Construction and application of community geriatric ward risk management system based on Australia and New Zealand risk management standards
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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。 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. -
Key words:
- 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) 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。 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) 后果 可能性 评估 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。 -
[1] 王玲, 杨丽, 朱雪梅, 等. 风险管理在医学领域的研究现状及应用进展[J]. 中国卫生质量管理, 2019, 26(4): 85-90. https://www.cnki.com.cn/Article/CJFDTOTAL-WSJG201904031.htmWANG L, YANG L, ZHU X M, et al. Advances in research and application of risk management in the medical field[J]. Chinese Health Quality Management, 2019, 26(4): 85-90. https://www.cnki.com.cn/Article/CJFDTOTAL-WSJG201904031.htm [2] 鲍勇, 邹鹿鸣. 中国社区慢病风险与健康管理发展战略(一)[J]. 中华全科医学, 2010, 8(6): 671-672. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201006002.htmBAO Y, ZHOU L M. The community chronic disease risk and health management development mode in community in Chinese[J]. Chinese Journal of General Practice, 2010, 8(6): 671-672. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201006002.htm [3] 陈骊, 陈向荣, 章洁, 等. 老年病房风险评价和FMEA分析[J]. 解放军医院管理杂志, 2017, 24(9): 811-813. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201709003.htmCHEN L, CHEN X R, ZHANG J, et al. Application of risk assessment system and FMEA in risk management of geriatric ward[J]. Hospital Administration Journal of Chinese People's Liberation Army, 2017, 24(9): 811-813. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201709003.htm [4] 张艳会, 张玉玲. 探究精细化管理在老年病房护理安全管理中的应用价值分析[J]. 中国卫生产业, 2020, 17(4): 19-20, 23. https://www.cnki.com.cn/Article/CJFDTOTAL-WSCY202004008.htmZHANG Y H, ZHANG Y L. Analysis of the application value of refined management in nursing safety management of geriatric ward[J]. China Health Industry, 2020, 17(4): 19-20, 23. https://www.cnki.com.cn/Article/CJFDTOTAL-WSCY202004008.htm [5] 商丹英, 贾勤, 李璐, 等. 风险管理模式在骨科术后患者压疮护理中的应用有效性探究[J]. 中华全科医学, 2015, 13(4): 664-666. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201504057.htmSHANG Y D, JIA Q, LI L, et al. Application of risk management nursing care intervention in surgery for pressure ulcers nursing after orthopedics operation[J]. Chinese Journal of General Practice, 2015, 13(4): 664-666. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201504057.htm [6] 黄安平. AS/NZS 4360风险管理标准评介[J]. 北方经贸, 2003(10): 99-100. doi: 10.3969/j.issn.1005-913X.2003.10.043HUANG A P. AS/NZS 4360 standard overview[J]. Northern Economy and Trade, 2003(10): 99-100. doi: 10.3969/j.issn.1005-913X.2003.10.043 [7] CHEN L. The risk management of medical device-related pressure ulcers based on the Australian/New Zealand Standard[J]. J Int Med Res, 2018, 46(10): 4129-4139. doi: 10.1177/0300060518786902 [8] 黄美莲, 钟文凯, 谭菜军, 等. 《澳新4360标准》在精神科护理风险管理中的应用[J]. 护理学报, 2018, 25(2): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201802006.htmHUANG M L, ZHONG W K, TAN C J, et al. Application of AS/NZS 4360 risk management in risk management of psychiatry department[J]. Journal of Nursing(China), 2018, 25(2): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201802006.htm [9] 潘玉琴, 徐维虹. 澳新4360标准在手术室护理风险筛查中的应用[J]. 护理学杂志, 2016, 31(12): 42-44. doi: 10.3870/j.issn.1001-4152.2016.12.042PAN Y Q, XU W H. Application of AS/NZS 4360 in nursing risks screening in operating room[J]. Journal of Nursing Science, 2016, 31(12): 42-44. doi: 10.3870/j.issn.1001-4152.2016.12.042 [10] 张堪, 沈福来. 科学研究的逻辑[M]. 北京: 科学出版社, 2019.ZHANG K, SHEN F L. The logic of scientific research[M]. Beijing: Science Press, 2019. [11] 余江. 军队综合性医院风险管理研究[D]. 重庆: 第三军医大学, 2008.Yu J. Study on risk management of military general hospital[D]. Chongqing: Third Military Medical University, 2008. [12] 何建花. PDCA循环管理在重症监护中心护理风险管理中的实施效果[J]. 护理实践与研究, 2017, 14(8): 123-124. doi: 10.3969/j.issn.1672-9676.2017.08.054HE J H. Effect of PDCA cycle management on nursing risk management in intensive care center[J]. Nursing Practice and Research, 2017, 14(8): 123-124. doi: 10.3969/j.issn.1672-9676.2017.08.054 [13] 王秀霞, 张艺, 王翊, 等. 基于KPI模型的护理绩效考核关键指标体系的构建与实施[J]. 护士进修杂志, 2020, 35(18): 1682-1684. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202018013.htmWANG X X, ZHANG Y, WANG X, et al. Construction and implementation of key index system of nursing performance assessment based on KPI model[J]. Journal of Nurses Training, 2020, 35(18): 1682-1684. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202018013.htm [14] 王梦洁, 何小舟. 风险管理在医院行政管理中的应用[J]. 江苏卫生事业管理, 2015, 26(1): 34-38. https://www.cnki.com.cn/Article/CJFDTOTAL-JWSG201501020.htmWANG M J, HE X Z. Application of risk management in hospital administration[J]. Jiangsu Healthcare Administration, 2015, 26(1): 34-38. https://www.cnki.com.cn/Article/CJFDTOTAL-JWSG201501020.htm [15] 程静, 李红, 阚亦非. 澳新风险管理标准在特需护理服务中的应用[J]. 河南医学高等专科学校学报, 2020, 32(6): 660-663. doi: 10.3969/j.issn.1008-9276.2020.06.016CHENG J, LI H, KAN Y F. Application of ANZ Risk management standard in special needs nursing service[J]. Journal of Henan Medical College, 2020, 32(6): 660-663. doi: 10.3969/j.issn.1008-9276.2020.06.016
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