对麻醉科质量控制的认识课件

1、对麻醉科质量控制的认识徐州医学院附属医院麻醉科 刘功俭内容一、医疗质量内涵的拓展二、麻醉科质量与麻醉质量三、麻醉质量的底线-安全四、加强教育，提高麻醉安全与质量一、医疗质量内涵的拓展传统医疗质量是指医疗服务及时性、安全性和有效性，是通过临床技术科室和医务人员遵循医疗规章制度、执行操作规程和技术规范、实施自我评价和控制所能达到的医疗技术效果。在医疗市场和现代医学模式影响下，美国卫生机构资格认证联合委员会(JCAHO)对现代医疗质量的定义是：在现有医学基础上，医疗卫生服务可以提高满意结果可能性的程度和降低不满意结果可能性的程度。与传统概念相比，现代医疗质量概念内涵外延更加丰富，已涉及诸如工作效率、

2、费用控制、服务态度、对病人个人需要的及时反应、对病人价值观的尊重、服务可及性等多方面因素，成为医疗机构人员素质、技术服务水平、设施环境条件、费用水平、管理水平的综合体现。医疗质量的两个方面一是质量的技术特征及技术质量，它反映医疗过程的科技含量，涉及病人的根本利益；二是服务特征及服务质量，它反映医疗的职业道德、服务流程、服务艺术，是以病人满意度与满足病人心理需求为标准。只有树立现代医疗质量观，从多层次、多视角加强医疗质量管理，才能符合现代医疗质量理念的要求。影响医疗质量的因素医务人员的业务素质和道德素养；医院管理层的质量意识和质量管理水平；药品、医疗器械、医疗用品及医疗环境质量；医疗质量保证机制

3、和各项规章制度、技术规范是否健全并落实；上级卫生行政部门及行业中介组织对医疗质量的监管督查；医院的补偿机制是否健全；行业不正之风是否受到有效遏制；医院服务理念的转变等。二、麻醉科质量与麻醉质量通常所说麻醉质量的含义（一）麻醉科工作质量（二）麻醉质量（一）麻醉科工作质量质量控制质量保证质量持续改进结构管理结构指人员、设备及其组织形式。就麻醉科而言，结构“软件”方面包括麻醉科医师一般素质、业务水平、开展业务范围和工作量；麻醉科建制、规章制度及相应法律法规。结构“硬件”方面包括麻醉监测设备、麻醉仪器及手术室规模设置。大多数基层医院，目前麻醉科正规化建设还处在起步阶段。虽在人员建制上基本能满足1:1.

4、5要求，但麻醉队伍人员素质参差不齐。据统计，县级基层医院麻醉医师中，中专学历护士约占，临床医学专业毕业生约占30%，麻醉学专业本、专科毕业生仅占50%。为切实提高麻醉科服务质量，就必须推行麻醉科科学化、系统化管理。过程管理过程管理指遵循医疗指南或诊疗常规进行工作的实际过程，这是管理三联体中最为重要的部分，它就是麻醉工作的工作程序和序贯协调活动的过程，麻醉的安全性及患者的满意度是过程管理的指标。麻醉的过程管理包括术前、术中、术后三个环节，术前包括术前访视、病情评估、患者知情同意书、拟行麻醉实施方案、特殊准备及伴随疾病的处理。术中要求麻醉方式安全可行，麻醉平稳，严密监测，及时恰当地处置，完整、正确

5、的记录。术后麻醉工作包括术后随访、并发症的处理与重要事件的讨论和报告。处于正规化起步阶段的基层医院，必须彻底摒弃过去的观点。从“打一针”转变到系统化、科学化的现代麻醉。这是一个长期、艰苦的过程。社会的进步，科学的发展与普及，现实手术业务扩展的客观需要，都有助于麻醉的现代化进步。麻醉科必须在加强学科建设与管理中，特别是过程管理中，提高服务质量，走向全面质量管理。（二）麻醉质量Anesthesia quality from the patients perspective(1) Simple ratings are inadequate to address the complexity of m

6、easuring satisfaction. This is true for a variety of reasons such as expectations vary by individual, expectations may be colored by previous experience, judgments are subjective, confounders such as how attractive the facility is, how friendly the staff are and when in relation to the administratio

7、n of anesthesia the survey is conducted 。(2) Baseline satisfaction tends to be high, so improvements are difficult to detect. (3) Ratings tend to overestimate satisfaction.(4) Some instruments use surrogate outcomes (e.g. postoperative pain, nausea) that are not necessarily related to satisfaction.A

8、NESTHESIA & PATIENT SAFETY“Because to Err is Human”What is Patient Safety?.The absence of the potential for patient harm.Involves all Health care givers, All job descriptions.Involves all Departments.Time frame: 24X7Health Professions Education: A Bridge to Quality (2003) All health professionals sh

9、ould be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.Relative Focus of Education in the Health ProfessionsProfessional knowledgeIndividual learningIndividual consequences for er

10、rorDisciplinary focusSystems knowledgeTeam/Group learningLearning from errorInterprofessional/ patient focusMedicines Translation of General Competencies(Adopted February, 1999 by ACGME)Patient CareMedical KnowledgePractice-based Learning and ImprovementProfessionalismInterpersonal and Communication

11、 SkillsSystems-based PracticeAnesthesiology is still among the leading disciplines with regard to patient safety.The second challenge “Safe Surgery Saves Lives”focuses on prevention of complications resulting from surgery.Anesthesiologists are involved with the patient safety starting from pre-opera

12、tive to post-operative period.Common Causes Of Anaesthesia Related MishapsJudgement ErrorsMedication ErrorsInadequate resuscitation, ventilation , reversal, crisis management ,monitoring , post-operative management.Technical mishaps.AspirationWrong choice of patients.Hypoxic mixturePrevention of Mis

13、hapsAs We all know that “Prevention Is Better Than CureWe need to prevent these critical events.For this number of steps should be taken to achieve this goal-Pre-Anesthetic PreparationVigilanceMonitoring Selection of safer anesthetic and adjuvant drugs.Better education and training .Quality AssurancePre Anesthetic Preparation1)Pre-Anaesthetic Check Up-Pre-operative asses