基于澳新风险管理标准的社区老年病房风险管理体系构建与应用

盛清; 诸光花; 蔡利强

doi:10.16766/j.cnki.issn.1674-4152.002419

基于澳新风险管理标准的社区老年病房风险管理体系构建与应用

doi: 10.16766/j.cnki.issn.1674-4152.002419

1.
上海市闵行区江川社区卫生服务中心，上海 202400
2.
上海市浦东新区大团社区卫生服务中心，上海 201311

基金项目:

上海市浦东新区卫生系统社区学科带头人培养计划项目 PWRsd2019-07

详细信息

通讯作者:
诸光花, E-mail: jcywk11111@163.com

中图分类号: R197.323 R197.61
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- 文章访问数: 169
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-05
- 网络出版日期: 2022-08-20

Construction and application of community geriatric ward risk management system based on Australia and New Zealand risk management standards

1.
Jiangchuan Community Health Service Center, Minhang District, Shanghai 202400, China

摘要

摘要: 目的基于澳新风险管理标准构建社区卫生服务中心老年病房风险管理体系，并对实施和应用效果进行评价。方法按照澳新风险管理标准建立老年病房风险管理体系，制定组织架构和岗位职责，建立风险管理的目标、环境、识别、分析、评价和控制等制度体系；运用风险量化矩阵的工具，通过风险类型、风险描述、现有控制措施、最初后果、最初发生可能性、最初风险评分、增加其他控制措施、剩余后果、剩余可能性、剩余风险评估等方式评价社区老年病房的风险。结果通过江川社区卫生服务中心院部统计数据显示，2019年全年全院上报老年病房不良事件63起，前5位高频发或后果严重的事件为疥疮(18起)、压疮(13起)、跌倒(8起)、猝死(7起)、轻生事件(4起)，均属于患者服务与安全风险，故将社区老年病房的疥疮、压疮、跌倒、猝死、轻生作为5个重要风险点。运用风险管理体系，通过风险量化矩阵的工具，对5个重要风险点进行评估，结果分别为16、15、12、10、10分。采用PDCA管理循环模型做好风险控制的落实与实施，再运用风险量化矩阵工具评估5个重要风险点的剩余风险，分别为8、12、9、5、5分。结论基于澳新风险管理标准构建社区卫生服务中心老年病房风险管理体系能够达到对风险的预防和控制，是一个能有效控制老年病房风险的管理工具，值得学习和推广。
- 风险管理 /
- 老年病房 /
- 剩余风险 /
- 体系构建
Abstract: Objective On the basis of the Australia and New Zealand (ANZ) risk management standard, a risk management system for the geriatric ward in community health service centre was constructed, implemented, applied and evaluated. Methods According to the ANZ risk management standard, risk management system of geriatric ward was established, organisational structure and post responsibilities were established, the target, environment, appraisal, analysis, evaluation and control system of risk management were planned. Using the tools of risk quantification matrix, the risk of community geriatric ward was evaluated through risk type, risk description, existing control measures, initial consequences, initial occurrence possibility, initial risk score Increase other control measures, residual consequences, residual possibility and other ways. Results According to the statistics of the hospital and the department in 2019, 63 adverse events were reported in the geriatric ward throughout the hospital. The top five events with high frequency or serious consequences were scabies (18 cases), pressure sores (13 cases), falls (8 cases), sudden death (7 cases) and suicide events (4 cases). Therefore, scabies, pressure sores, falls, sudden deaths and suicides in community geriatric wards were regarded as five important risk points. Using the risk management system and the tools of the risk quantification matrix, the five important risk points were evaluated, which had a score of 16, 15, 12, 10 and 10 points, respectively. The PDCA management cycle model was used to implement risk control, and then the residual risk was evaluated as 8, 12, 9, 5 and 5 points, respectively. Conclusion The risk management system of geriatric ward in community health service center based on ANZ risk management standards can achieve risk prevention and control. It is a management tool that can effectively control the risk of geriatric ward, which is worthy of learning and promotion.
- Risk management /
- Geriatric ward /
- Residual risk /
- System building

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表 1 老年病房风险量化矩阵

Table 1. Geriatric ward risk quantification matrix

风险存在的可能性	频率	风险产生的后果(分)
风险存在的可能性	频率	不严重	轻微严重	中度严重	较大严重	极其严重
几乎确定	实际至少每个月1次	5	10	15	20	25
很可能	每2个月发生1次	4	8	12	16	20
可能	可能1~2个月1次	3	6	9	12	15
不太可能	可能2~5年1次	2	4	6	8	10
几乎不可能	可能5年或以上1次	1	2	3	4	5
注：根据后果和可能，风险量化矩阵1~5分为低风险、6~15分为中风险、16~25分为高风险。

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表 2 老年病房风险描述、现有控制措施、风险评估汇总表(简易版)

Table 2. Geriatric ward risk description, existing control measures, risk assessment summary sheet (simple version)

风险类型	主要原因	现有主要控制措施	最初风险评估(分)			风险降低主要策略	剩余风险评估(分)
风险类型	主要原因	现有主要控制措施	后果	可能性	评估	风险降低主要策略	后果	可能性	评估
疥疮	护理单发患者个人防护不到位导致传播。	环境消毒、单发患者护理干预	4	4	16	加强护工院感知识培训和管理	4	2	8
压疮	老人长期卧床或护士压疮评估干预不到位	《Braden压力性损伤危险因素评估表》评估和干预	3	5	15	建立压疮护理三级监管制度	3	4	12
跌倒	老年人反应迟钝、安全防范措施不到位	配备物理设备设施	3	4	12	物理设备防御加护理人员干预	3	3	9
猝死	对猝死识别能力不够	落实医疗质量和医疗安全的核心制度	5	2	10	提高医生风险意识和提高猝死识别能力	5	1	5
轻生	未及时发现老年人心理和精神状态异常	配备物理设备设施	5	2	10	医生精神异常识别能力培训	5	1	5
注：风险主要原因、现有措施和风险降低主要策略比较简单，具体内容见正文，本表可直观看到最初风险和剩余风险的评估。

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