医疗质量管理实施方案、考核体系及管理流程

医疗质量管理实施方案、考核体系及管理流程医疗质量管理控制方案、考核体系及管理流程医疗质量是医院发展之本，优质的医疗质量必然产生良好的社会效益和经济效益。为提升我院的医疗质量和确保医疗安全，特此制定全程医疗质量控制方案，以求正确有效地实施标准化医疗质量管理。一、指导思想（一）、实行全面质量管理和全程质量控制。建立从患者就医到离院，包括门诊医疗、病房医疗和部分院外医疗活动的全程质量控制流程和全程质量管理体系。明确管控内容并将其纳入医疗管理部门的日常工作，实施动态监控并与科室目标责任制结合，保证质控措施的落实。（二）、以规章制度和医疗常规为依据，并不断修（三）、强化十三项医疗核心制度，如三级医师负责制度、会诊制度和病例讨论制度等，将医务人员个人医疗行为最大限度地引导到正确的诊疗方案中。（四）、质量控制部门有计划、有针对性地进行干预，对多因素影响或多项诊疗活动协同作用的质量问题，进行专门调研，并制定全面的干预措施。二、管理体系全程医疗质量控制系统的人员组成可分为医院医疗质量管理委员会、科室医疗质量控制小组和各级医务人员自我管理三级管理体系。（一）、医院医疗质量管理委员会医院医疗质量管理委员会由院领导、医疗护理部负责人和科主任组成，业务院长任组长，院长是医疗质量管理工作的第一责任者。医疗护理部作为医疗质量控制常设的办事机构。其职责分述如下:1、医疗质量管理委员会职责、教育各级医务人员树立全心全意为患者服务的思想，改进医疗作风，改善服务态度，增强质量意识。保证医疗安全，严防差错事故。审核医院内医疗、护理方面的规章制度，并制定各项质量评审要求和奖惩制度。(3)、掌握各科室诊断、治疗、护理等医疗质量情况(及时制定措施，不断提高医疗护理质量。、对重大医疗、护理质量问题进行鉴定，对医疗护理质量中存在的问题，提出整改要求。、定期向全院通报重大医疗、护理质量情况和处理决定。、对院内有关医疗管理的体制变动，质量标准的修定进行讨论，提出建议，提交院长办公会义审议。2、医疗护理部职责、医疗护理部接受主管院长和医疗质量管理委员会的领导，对医院全程医疗质量进行监控。、定期组织会议收集科室主任和质控小组反映的医疗质量问题，协调各科室质量控制过程中存在的问题和矛盾。、抽查各科室住院环节质量，提出干预措施并向主管院长或医院医疗质量管理委员会汇报。收集门诊和病案质控组反馈的各科室终未医疗质量统计结果，分析、确认后，通报相应科室人员并提出整改意见。、每月向医院提出全程医疗质量量化考核结果，以便与绩效工资挂钩。、定期编辑医疗质量简报和不良医疗文件公示栏。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds一、指导思想（一）、实行全面质量管理和全程质量控制。建立从患者就医到离院，包括门诊医疗、病房医疗和部分院外医疗活动的全程质量控制流程和全程质量管理体系。明确管控内容并将其纳入医疗管理部门的日常工作，实施动态监控并与科室目标责任制结合，保证质控措施的落实。（二）、以规章制度和医疗常规为依据，并不断修（三）、强化十三项医疗核心制度，如三级医师负责制度、会诊制度和病例讨论制度等，将医务人员个人医疗行为最大限度地引导到正确的诊疗方案中。（四）、质量控制部门有计划、有针对性地进行干预，对多因素影响或多项诊疗活动协同作用的质量问题，进行专门调研，并制定全面的干预措施。二、管理体系全程医疗质量控制系统的人员组成可分为医院医疗质量管理委员会、科室医疗质量控制小组和各级医务人员自我管理三级管理体系。（一）、医院医疗质量管理委员会医院医疗质量管理委员会由院领导、医疗护理部负责人和科主任组成，业务院长任组长，院长是医疗质量管理工作的第一责任者。医疗护理部作为医疗质量控制常设的办事机构。其职责分述如下:1、医疗质量管理委员会职责（1）、教育各级医务人员树立全心全意为患者服务的思想，改进医疗作风，改善服务态度，增强质量意识。