1、The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come First持续质量改进在提高高危用药患者中心持续质量改进在提高高危用药患者中心静脉置管率中的应用静脉置管率中的应用The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come First液体外渗液体外渗The Needs of The Patient
2、s and The Customers Come FirstThe Needs of The Patients and The Customers Come First案例案例 一名住院患者由于持续经外周静脉注射尼莫地平，出现液体外渗、肢体肿胀明显、局部出现张力性水泡等症状。虽然事后经过对症处理，该患者的症状有所好转，但这给患者带来的痛苦与潜在的医患纠纷是不可忽视的。The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come First使用高危用药静
3、脉选择方式现状使用高危用药静脉选择方式现状The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come Firstfishbonefishbone 人 医患沟通少 缺乏医护合作 知识不足 文化水平参差不齐宣教不到位 自身知识缺乏穿刺水平参差不齐 患者认知不足 工作量大 经验不足 恐惧 病情危重，对静脉输液不重视设备不齐全穿刺风险大 管道多样费用昂贵 导管细，易折断，易堵管穿刺禁忌症多 维护不方便 事 物The Needs of The Patients
4、 and The Customers Come FirstThe Needs of The Patients and The Customers Come FirstP P（PlanPlan）数据来源：科室统计高危用药输液血管通路的表单记录。数据收集方法：由科室持续质量改进负责人落实并进行统计分析。样本量大小：科室所有高危用药患者。数据监测期限：2011年7月至2012年7月，每月持续监测。在次月下旬完成上月的数据统计。项目启动后前三个月的数据需要护士长加以验证。The Needs of The Patients and The Customers Come FirstThe Needs of
5、 The Patients and The Customers Come FirstD(DO)D(DO)科内静脉输液专科知识的培训与考核 改善HIS 和电子病历系统的功能 组织协调，解答困惑，公正评价，并使其标准化。咨询顾问制作宣传栏，DO 辅导员辅导员辅助科室辅助科室护士长组织学习及考核，开展知识讲座，制作日常维护告知书The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come FirstDODOThe Needs of The Patients
6、and The Customers Come FirstThe Needs of The Patients and The Customers Come FirstDODOD D（DoDo）优化前流程 优化后流程PICC穿刺电话预约符合专科护士评估不符合不穿评估血管需要B超引导穿刺取B超机PICC穿刺责任护士评估化验，血管条件填写护理会诊单专科护士根据会诊单准备用物穿刺The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come FirstC(Chec
7、kC(Check）The Needs of The Patients and The Customers Come FirstThe Needs of The Patients and The Customers Come FirstA(Action)A(Action)进一步的改善空间主要在于：1.目前预约CVC穿刺流程烦琐，需医生陪同前往麻醉科穿刺，在一定程度上制约了中心静脉穿刺的开展，迫切需要简化CVC穿刺流程。2.还需加强医护合作，全员重视合理静脉输液的重要性,加强与麻醉室、导管室的合作，确保符合中心静脉穿刺适应症患者术中行中心静脉穿刺术，提高术中中心静脉置管率。3.改变患者及家属的传统输液理念。Thank you!
