神外守脑圈课件.ppt

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1、降低气管切开护理降低气管切开护理 的不规范率的不规范率神经外科神经外科2014年守脑圈成果总结年守脑圈成果总结神经外科守脑圈神经外科守脑圈神经外科气管切开患者较多，气管切开护理在日神经外科气管切开患者较多，气管切开护理在日常护理工作中占了很大比例，其质量直接影响到常护理工作中占了很大比例，其质量直接影响到神经外科危重患者的护理质量。守脑圈旨在降低神经外科危重患者的护理质量。守脑圈旨在降低气管切开护理的不规范性，提高神经外科气管切气管切开护理的不规范性，提高神经外科气管切开患者的护理质量。开患者的护理质量。守脑圈，寓意为守护大脑。神经外科又称脑外科，守脑圈，寓意为守护大脑。神经外科又称脑外科，主

2、要收治中枢神经系统（脑和脊髓）及周围神经主要收治中枢神经系统（脑和脊髓）及周围神经系统疾病手术治疗的患者，危重患者多，治疗护系统疾病手术治疗的患者，危重患者多，治疗护理工作繁重，神外护士以患者康复为工作目标，理工作繁重，神外护士以患者康复为工作目标，致力于守护患者生命，守护患者安全，守护患者致力于守护患者生命，守护患者安全，守护患者大脑。大脑。组圈动机组圈动机圈名意义圈名意义圈徽意义圈徽意义 中间蓝色的蛇杖做为西医标志，寓意镇住病魔，救死扶伤；黄色代表神经的颜色，绘成大脑的轮廓，QCC为品管圈缩写，上方neurosurgery为神经外科的英文名称；下方绿色托举状双手寓意用护士的双手托起生命的绿

3、色，追求护理精益求精的护理品质，守护大脑，守护生命中枢。整体圈徽的意义为神外护士以品管圈为工具进行护理质量管理，提升护理品质内涵，守护中枢神经系统，以双手承托患者生命的绿色。守脑圈成员守脑圈成员圈名圈名成立日期成立日期圈员圈员人数人数平均平均年龄年龄辅导员辅导员圈长圈长所属单位所属单位守脑圈2014.3.573110-15年5-9年1-4年圈圈员护龄结构构10-15年5-9年1-4年姓名姓名年龄年龄学历学历职称职称护龄护龄辅导员本科副主任护师圈长大专护士圈员本科主管护师圈员本科主管护师圈员本科护师圈员本科护师圈员本科护士圈员大专护士主题选定主题选定主题评价题目主题评价题目上上级级政政策策可可

4、行行性性迫迫切切性性圈圈能能力力总总分分顺顺序序选选定定1.1.降低泵人药物静脉炎的发生率降低泵人药物静脉炎的发生率3529292111452.2.减少输液单护士执行签名漏签率减少输液单护士执行签名漏签率3521312911633.3.降低气管切开护理的不规范率降低气管切开护理的不规范率35 33312712614.4.提高危重患者床旁评估的规范性提高危重患者床旁评估的规范性3533212911825.5.缩短急诊手术患者的术前准备时间缩短急诊手术患者的术前准备时间292121178866.6.提高护士操作前后洗手的依从性提高护士操作前后洗手的依从性352921311164主题评价表评价说明评

5、价说明分分数数上级政策上级政策可行性可行性迫切性迫切性圈能力圈能力1 1没听说过不可行半年后再说需多部门配合3 3偶尔告知较可行下次解决需一个部门配合5 5经常提醒可行尽快解决自行能解决本期活动主题本期活动主题 ：降低气管切开护理的不规范率：降低气管切开护理的不规范率选题背景选题背景 气管切开可解除呼吸道梗阻，改善呼吸，便于吸痰及给氧，是抢救危重患者的重要手段，但同时因气管切开后呼吸通路发生了变化，并由此带来了一系列新的问题，也会引起较多的并发症，因此加强对气管切开患者的护理,对预防切口感染及下呼吸道感染有重要作用，高效的气道护理是保持气道通畅、预防切口感染及治疗肺部感染的关键。名词定义名词定

