量和医疗安全,有利于值班模式在全院的展开。Dual nurses on duty mode in psychiatric department effects on nursing safety and quality/ZHU Wenjie//Chinese Hospitals.-2011,15(1)展开更多
AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients ...AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010. This was a randomized cross-over study, in which each patient underwent ERCP twice, once with BIS monitoring and once with control monitoring. Whether BIS monitoring was done during the first or second ERCP procedure was random. Patients were intermittently administered a mixed regimen including midazolam, pethidine, and propofol by trained nurses. The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring. The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups. RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9 ± 30.8 mg in the control group (P = 0.673). The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P = 0.103). The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups. The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor. No significant differences in the frequency of < 80% oxygen saturation, hypotension (< 80 mmHg), or bradycardia (< 50 beats/min) were observed between the two study groups. Four cases of poor cooperation occurred, in which the procedure should be stopped to add the propofol dose. After adding the propofol, the procedure could be conducted successfully (one case in the BIS group, three cases in the control group). The endoscopist rated patient sedation as excellent for all patients in both groups. All patients in both groups rated their level of satisfaction as high (no discomfort). During the post-procedural follow-up in the recovery area, no cases of clinically significant hypoxic episodes were recorded in either group. No other postoperative side effects related to sedation were observed in either group. CONCLUSION:BIS monitoring trend to slighlty reduce the mean propofol dose. Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.展开更多
文摘目的:探讨实行双护士值班模式对提高护理安全质量的意义,提出管理对策,完善值班制度。方法:对实行双护士值班模式前、后的护理投诉、纠纷、不良事件、满意度、职业伤害次数、严重程度、发生时间及男、女病区实施双护士模式后前6个月与后6个月护理人员受伤害例数进行比较。结果:实行双护士值班制度后护理投诉、纠纷减少,护理不良事件发生率降低,护理满意度提高,护理人员受伤害严重程度下降;护理人员受伤害次数增加,年轻护士、夜间伤害发生率增多。结论:双护士值班模式在精神科病房的开展,在提高护理质量上比单护士模式有明显的优势,但在护理人员的人身安全和心理健康方面存在缺陷;管理者必须重视存在问题的改进,使制度不断完善,保证护理质量和医疗安全,有利于值班模式在全院的展开。Dual nurses on duty mode in psychiatric department effects on nursing safety and quality/ZHU Wenjie//Chinese Hospitals.-2011,15(1)
文摘AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010. This was a randomized cross-over study, in which each patient underwent ERCP twice, once with BIS monitoring and once with control monitoring. Whether BIS monitoring was done during the first or second ERCP procedure was random. Patients were intermittently administered a mixed regimen including midazolam, pethidine, and propofol by trained nurses. The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring. The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups. RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9 ± 30.8 mg in the control group (P = 0.673). The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P = 0.103). The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups. The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor. No significant differences in the frequency of < 80% oxygen saturation, hypotension (< 80 mmHg), or bradycardia (< 50 beats/min) were observed between the two study groups. Four cases of poor cooperation occurred, in which the procedure should be stopped to add the propofol dose. After adding the propofol, the procedure could be conducted successfully (one case in the BIS group, three cases in the control group). The endoscopist rated patient sedation as excellent for all patients in both groups. All patients in both groups rated their level of satisfaction as high (no discomfort). During the post-procedural follow-up in the recovery area, no cases of clinically significant hypoxic episodes were recorded in either group. No other postoperative side effects related to sedation were observed in either group. CONCLUSION:BIS monitoring trend to slighlty reduce the mean propofol dose. Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.
