目的 探讨护士参与护理不良事件讨论会的做法与效果.方法 成立护理安全管理小组,组织相关人员进行集中讨论,运用"系统管理观"的管理理论,从质量要素与系统原因进行归因分析,查找护理安全隐患与漏洞,提出整改和防范措施;参会者每人负责一例护理不良事件总结,制作成多媒体分别在全院护理安全会上汇报;由护士长组织全体护理人员学习,实现信息资源共享.结果 护理不良事件发生率明显降低(P＜0.01或P＜0.05).结论 护士参与护理不良事件讨论会可提高护士风险评估意识和安全管理能力,降低护理不良事件发生率.%Objective To explore the methods and effects of nurse participating in the diseussion for nursing adverse event.Methods A nursing safety management group was organized to gather related personnel to discuss nursing adverse event.In the discussion, system management concept was used, attribution analysis was conducted from the aspects of quality factors and system rensons,incipient faults in nursing safety were found out and prevention measures were proposed.Each participant in the group was responsible for analyzing one case of nursing error and reported it in the hospital nursing safety meeting in the form of multimedia.The head nurses were responsible to organize other nurses to learn these reports.Results The incidence rate of nursing adverse event was significantly lower than before ( P ＜ 0.01 or P ＜ 0.05 ).Conclusion Involving nurses in the discussion of nursing adverse event could improve their awareness of risk assessment and the ability of safety manngement,so as to reduce the incidence of nursing.
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