保证医疗安全，严防差错事故。（2）审核医院内医疗、护理方面的规章制度，并制定各项质量评审要求和奖惩制度。（3）、掌握各科室诊断、治疗、护理等医疗质量情况（及时制定措施，不断提高医疗护理质量。（4）、对重大医疗、护理质量问题进行鉴定，对医疗护理质量中存在的问题，提出整改要求。、定期向全院通报重大医疗、护理质量情况和处理决定。、对院内有关医疗管理的体制变动，质量标准的修定进行讨论，提出建议，提交院长办公会义审议。2、医疗护理部职责、医疗护理部接受主管院长和医疗质量管理委员会的领导，对医院全程医疗质量进行监控。、定期组织会议收集科室主任和质控小组反映的医疗质量问题，协调各科室质量控制过程中存在的问题和矛盾。、抽查各科室住院环节质量，提出干预措施并向主管院长或医院医疗质量管理委员会汇报。收集门诊和病案质控组反馈的各科室终未医疗质量统计结果，分析、确认后，通报相应科室人员并提出整改意见。、每月向医院提出全程医疗质量量化考核结果，以便与绩效工资挂钩。、定期编辑医疗质量简报和不良医疗文件公示栏。(二)、科室医疗质量控制小组职责科室是医疗质量管理体系的重要组成部分，科主任是科室医疗质量的第一责任者。科室质控小组职责如下:(1)、各科室医疗质量控制小组由科主任、护士长和科室质控人员组成。(2)、结合本专业特点及发展趋势，制定及修订本科室疾病诊疗常规、药物使用规范并组织实施，责任落实到个人，与绩效工资挂钩。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(3)、定期组织各级人员学习医疗、护理常规，强化质量意识。参加医疗质控办公室的会议，反映问题。收集与本科室有关的问题，提出整改措施。(三)、医务人员自我管理在医疗活动过程中，医务人员的个人行为具有较大的独立性，其个人素质、医疗技术水平对医疗质量影响较大，是质量不稳定的主要因素，是质量控制的基本点。在质控过程中，特别要强调三级医师负责制度、会诊制度和病例讨论等把关制度，确保医疗质量控制的正确实施。对各级医务人员的要求分述如下:1(门诊医师(1)严格执行首诊医师负责制。(2)询问病史详细、物理检查认真，要有初步诊断。门诊病历书写完整、规范、准确。合理检查，申请单书写规范。具体用药在病历中记载。药物用法、用量、疗程和配伍合理。处方书写合格。第二次就诊诊断未明确者，接诊医师应:a.建议专科就诊;b.请上级医师诊视;c•收住院。第三次就诊诊断仍未明确者，接诊医师应:a•请科主任会诊b.收住院;c.患者拒绝住院需履行签字手续。按专科收治病人。2(病房住院医师病人入院30分钟内进行检查并作出初步处理。急、危、重病人应即刻处理并向上级医师报告。按规定时间完成病历书写(普通病人24小时、危重病人6小时内完成;首次病程记录应当在患者入院后8小时内完成，急诊病人术前完成)。病历书写完整、规范，不得缺项。24小时内完成血、尿、便化验，并根据病情尽快完成肝、肾功能、胸透和其它所需的专科检查。未完成的病程录中注明原因。按专科诊疗常规制定初步诊疗方案。对所管病人，每天至少上、下午各巡诊一次。按规定时间及要求完成病程记录(会诊、术前讨论、术前小结、转出和转入、特殊治疗、病人家属谈话和签字、出院记录和死亡讨论等一切医疗活动均应有详细的记录)。(9)对所管病人的病情变化应及时向上级医师汇报。(10)诊疗过程应遵守消毒隔离规定，严格无菌操作，防止医院感染病例发生。若有医院感染病例，及时填表报告。病人出院时须经上级医师批准，全愈者主治医师审签，好转、未愈者需科主任批准，应注明出院医嘱并交代注意事项。3(病房主治医师(1)及时对下级医师开出的医嘱进行审核，对下级医师的操作进行必要的指导。(2)新入院的普通病人要在48小时内进行首次查房。除对病史和查体的补充外，查房内容要求有:?诊断及诊断依据;?必要的鉴别诊断;?治疗原则;?诊治中的注意事项。