Talking about the hidden danger of nursing safety in dental clinic and its prevention.
Nursing safety means that patients will not suffer psychological and functional damage, obstacles, defects or death beyond the scope permitted by laws and regulations during the whole nursing process [1]. Due to the particularity of oral diagnosis and treatment and the enhancement of people's oral health awareness, hidden dangers in oral clinic work are increasingly exposed.
1 analysis of the hidden dangers and causes of dental clinic safety
1. 1 nurse-patient dispute
1. 1. 1 Nurses' own quality: knowledge structure, technical level and ability, compared with the development of medical technology and the diversified service needs of the people [2]. In recent years, due to the increase in the number of nurses employed, the increase in mobility, the lack of professional knowledge and experience in dentistry, the lack of active service awareness, the inability to understand the psychological needs of patients in time, or the lack of inquiry and explanation for patients, patients are dissatisfied and disputes arise. For example, the guidance nurse lacks specialized knowledge, which can not satisfy the patient's consultation or lead to misleading guidance, resulting in repeated registration and queuing of patients.
1. 1.2 Patient factors: With the continuous enhancement of patients' awareness of oral health care, legal system and self-protection, patients' expectations of hospital medical technology and service quality are too high. At the same time, due to the increase of medical expenses, the constant exposure of medical disputes and the guiding role of public opinion, patients have distrust of medical staff when they see a doctor, and a little carelessness will lead to disputes.
1. 1.3 The medical environment is poor, and the medical treatment process is complicated: due to the influence of the architectural structure, the layout of the dental clinic in our hospital is unreasonable, and it is impossible to provide one-stop service, so patients have to queue up repeatedly to draw prices, pay fees and get medicines. The imperfect appointment system leads to long waiting time or even withdrawal of the number of patients during the peak period of medical treatment, which leads to complaints and disputes.
1.2 Risk of nosocomial infection The important risk factors of nosocomial infection in dental clinics come from secretions, blood and a large number of * * * microorganisms in patients' mouths.
1.2. 1 particularity of oral diagnosis and treatment: the mobility of oral outpatients is large, and the number of patients is large. Bacteria in patients' mouth and respiratory tract will cause air pollution due to droplets and aerosols, which will lead to the spread of diseases such as tuberculosis, pneumonia and influenza.
1.2.2 Complexity of dental instruments: There are many kinds of instruments used in oral therapy, which are complex in structure and expensive, which brings difficulties to disinfection and sterilization of instruments. For example, the structure of the water-gas pipeline system in the dental comprehensive treatment table is complex, and the high-speed equipment will instantly generate strong suction when it stops running, which will pollute the water-gas pipeline. Improper disinfection and sterilization can easily lead to hospital infection. In oral diagnosis and treatment, medical staff should use all kinds of sharp instruments, such as probes, file expanding needles, pulp pulling needles and so on. A little carelessness may lead to occupational exposure of medical staff.
1.2.3 medical staff do not have a strong aseptic concept and do not pay attention to standardized prevention: for a long time, dental medical staff think that the oral cavity itself is a polluted environment and it is impossible to carry out aseptic operation. At work, we often only pay attention to our own protection, ignoring the protection of patients.
1.3 Adverse Drug Reactions Since all the patients were discharged from the hospital after outpatient treatment, if the drug notification and precautions were ignored, the adverse drug reactions could not be observed and handled in time, which led to medical disputes. Such as anesthetic, clove oil, plasticizing solution, cresol formaldehyde and other dental drugs, allergic reactions caused by repair materials such as nickel chromium and silver mercury, and improper use of arsenious acid inactivator causes drug-induced periapical periodontitis and mucosal alveolar bone necrosis. The use of tetracycline drugs leads to tooth development defects in children.
1.4 The unsafe factors of accidental oral care mainly include broken needle, wrong tooth extraction, temporomandibular joint injury, high proportion of cardiovascular and cerebrovascular diseases in the elderly, and accidents caused by tension. Mainly due to the lack of professional basic knowledge and clinical experience of nursing staff, improper coordination of nursing beside the chair or violation of operating procedures.
2 Preventive measures
2. 1 Perfecting and implementing various rules and regulations is a powerful guarantee for nursing safety [3]. It is necessary to conscientiously implement the post responsibility system of all kinds of nursing staff at all levels, the operating norms of disinfection technology for oral medical instruments in medical institutions, and the aseptic operation system, strengthen nursing safety management, and encourage the reporting system of nursing adverse events. Regular safety training for nursing staff, regular analysis and summary of nursing adverse events, and rectification. Discuss typical cases, nip in the bud, and improve nursing safety awareness.
2.2 strengthen the communication between nurses and patients, improve the process of medical treatment, enhance nurses' awareness of active service, and establish? People-oriented? Improve service attitude, standardize service behavior, and show respect, understanding and humanistic care to patients in the whole process of seeing a doctor. Strengthen nurse-patient communication, fully understand patients' physiological, psychological and social needs, and patiently answer patients' questions with sincere, enthusiastic, thoughtful and meticulous service and rich professional knowledge to meet patients' needs. Improve the medical environment, provide newspapers, magazines and health education columns for patients, and eliminate patients' anxiety caused by waiting; Improve the medical treatment process and provide one-stop service. For those who are inconvenient to move, nurses can do it for them or provide on-site service; Reasonable allocation of nurses, arrange nurses with certain work experience and rich professional knowledge to serve as triage, medical guidance and consultation. Improve the registration reservation system to avoid long waiting.
