ObjectiveTo investigate the status of antibiotic drug use in the outpatient department based on the special rectification activities of antibiotic drugs, identify the reasons for irrational use of antibiotic agents and propose the solutions. MethodsPrescription of antibiotic drugs were analyzed by a retrospective comparative analysis during April to June 2011, August to October 2011 and August to October 2012. ResultsPrescriptions of antibiotic drugs were 435 (36.25%), 367 (30.58%) and 223 (18.58%) during April to June 2011, August to October 2011 and August to October 2012, respectively, and the unreasonable prescriptions were 35 (2.92%), 27 (2.25%), and 14 (1.25%) respectively. ConclusionThere is a decreased tendency of prescription of antibiotic drugs in the outpatient department of our hospital because of the special rectification activities of antibiotic drugs. It is in accordance with antibiotic use rate of <20% target of "antibiotics in 2012 special rectification program" in hospital outpatient service. But there are some unreasonable phenomena in the use of antibiotics, and to promote the reasonable use of antibiotics, we should strengthen management.
ObjectiveTo analyze the reasons for operation cancellation, in order to improve the efficiency and quality of work in Day-surgery (DS) ward. MethodsRetrospective study and related factor analysis were carried out for 985 cases of canceled DS operations from October 2012 to October 2013. ResultsThe main factors for canceling DS operations included diseases, patients and relatives refusing operation, incomplete preoperative preparation and accidental events. ConclusionDS medical staff of each department should enhance the sense of responsibility and cooperation. Preoperative treatment of patients with chronic diseases and preoperative health education and psychological aids should be strengthened to reduce temporary cancellation of DS operations.
ObjectiveTo analyze the reasons for Non-iatrogenic Complaint in general hospital inpatients and its preventive measures. MethodsWe analyzed 338 cases of non-iatrogenic complaint from January 2008 to December 2013 in two tertiary hospitals. ResultsComplaint for poor service attitude of medical personnel and poor communication between doctors/nurses and patients accounted for 86.1% and 62.4% respectively. Complaint for poor hospital management accounted for 46.2%. Non-iatrogenic complaint which appeared in the form of medical dispute complaint due to technical factors accounted for 20.1%. The first five departments being complained were Emergency Department, Pediatrics Department, Obstetrics Department, Osteology Department, Cardiology Department, respectively. Among all complaint, the proportion of complaint from emergency patients exceeded that from nonemergency patients. The proportion of complaint from patients whose duration of hospitalization exceeded two weeks were much more than that from patients whose duration of hospitalization was less than two weeks. The proportion of complaint from patients whoes frequency of hospitalization within one year was more than two times exceeded that from patients whose frequency of hospitalization within one year was less than two times. The proportion of complaint from patients who earned their high school diploma exceeded that from patients who droped out of their high school. The proportion of complaint from town patients exceeded that from rural patients. The proportion of complaint from patients under 45 years old was more than that from patients ≥ 45. ConclusionMore weight and strengthen should be placed on doctor-patient communication in clinical practice. Humane medical service deserve special emphasis and the patientcentered service idea should also be established, so that non-iatrogenic complaint may be reduced.
ObjectiveTo investigate the reason, prevention, and treatment measures of gastrointestinal unplanned reoperation. MethodsClinical data of 21 patients who carried out gastrointestinal unplanned reoperation for various reasons from Jun. 2012 to Jun. 2013 in our hospital were retrospectively analyzed. ResultsTwenty-one of 2 492 patients with gastrointestinal tract surgery carried out gastrointestinal unplanned reoperation, and the incidence of reoperation was 0.8%. The causes of reoperation were intra-abdominal hemorrhage in 10 cases, gastrointestinal fistula in 7 cases, inflammatory intestinal obstruction with peritonitis in 1 case, and incision dehiscence in 3 cases. After undergoing suture hemostasis, colostomy, anastomotic fistula repair, debridement, and suture,20 cases were cured or improved, and 1 case died. The median of hospitalization expense was 76 000 yuan(46 000-116 000 yuan), and the median of hospital stay was 25-day(16-49 days). ConclusionsGastrointestinal unplanned reoperation can cause more serious economic and emotional burden to patients, standardizing surgical procedure and enhancing perioperative monitoring can reduce the incidence of unplanned reoperation. In addition, grasp legitimately the indications of reoperation, implement timely, and effective reoperation can avoid further deterioration of the disease.
ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.
Objective To summarize the characteristics of surgery-related near misses including events composition, cause of incident, specialty category, personnel allocation etc, and to provide experience of feedforward control for the nurses in operating room and a clinical basis of safety standards for the management of operating rooms. Method The 240 surgery-related near misses occurred between July 2014 and July 2016 were retrospectively analyzed, using frequencies and percentiles to describe the count data. Results The 240 surgery-related near misses were mainly associated with surgical stitches (91 cases, 37.9%), surgical dressings (52 cases, 21.7%) and surgical instruments (45 cases, 18.8%). The main features of the 91 cases of surgical stitching included loss of suture needles (40.7%, 37/91) and fracture events (37.4%, 34/91). Among the 52 cases of surgical dressings, the most commonly were gauze dressing events (43 cases, 82.7%), in which 19 were with unclear numbers of retained gauzes in the reoperation patient’s body, and 15 were postoperative counting anomalies. Among the 45 cases of surgical instruments, the fracture and defect were the most common (21 cases, 46.7%). Conclusion The operation nurses should focus on the prevention of suture needle loss, the surgical dressings loss and the fracture and defect of surgical instruments, etc, to reduce or avoid the surgery-related near misses.
ObjectiveTo find out the influencing factors of electrocardiogram (ECG) monitor configuration decision in surgical nursing units and form a scientific configuration standard, so as to provide a basis for the reasonable configuration of ECG monitors.MethodsFrom May to June 2018, the indexes and weights affecting the configuration of ECG monitors in surgical nursing units of a large public hospital were determined by interview survey method and analytic hierarchy process.ResultsThe influencing factors for configuration of ECG monitors in surgical nursing units were the number of operations, number of rescues, number of emergencies, number of deaths, and number of patients transferred to and out of intensive care unit, and the weights were 0.459 7, 0.224 9, 0.155 3, 0.111 2, and 0.049 0, respectively. The classification of nursing units was taken as plan, and the configuration standard of ECG monitors was established.ConclusionThe configuration model of ECG monitors in surgical nursing units based on analytic hierarchy process realizes the combination of qualitative and quantitative analysis, which provides scientific and reasonable reference for the configuration of ECG monitors.