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1、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
2、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
3、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
4、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：20
5、14.6.12.,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。
6、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
7、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 m
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