(3)新入院的急、危、重病人随时检查、处理，并向上级医师汇报病情。(4)及时检查、修改下级医师书写的病历，把好出院病历质量关，并在病历首页签名。(5)入院3天未能确诊或有跨专业病种的病例时应及时举行科内或科间会诊。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(6)待诊病人在入院1周内仍诊断不明时，向主任请示病例讨论或院内会诊。根据抗菌素的合理使用原则正确分级使用抗生素和专科用药。手术和介入治疗前亲自检查病人，做好术前准备，按手术分级管理标准拟订严密的手术方案并实施。术后即刻完成术后记录，24小时完成手术记录。术后严密观察患者病情变化，并做好术后工作。负责治愈患者出院的审批手续，并向上级医师汇报。4(病房主任(副主任)医师组织或参与制定本科质量管理方案、各项规章制度、诊疗和操作常规。(2)指导下级医师做好医疗工作，督促检查下级医师执行各项制度和诊疗常规。(3)对新入院的普通病人要求72小时内进行首次查房;危重病人至少每日查房1次;病人病情变化应随时查房;每周组织全科查房1次。(4)查房内容除对病史和查体的补充外，普通病人应有:?诊断及其诊断依据;?鉴别诊断;?治疗原则;?有关方面的新进展。未确诊病人应有:?鉴别诊断;?明确的诊断思路和方法;?拟定相应的治疗措施。危重病人应有:?当前的主要问题;?解决主要问题的方法。疑难病例及入院1周未确诊病例，组织科内讨论或院内会诊，必要时向医务处申请院外会诊。指导和监督下级医师正确分级使用抗生素和专科用药。组织术前和重要治疗前病例讨论，指导下级医师做好术中、术后医疗工作。重大手术和重要治疗要亲自参加。审批未愈患者出院，并指导病人出院后的继续治疗。审签主治医师审查的转科、出院病历。5(医患沟通各级医师在诊疗过程中要增强自律和维权意识，重视患者知情同意权、知情选择权，在医疗服务过程中落实谈话、签字、记录、报告、实物保存等有关工作制度。三、考核内容全程医疗质量控制包括门诊医疗、病房医疗、院外部分医疗活动等多个组成部分。其考核内容按过程分为:(一)门诊医疗1、挂号、分诊咨询处、挂号室:按照专业病种及病情轻重缓急指导患者挂号。分诊护士:?对一般病人应测量血压，发热患者应测量体温。?加强巡视，视病情轻重，决定病人是否需要提前就诊。?根据病人主诉指导分诊，发现传染病患者要及时隔离，并指导就诊。?复查再分诊，保证患者专科专治。2、首诊医师:、首诊医师负责制:a、询问病史详细，物理检查认真，拟定初步诊断，做出恰当处理，同时按病历要求书写门诊、急诊病历。b(建议专科门诊就诊。c(收住院。(2)、第二次就诊仍未明确诊断或治疗无效者:?原接诊医师应:a•应提请上级医师会诊，b.建议专科就诊;c.收住院。？新接诊医师应:a收住院;b门诊治疗。(3)、第三次就诊:仍未能确诊，接诊医师应:a.请科主任会诊b.收住院，患者拒绝住院应履行签字手续。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(二)、病房医疗:l、24小时内、病人入院30分钟内应给予初步处理。、由经治医师做出初步诊疗意见并完成病历书写。、必要时由主治医师提出并请示上级医师组织科内讨论、科间或院内会诊。(4)、急、危、重病人随时请上级医师查看并于6小时内完成病历书写。2、入院三天内(1)、确诊者按诊疗常规进行。、未确诊者，做进一步检查，必要时组织科内讨论、科间会诊。3、入院后1周未确诊者，必须进行科内病例讨论或院内会诊，可请市一院专家会诊，确诊者按诊疗计划实施，2周内仍未能确诊者须进行院外会诊。(特殊专业按诊疗常规执行)。4、治疗措施(1)药物治疗?药物选择:a制定专科用药规范并严格执行;b.加强抗生素的合理使用;?用药后注意观察疗效;?根据病情、疗效及时更改、调整用药方案。?注意观察药物的不良作用，注意药物间的相互作用，注意药物对其它脏器及其它疾病的影响。