2.3 Strengthening the training of stomatology professional technology and first aid technology Due to the popularization of four-handed operation and the continuous application of new technologies and materials in stomatology, nurses are required to constantly learn and master the nursing operation process to meet the needs of clinical work. Nurses in dental clinics are generally not proficient in first aid technology and lack first aid ability. Therefore, we should strengthen the training of nurses' first-aid knowledge, first-aid technology and the use of first-aid equipment, as well as the prevention training of patients' fall, sudden syncope, cardiac arrest, drug allergic shock and other emergency plans, so as to strengthen nurses' ability to deal with first-aid events.
2.4 Strengthen the training of hospital infection knowledge, strengthen the concept of sterility, strictly implement the standard prevention and aseptic operation principles and the disinfection and isolation system of oral instruments. Instruments should be disinfected or sterilized by one person, and the environment and the surface of objects should be disinfected and monitored regularly. Medical wastes are strictly classified and handled correctly.
2.5 In order to prevent accidents in advance, nurses should assist doctors to make a preliminary assessment of patients and understand their basic health and psychological state. For example, elderly patients should know about blood pressure, recent history of heart attack, diabetes, and blood sugar control, while female patients should know whether it is menstrual period and whether they have allergic history. Psychological counseling should be given to timid and nervous patients to avoid fasting treatment. Warning should be given to places where the ground is slippery and easy to fall.
2.6 Strengthening Informing Obligatory Patients, as a special consumer, have the right and hope to know the purpose, methods, precautions, adverse reactions and risks of their treatment and nursing. Special examination and treatment should be approved by the patient and signed. After root canal therapy, new denture, tooth extraction and orthodontic treatment, patients should be informed of matters needing attention and possible adverse reactions.
3 abstract
Nursing safety is the premise of improving nursing quality, and it is an important link to prevent medical accidents and reduce medical disputes [4]. Learn to evaluate and identify possible unsafe factors and signals in daily work, regularly analyze and discuss unsafe factors in nursing work, and formulate corresponding preventive measures to ensure the medical safety of patients.
refer to
Hua, Yang. Strengthening the management of nursing safety details [J]. chinese nursing management, 2008,8 (4): 51? 52.
[2] Sun Xiaolan. Talking about nursing and nursing disputes [J]. China Journal of Modern Clinical Nursing, 2008,3 (3): 243? 244.
[3] Duan Wenyu, Zhao Yuying, Zhang Lixia. Cause analysis and preventive measures of nursing errors in hemodialysis room [J]. chinese journal of practical nervous diseases, 2009, 12 (4): 8 1.
[4] Wu Jiping. Talking about the safety and quality management of outpatient nursing [J]. Modern Preventive Medicine, 2008,35 (24): 35? 36.
Regarding the hidden dangers of safety nursing, the second article discusses the countermeasures to prevent the hidden dangers of emergency nursing.
With the development of society, people's demand for medical services is increasing, their health requirements are getting higher and higher, and their awareness of law and self-protection is getting stronger and stronger. However, medical behavior is a complex high-risk behavior, and there may be unsafe factors in every link. The emergency department is responsible for the diagnosis and treatment of public health emergencies and critical patients, and the emergency work has certain particularity and complexity. The quality of emergency medical treatment directly reflects the quality of hospital medical treatment. Therefore, emergency nursing safety management has always been the focus of hospital nursing managers. However, in recent years, with the improvement of legal society and the reform of medical system and personnel system, the self-protection awareness of patients and their families has gradually improved, while the clinical emergency nurses are getting younger and younger, and their legal awareness and self-protection awareness are very weak, which brings certain hidden dangers to emergency nursing safety. In view of the hidden dangers in emergency nursing, the corresponding preventive countermeasures are formulated to make emergency nursing safer, faster and more effective and minimize the occurrence of medical accidents.
1 nursing safety hazards in emergency department
1. 1 Lack of communication between doctors and patients, blunt service attitude: most patients who come to the emergency department are urgent and serious, often showing irritability and pain, and their families also show nervousness and excitement. What they need at this time is love, consideration and comfort. A small number of medical staff lack sympathy and patience, speak bluntly, reprimand patients and pay no attention to their psychological state, which is easy to cause dissatisfaction among patients and their families. Once the diagnosis and treatment effect is not good, it is easy to have disputes.
1.2 Weak sense of responsibility, carelessness: individual medical staff do not seriously abide by the operating procedures, do not comprehensively ask patients, do not carefully observe the condition, do not do the items of the examination, do not stress the principle of treatment, do not have a strong sense of sterility during the operation, do not strictly check three or seven pairs, do not implement the handover system, and even shirk and delay the diagnosis and rescue of patients, resulting in medical errors and disputes.
