MICU护理质量安全管理方案Microsoft Word 文档.doc

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micu质量安全管理方案一、成立护理质量监督小组：组长：李云 科质控安全员：邓春红成员：邓春红、肖敏智、庞群英、黄丽芬、蔡丽碧、张怀雁 二、质量安全管理方法：1、 质量安全监督小组成员对所负责的监管内容进行监督管理。2、每月向组长进行书面总结汇报，递交总结报告一份。报告内容包括：存在的问题；导致的后果；分析问题发生原因；提出整改方案；跟踪改进效果。3、护理组长根据各成员的总结内容每月组织全科护士进行反馈。三、质量安全管理内容： 危重病人护理质量管理责任人：邓春红 协管人：黄丽芬监管 “2009年成人icu专科护理十大安全质量目标”落实情况。管道安全标准：1.向患者及家属解释留置各种管道的目的、作用和保护方法，取得其理解和配合。2.对于可在x射线下显像的管道，如气管插管、鼻胃管、中心静脉置管等，应结合x射线判断其位置是否正确。3.各种管道固定必须严格按照护理规范并结合患者实际情况选择固定方式，保证管道的放置处于安全位置，每班记录有关管道（如气管插管、鼻胃管等）外露刻度。4.各种管道必须有清晰的标识，在离管道入口10-15cm处，注明管道的名称和日期（用不脱色的油笔写在3m纸质胶布上）。5.保持引流系统的密闭性，减少因频繁更换而导致的污染机会。如对于胸腔引流管留置时间较长的病人，水封瓶每周更换1次，更换时应严格执行无菌操作。6.烦躁患者做好保护性约束（比如手套式），防止患者无意识地拔除管道。特别烦躁的患者应报告医生，与医生共同评估，可能发生意外拔管的患者应给予适当镇静，并做好应急处理准备。7.保证管道的接头连接紧密，保持管道通畅，固定合理、安全，每班要有记录。静脉治疗标准：1.建立专业的静脉治疗小组。对导管插入和护理的人员进行培训。严格遵守无菌操作规范。2.触摸、插入、更换或包扎血管内导管前、后，均要洗手或手消毒。3.插管或更换导管的覆盖敷料，包括插孔及管口的外表消毒，均要戴无菌手套，采取正确的无菌技术。4.置管和局部换药时的皮肤消毒剂宜选择1-2碘酊、碘酒或酒精，消毒后让消毒剂自然风干，使皮肤上的细菌被杀灭。5.选用透明半渗透性聚氨酯贴膜（例如3m透明敷料系列产品）保护穿刺点，每周更换2次敷料，变湿、松动或受到污染，应及时更换。如果覆盖膜出汗较多患者、高温季节、穿刺点有出血或者渗出等情况，应该首选无菌纱布敷料，常规2天更换一次，受到污染，应及时更换。6.增加导管的管腔数量会增加感染的危险性，如有可能，尽可能使用单腔导管。7.导管使用过程中，保持系统密闭。8.中心静脉导管通常不需常规更换，当导管不再需要时，应立即拔除，一旦发生血管内导管相关感染，应及时拔除导管。人工气道管理标准：1.严格执行手卫生。2.机械通气患者如果没有体位改变的禁忌症，应予抬高床头30-45，避免镇静时间过长和程度过深，避免误吸，尽早撤机，以减少呼吸机相关肺炎的发生。3.重视气管插管病人的口腔护理，选择合适的口腔护理方法和工具，每班口腔护理一次。4.按需吸痰。机械通气的患者应通过各种指标及时评估气道内是否有分泌物，包括听诊呼吸音，患者是否能有效咳嗽，气道内可否见到分泌物。在容量控制机械通气时气道峰压增加，压力控制机械通气时潮气量减少时，需要考虑气道分泌物增加引起，应通过气道吸引确保分泌物的充分清除。5.常规监测人工气道的气囊压力，高容低压套囊压力在25cmh2o-30cmh2o之间，预防并发症。6.机械通气时在管路中常规应用气道湿化装置,不推荐在吸痰前常规进行气道内生理盐水湿化。加热型湿化器加水须使用无菌水，每日更