(2)、手术治疗?.术前按诊疗常规做好术前准备，按手术分级审批;?.按手术常规操作;?按诊疗常规做好术后处理。、特殊诊疗按各专业诊疗常规执行。5、转归:、治愈——出院，专科门诊随访。、好转——专科门诊随访。、未愈——患者要求出院或转院需履行签字手续。、死亡——24小时内完成死亡记录，l周内完成死亡病例讨论并及时上交病案。(三)出院1、治愈者由主治医师审批出院。2、好转者由主任或副主任医师向患者交待专科门诊继续治疗或返院治疗的注意事项，并批准方可出院。3、未愈者由科主任（或正、副主任医师）向病人做继续治疗指导并批准方可出院。4、管床医师必须在患者出院时出具“出院小结”。（四）病案归档凡出院病历应于患者出院后5个工作日完成，未完成者有病案室统计，上报医务科。注:1、根据病情，不受时间限制及时组织各种形式的会诊，如院外会诊等。2、重危病人应床边交接班，每天有交接班记录。3、报告方式:对病危病人须将病危通知单送交医务处;对特殊、紧急抢救病人须电话报告院部;对死亡及入院两周未确诊病例应书面上报医务处。四、考核方法和奖惩制度1、门诊医疗质量由各门诊部负责考核、统计;基础质量由医务处、护理部职能处室负责考评。住院医疗环节质量由质控小组对正在诊疗过程中的“活病历”随机抽查，按考核表内容逐点考核，一般每个月对每个医疗组考核1-2次;终未质量主要由科室质控人员、病案室负责考评。2（分析各项诊疗活动对整体医疗质量的影响程度，对各质控点控制措施的落实情况，按合格（?）、轻度缺陷（1）、中度缺陷（2）、重度缺陷（X）分为四个级别进行定性标化，并在质控考核表扣除相应分值。具体评分要求如下:inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds病房医疗质量监控量化考核的满分为80分，如检查的各项所得总分大于64分为合格。各质控点（考核中每单项）检查实得分数占应得分数的百分数?80,者为合格，70,,79,为轻度缺陷，60,,69,为中度缺陷，＜60,为重度缺陷。3、质控小组每月对各质控点缺陷发生情况统计分析一次，与科室考核分值与科室绩效工资挂钩。4、重大医疗质量问题按医院有关规定视情节给予罚款，取消先进科室评审资格和对责任人进行行政处罚等处理。无门诊病历、不合格处方（低于考核分值5分）和未在规定时间完成住院病历的按医院规定处罚到责任人。科室检查日期经管医师扣分情况考核内容及标准分值扣分标准住院号缺陷程度门诊医疗部分20分门诊病历首诊病历书写完整规范准确。主诉精炼,现病史与主诉相符,既往史、与诊断及鉴别诊断相关的重要阳性体征不得遗漏。5主诉、现病史、既往史、重要阳性体征每遗漏一项扣1分，书写不规范每处扣0.2诊断2缺诊断扣0.5分有关常规检查是否进行、申请单书写是否规范。1一项不合要求扣0.5分具体药物在病历中记载1无记载扣1分医师签名1无医师签名或不规范扣1分首诊医师首诊医师负责制2不合要求扣2分第二次就诊诊断未明确者应a.建议专科就诊b.请上级医师会诊c.收住院1不合要求扣1分第三次就诊诊断仍未明确者，接诊医师应a.请科主任会诊b.收住院c.患者拒绝住院需履行签字手续1不合要求扣1分按专科收治病人1不合要求扣1分门诊医疗部分20分处方前记（一般项目填写齐全）1项目缺项者扣除1分正文处方书写正确，格式以每药“两行全量书写法”为准1未符合要求者扣1分后记（医师签名、药品金额以及审核、调配、核对、发药的药学人员签名1医师未签全名或无调剂、复核双人签名的扣1分药物用法、用量、疗程及配伍应用合理1不合要求扣1分西药、中成药、中药饮片分别开具1未按规定执行扣1分病房医疗部分80分inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast45timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandma