神外守脑圈课件.ppt

降低气管切开护理 的不规范率,神经外科,2014年守脑圈成果总结,神经外科守脑圈,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,主题选定,主题评价表,本期活动主题：降低气管切开护理的不规范率,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 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：,气管切开护理不规范项目数,选题理由,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,减少并发症发生，减轻经济负担,对科室而言,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,1,2,3,4,活动计划,制图人：2014.4.5,表示计划实施 表示完成,神外守脑圈“降低气管切开护理的不规范性”活动计划表,现况把握-1,气切护理流程图,制图人：2014.4.9,现况把握-2,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What:气管切开的患者Why:了解气切护理不规范的现状及原因How:实际观察法How many: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）,现况把握-3,查检表,现况把握-4,查检结果统计分析,现况把握-5,改善前柏拉图,根据80/20法则，需改善的项目有：,气囊压力不足,气切固定带不洁,气切固定带过松,气切口敷料不洁,改善重点为80.3%,制图人：2014.5.28.,80.3%,目标设定,现况值=不规范项目/总查检项目*100%=1831645100%=11.1%改善重点为80.3%圈能力为27/35*100%=77%,目标设定,目标值=现况值-（现况值*改善重点*圈能力）=11.1-（11.1*80.3%*77%）4.2%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：2014.5.30.,解析-1,制图人：2014.6.12.,解析-2,制图人：2014.6.12.,解析-3,制图人：2014.6.12.,解析-4,制图人：2014.6.12.,解析-5,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 2014.6.12.,解析-6,制图人：张娟 徐靓 2014.6.12.,解析-7,通过现场查看进行真因验证,真因查检后柏拉图,制图人：2014.6.12.,解析-8,制表人：2014.6.12.,对策拟定-1,利用头脑风暴进行5w1h的方法寻找对策why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,对策思路二,对策拟定-1,why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,对策思路四,对策拟定-2,通过制作亲和图根据标准拟定对策,制表人：2014.6.12.,对策实施与检讨-1,制表人：2014.9.25.,对策实施与检讨-2,制表人：2014.9.25.,对策实施与检讨-3,制表人：2014.9.25.,对策实施与检讨-3,制表人：2014.9.25.,选题理由,ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.,Description of the contents Description of the contents,Description of the contents Description of the contents,Description of the contents Description of the contents,Content Title,Content Title,Content Title,Contents,Click to add title in here,Click to add title in here,Click to add title in here,Click to add title in here,4,1,2,3,ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.,Click to edit title style,Text in here,Text in here,Contents,Contents,ThemeGallery is 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