1.3 professional skills are not too hard: nurses can't repeatedly puncture the needle in the rescue, and they can't give drugs intravenously at once, which affects the rescue speed, and the artificial airway of patients with cardiac arrest can't be established immediately, which delays the rescue opportunity.
1.4 lack of awareness of first aid: most emergency patients are sudden or seriously ill, and their families and patients are often anxious, hoping that patients will be rescued in time after admission. For example, nurses do not see a doctor in time, act slowly, take blood tests in time, and escort the examination in time. The medicine used will not be used immediately, and once the condition deteriorates, disputes will occur.
1.5 first-aid drugs are not in place: the emergency department is an emergency department, and first-aid articles, instruments and drugs should always be in a good standby state. If the articles are not fully prepared before rescue, or the articles are not replenished in time after rescue, the rescue work will be in a hurry, which will affect the rescue work and directly affect the efficiency and quality of rescue.
1.6 untimely and imperfect rescue records: medical records are legal documents to record medical activities, and nursing records are an indispensable part of medical records. In emergency nursing, the rescue record is not standardized, the content is incoherent, and the focus is not prominent, which leads to potential disputes.
1.7 Poor communication between doctors and nurses Because the emergency department is busy, doctors have no time to write written orders, so there are more oral orders. At this time, if the communication between doctors and nurses can't be carried out anytime and anywhere, nurses can easily use the wrong medicine or repeat the medicine because they don't hear clearly. In addition, nurses' nursing records are not timely enough, which leads to problems [1].
2 Preventive measures
2. 1 Improve the emergency risk management mechanism
2. 1.65438+
Organize timely declaration, control and avoidance of risks that have occurred, and properly handle them to minimize the risk cost.
2. 1.2 making a scientific risk management plan: according to the past experience and the current situation of emergency nursing, making a feasible risk management plan, defining the objectives and measures, and organizing the implementation.
2.2 Improve the emergency risk management rules and regulations: On the basis of adhering to and implementing the daily nursing work system, focus on improving the following systems.
2.2. 1 risk identification and monitoring system: through investigation and study, we can know the ideological and moral status and professional and technical status of emergency nurses at any time, and grasp the psychological status of patients and their relatives in time. 2.2.2 Risk analysis and declaration system: once nursing risks occur, the parties concerned must declare according to the specified requirements, and the head nurse will organize the members of the risk management team to identify, evaluate and evaluate them.
2.2.3 Risk prevention system: In order to prevent the occurrence of nursing risks, nurses should be urged to strictly implement nursing operation norms and resolutely implement various safety and quality management measures in emergency clinical nursing.
2.3 improve the comprehensive quality of nursing staff: the success or failure of risk management is closely related to people's quality [3]. Emergency nursing risk management should also implement the people-oriented principle.
2.3. 1 Strengthening nurses' risk awareness: Strengthening nurses' risk awareness education, combining nursing risks with the sacred duty of saving lives and respecting patients' legitimate rights and interests, so that every nurse can have a correct understanding of nursing risks.
2.3.2 Strengthen the professional training of nursing staff: master new nursing technology in time, constantly recharge and update knowledge. In particular, it is necessary to strengthen the training of emergency response capabilities.
2.3.3 Strengthen nurses' self-protection awareness and risk awareness: strengthen nursing risk education in emergency management, study relevant laws and regulations and hospital rules and regulations in a targeted manner, firmly establish the concept of quality and safety first, service first, patients first, and nursing according to law, so as to nip in the bud and provide patients with safe care.
2.4 Nurses have good language communication skills: Good language communication skills are the basic requirements for the quality of emergency nurses. Nurses are required to show understanding, tolerance and consideration for patients' pain, avoid blunt language and cold expression, have a high sense of responsibility, respond quickly and be calm.
2.5 All kinds of medicines, articles and equipment in the emergency room are in place: in a good standby state. It is required to check all rescue instruments in each shift to ensure that the instrument integrity rate reaches 100% and the required items are fully prepared. After patients arrive at the department, they should actively organize nursing staff to rescue them, formulate perfect nursing plans and implement them one by one.
2.6 Emergency nurses should strengthen self-discipline and self-discipline: Emergency nurses should strictly implement the nursing system and operating procedures, conscientiously implement three checks and seven pairs, and closely observe the patient's condition changes.
Nursing safety management is an art, which needs to be constantly summarized and learned in practice. Safety is the basic need of people and nursing work. Establish and improve rules and regulations, job responsibilities and work standards, mobilize the enthusiasm and creativity of nurses, ensure the quality of clinical nursing, and strengthen risk education in clinical work. Everyone should implement various work systems and operating procedures, nip in the bud, and provide guarantee for safe nursing.
refer to
[1] Xie Xiaohong. Analysis and countermeasures of defects in emergency nursing records. China Journal of Misdiagnosis, 2004, 1 (1): 143.
[2] Thank you. On the principle of legal basis in handling medical disputes. China Hospital Management, 2003,23 (6): 32
[3] Dong Aizhu. Investigation and analysis of nurses' knowledge of safety management. China Journal of Nursing, 2004,39 (3):194-196.