6、义 规范的气管切开护理包括气道湿化适宜、气管切开固定带松紧适宜、气切口皮肤无炎性反应、气切口敷料清洁、气切套管清洁、气囊压力适宜、适时吸痰等。100%气管切开护理总评价项目数气管切开护理不规范率=衡量指标衡量指标：气管切开护理不规范项目数选题理由选题理由对医院而言对医院而言提升患者满意度及医院良好社会效益对患者而言对患者而言减少并发症发生，减轻经济负担对科室而言对科室而言对个人而言对个人而言提高危重患者治愈率，降低并发症发生率提高工作效率，提升护理品质活动计划活动计划制图人：制图人：2014.4.5表示计划实施表示计划实施 表示完成表示完成 神外守脑圈神外守脑圈“降低气管切开护理的不规范性降低

7、气管切开护理的不规范性”活动计划表活动计划表现况把握现况把握-1气切护理流程图气切护理流程图制图人：制图人：现况把握现况把握-2查检神经外科气管切开护理不规范性的现况查检神经外科气管切开护理不规范性的现况Who:When:2014.4.225.26Where:神经外科神经外科What:气管切开的患者气管切开的患者Why:了解气切护理不规范的现状及原因了解气切护理不规范的现状及原因How:实际观察法实际观察法How many:神经外科所有气管切开患者神经外科所有气管切开患者 （一次性套管和金属套管均在范围内）（一次性套管和金属套管均在范围内）现况把握现况把握-3查检表查检表现况把握现况把握-4查

8、检结果统计分析查检结果统计分析现况把握现况把握-5改善前柏拉图改善前柏拉图根据根据80/20法则，需改善的项目有：法则，需改善的项目有：气囊压力不足气囊压力不足气切固定带不洁气切固定带不洁气切固定带过松气切固定带过松气切口敷料不洁气切口敷料不洁改善重点为改善重点为80.3%制图人：制图人：2014.5.28.80.3%目标设定目标设定现况值现况值=不规范项目/总查检项目*100%=1831645100%=11.1%改善重点改善重点为80.3%圈能力圈能力为27/35*100%=77%目标设定目标设定目标值目标值=现况值-（现况值*改善重点*圈能力）=11.1-（11.1*80.3%*77%）4

9、.2%根据圈能力及现况将目标值设定为4.2%，本次圈活动目标为将气管切开护理不规范183例降为69例。制图人：制图人：解析解析-1制图人：制图人：解析解析-2制图人：制图人：解析解析-3制图人：制图人：解析解析-4制图人：制图人：解析解析-5要因选定表要因选定表重要的5分，一般的3分，不重要的1分。制表人：张娟制表人：张娟 解析解析-6制图人：张娟制图人：张娟 徐靓徐靓 解析解析-7通过现场查看进行真因验证通过现场查看进行真因验证真因查检后柏拉图真因查检后柏拉图制图人：制图人：解析解析-8制表人：制表人：对策拟定对策拟定-1利用头脑风暴进行利用头脑风暴进行5w1h的方法寻找对策的方法寻找对策w

10、hy气囊压力不足？因为没有及时注气。why没有及时注气？因为护士忙于其他工作没有发现气囊需要注气。why没发现？因为没有专门观察气囊。why没有观察？因为护士没有认为气囊充盈很重要。加强质控和进行气管切开护理的专题培训。why护士未能及时发现处理不规范情况？因为护士少工作量大，巡视未有效落实。why不能有效落实？因为巡视内容不明确。why不明确？因为低年资护士专科能力不足。加强培训，利用评估交接表细化观察项目，使 护士明确观察内容。对策思路一对策思路一对策思路二对策思路二对策拟定对策拟定-1why气切固定带不清洁？因为未及时更换。why没更换？因为需两人合作，不方便。why需两人合作？因为绷带

11、不好打结，为防止意外脱管必须两人操作更换。why气切固定带过松？因为绷带没有弹性，不易固定。更换气切固定带材料，以便操作。why气切口敷料不清洁？因为有血渍痰渍未及时更换。why未更换？因为护士工作忙没顾上。why没顾上？因为更换次数频繁。why更换频繁？因为渗血多，纱布吸收能力有限。寻找比纱布更适合的气切口敷料，增强吸收 能力及密闭性。对策思路三对策思路三对策思路四对策思路四对策拟定对策拟定-2通过制作亲和图根据标准拟定对策通过制作亲和图根据标准拟定对策制表人制表人：对策实施与检讨对策实施与检讨-1制表人制表人：对策实施与检讨对策实施与检讨-2制表人制表人：对策实施与检讨对策实施与检讨-3制

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