产科护理安全隐患的

【关 键 词】产科护理；安全隐患分析；防范管理

【中图分类号】R47【文献标识码】A【文章编号】1004-7484（2013）03-0222-02

产科护理工作技术含量高、风险大、事故发生率高,对产科护士的知识面要求广,做好关键环节质量监控和预防措施,对减少医疗护理纠纷的发生有着重要的现实意义.

1安全隐患分析

1.1护理队伍年轻化.现在一些新毕业的护士,因为不注重小事细节而影响护士形象；工作中计较得失,不利于团队合作；书写记录文笔欠缺,质量不高；应急抢救及特殊事件的处理能力不强,影响抢救的工作质量等等.

1.2责任心缺乏.产科患者的病情瞬息万变,具有难预料的特点,有些护士观察不细致,未能及时发现问题,产后不认真观察宫缩,宫缩不良没及时发现：膀胱充盈未及时排空,影响子宫收缩,造成产后大出血等,甚至危害母婴的身心健康.

1.3临床工作经验不足、技术不熟练.护士在抢救时,会因技术不熟练、临床工作经验不足而出现应急能力差,对诊疗设备和仪器性能不熟悉,操作生疏,在忙乱中出现差错,给护理安全埋下隐患.

1.4管理缺陷.护士的配置与患者医疗护理需求不成正比,护理工作繁杂琐碎,工作量大,夜班护士一人要照顾整个病区的危重患者、产妇、待产患者、新入院病人等等,无法顾及每位住院患者情绪和需求,顾此失彼,怎么写作不到位,病人不满意.这也是导致护患纠纷的一个客观因素.

1.5护理人员怎么写作态度差.护士不注意谈话的方式和语气,对孕产妇家属提出的问题回答简单、生硬而引起反感；不恰当不礼貌的粗语可变为恶性刺激,使病人及家属不满.

1.6时间漏洞.（1）科室晨会时间,极易发生产妇产后出血、引产患者漏产、胎心变化等无人发现.（2）节检测日期间,患者到辅助诊断科室做检查无医务人员陪同.（3）抢救危重患者时,医务人员少或者精力集中,往往顾此失彼.（4）现今产科管理为母婴同室,而医院又是开放性的公共场所,深夜忘记锁门,怕发生丢失婴儿事件.如果锁门室内有突发的异常情况护士又不能迅速进入屋内,这正是矛盾的所在之处.

1.7缺乏与患者和家属的沟通.患者和家属缺乏医学知识及对医院规章制度的了解,不配合护士的工作,会单方面强调理由而引发纠纷.

1.8基础设施配备及布局.医院的基础设施、病区物品配备和布局不当也存在着不安全因素.如地面过滑导致跌伤；热水瓶放置不当导致烫伤等.

1.9患者的因素：（1）病人心理承受力差,对疾病缺乏正确认识,易产生焦虑,恐惧,心烦意乱等到心理现象,导致病人人为的护理不安全因素.（2）患者及其家属由于突发疾病的影响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及经济承受能力的限制等因素,容易产生不良心境,引发护患冲突.（3）护理是一项护患双方共同参与的活动,有赖于患者的密切配合及支持[2],患者擅自离院外出而出现意外,虽然进行了告知,但是家属出于各种原因,不履行应尽的责任,将会增添许多的护理安全隐患.

1.10患者和社会方面的原因.患者和家属受医患矛盾的社会问题的影响,对医务人员误解而产生纠纷.患者预后不佳、对医护人员不信任,将自身疾病潜在风险转嫁给医护人员,引发纠纷.

2防范措施及管理

2.1强化关键制度的执行：规章制度天天讲,经常学,每月查找问题并制订防范措施,从而增强护理人员的安全意识.严格按照收费标准记录医疗费用,不乱收费,不重复收费.

2.2加强细节教育.增强责任心是防范差错事故和进行安全护理的有效方法.

2.3加强专业教育,提高业务技术水平.对护理人员进行专科知识、操作技术以及急救操作规程的培训、考核,以锻炼和提高护理队伍的技术水平和应急能力.

2.4加强语言修养,提高护士沟通水平,消除沟通隐患.定期进行人际沟通方面的培训,从仪表到言谈举止,从语言到沟通技巧,应该全方位提高.

2.5加强护理监控,提高护理质量.科室成立各项质控小组每班检查并记录质控登记本,以便总结改进,护理部成立医院护理质控检查组每月检查,并且进行总结评比.（1）抓关键患者：如缩宫素引产、经产妇等.（2）抓关键时间：如节检测日、双休班、夜班应增加初级护士人数；晨会及交接班时应有固定护士巡视病房.（3）抓关键人员：如新上岗护士及进修实习人员、责任心不强及技术较差人员、针对这些人员进行重点监控,合理搭班.（4）抓应急状态管理：对急救物品处于备用状态.长备应急护士,选择业务能力强,心理素质好的人员,并且科室应严格规定,出现大抢救时启动应急护士.

2.6有关医疗工作的法律知识.特别是新的《医疗事故处理条例》颁布实施,对护理人员明确责任,强化意识,指导自己的护理行为十分重要[3].用法律手段维护护患双方的合法权益.

2.7完善管理.公平合理的安排班次,互相协作,避免超负荷工作,从管理上防范纠纷隐患.

2.8护生带教.（1）加强护士安全带教意识,做到“放手不放眼,放做不放教”,把好护理安全关.（2）加强护生的法制教育.通过学习《执业护士法》、《医疗事故处理条例》等法律、法规,增强护生的法律意识.（3）定期检查、严格管理：护士长每天巡视护理安全情况,发现问题及时处理,并及时反馈给带教老师和护生.（4）在临床护理教学过程中,对护生的护理安全教育要贯穿始终,将各种医疗纠纷隐患消灭在萌芽状态.（5）对已发生的差错行为,要与护生一起分析发生差错的原因,要注意方法,注意态度.

2.9重视护理缺陷,强化护理质量“零缺陷”意识.要求第一次把工作做好,不做重复工作,实行自我控制、自我改进[4].护理工作达到零缺陷要围绕病人和医护人员两方面分析不安全因素,及时发现问题,找出护理安全隐患,进行缺陷控制,使医疗护理过程中可能发生的问题减少到最低限度.

2.10发扬团队精神,要鼓励和培养护士间的团队精神,倡导在繁忙琐碎的护理工作中相互提醒,相互监督,弥补工作中的缺陷和漏洞.

2.11基础设施完善、布局合理.（1）病区应有足够的照明,保持地板的平整与干燥,浴室厕所加上防滑地垫.对高危人群实行监控.（2）热水瓶应放于固定处,距离病床应大于热水瓶瓶身高度,并且要远离婴儿床至少一米.（3）孕产妇病区内病床应使用可升降护栏床,以保障病人安全.（4）压疮发生的高危人群应使用气垫床.

2.12解决护患纠纷,应培养正确规范的就医行为和道德,同时提高医疗护理质量,改变社会对医院的偏见,护患双方相互理解、体谅、信任,才能达成和谐的护患关系.

3小结

综上所述,防范妇产科护理安全隐患,护理人员要不断的自我完善,加强业务学习,提高自我保护意识,依法行医、以德行医,注重细节,并且要提高护理安全管理,加强风险识别,这是防范护理安全隐患的根本.