重症医学科利用PDCA循环降低ICU气管插管患者非计划拔管率品管圈

e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415降低气管插管患者非计划拔管率XX医科大学附属医院品管圈成果汇报目录02圈的介绍e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415项目简介项目实施过程项目效果评价总结及展望0403010501圈的介绍e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415圈徽寓意01021.1圈的介绍——生命圈e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415心型—两只C形的手代表CriticalCarei型—气管插管的患者全力以赴守护生命患者至上放在心上

e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415第一期的活动通过规范气管插管的固定使非计划拔管数下降5例第二期的活动通过规范身体约束和镇静评估使非计划拔管数下降3例1.1生命圈的历史80%40%50%80%临床一线人员20%管理人员岗位10%博士30%硕士60%本科学历20%高级职称30%中级职称50%初级职称职称e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE4151.2圈的介绍——团队介绍e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE41502项目简介e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415医疗纠纷再感染住院时间延长非计划拔管气道损伤再插管困难窒息气管插管非计划拔管：ICU不容忽视的重点问题2.1项目简介e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415气管插管非计划拔管的系统循环图JKoreanAcadNurs,XX,45(2),280-292.2.1项目简介e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE41503项目实施过程e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415主题评价题目上级政策重要性迫切性圈能力总分顺序选定降低非计划气管插管拔管率444646221581★降低深静脉非计划拔管发生率363838261382

降低鼻胃管非计划拔管发生率242830201024

降低导尿管非计划拔管发生率26242422965

降低胸腔引流管非计划拔管发生率383434201303

分数重要性迫切性圈能力上级政策评价说明1次重要次迫切需多部门配合次相关3重要迫切需其他部门配合相关5极重要极迫切本圈能达成极相关3.1主题选定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415提升形象科室改进服务质量医院减轻痛苦患者增强责任感个人增强团队凝聚力同事3.1主题选定——选题意义e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415步骤XX年XX年负责人8月9月10月11月12月1月2月3月4月5月6月7月主题选定王护士活动计划陈护士现况把握张护士目标设定王护士解析侯护士

对策拟定陈护士措施实施周护士效果确认孟护士标准化陈医师检讨改进刘护士成果发表王护士注：

为计划线，

为实施线3.2计划拟定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415文献资料国外：2%-22.5%国内：0.2%～14.6%IntensiveCareMedicine,XX:1-3.中华护理杂志,XX,50(5):598-602.3.2计划拟定——现状调查e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415UEE例数气管插管人日数UEE的发生率×100%＝国家卫生计生委办公厅．XX降低气管插管非计划拔管的发生率3.2计划拟定——衡量指标e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415XX.08.01——XX.07.31320条13条4.06%计划的气管插管拔管非计划的气管插管拔管气管插管非计划拔管率3.3现况把握e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE4153.3现况把握——流程图有效降低气管插管患者非计划拔管率患者气管插管护士评估患者非计划气管拔管的危险因素呼吸机管道固定方法不当及撤机流程不清晰改善呼吸机管道固定方法及完善撤机流程培训其他流程护士风险评估能力及干预不足组织护士培训及完善护士人力分配组织考核提高护士风险评估能力其他流程家庭支持力度不够增进患者与家属的感情交流增加家属探视时间；指导家属多鼓励患者其他流程缺少转移注意力的设施制定购买转移患者注意力的设施计划及管理计划合理安排患者休闲时间及方式其他流程e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415改善重点：降低未镇静未约束患者的气管插管非计划拔管率3.3现况把握——活动前气管插管非计划拔管原因分析4.06%现状值e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415目标值（%）=现况值–（现况值×改善重点×圈能力）

=4.06–(4.06×0.69×0.44)≈2.832.83%目标值3.4目标值设定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE4153.5鱼骨图分析人与患者计划拔管沟通不足心理问题医护镇静药物使用沟通不足社会支持不足

环机&物排班方式不合理杂音干扰风险评估不足环境封闭缺乏转移注意力的设施缺少气管插管固定流程撤机流程不够清晰缺少谵妄的评估指引评估后干预不足约束器具效果欠佳人力不足卧具不适沟通障碍知识缺乏法呼吸机管道固定未预留活动空间医生护士患者家属e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415序号末端原因圈员1圈员2圈员3圈员4圈员5圈员6圈员7圈员8圈员9圈员10总分是否要因1风险评估不足555335553544是2风险评估后干预不足535553355342是3呼吸机管道未预留活动空间355333553338是4护士人力不足111133113318否5与患者计划拔管不足335533333538是6医护镇静药物使用沟通不足111133113118否7社会支持不足335553333538是8患者沟通障碍335553553338是9患者心理问题335553333336是10患者知识缺乏111133113318否11经口气管插管331331131322否12约束器具效果欠佳331111333524否13缺少转移注意力的设施335333353334是14卧具不适331331131322否15杂音的干扰111133113318否16环境封闭331335131326是17缺少气管插管的固定流程113333333326否18缺少瞻望评估的指引333333333330否19撤机流程不够清晰335553333538是3.5鱼骨图分析——要因分析e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE4153.5鱼骨图分析——气管插管非计划拔管真因验证e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415原因分析对策方案评价总分采纳负责人执行时间对策编号可行性经济性圈能力护士对风险评估及干预能力的不足1.成立非计划拔管风险评估及干预培训小组423836116★王护士XX.11.1-11.10对策一2.制定非计划拔管风险评估及干预的内容，组织护士学习484244134★张护士侯护士XX.11.11-12.10对策一3.进行护士非计划拔管风险评估及干预的知识考核22201860★侯护士XX.12.11-XX.1.10对策一4.进行临床非计划拔管风险评估及干预的教学查房403844122★张护士王护士XX.1.20对策一5.制定“非计划性拔管危险因素评估与防范记录表”，指导护士临床工作313844113★侯护士XX.12对策一6.合理安排人力资源，减轻护士劳动强度。如在抢救、新收危重患者、或者评估患者具有非计划拔管高风险时，增加该护理组的人力22313083★张护士侯护士XX.11.1起对策一3.6对策选定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415原因分析对策方案评价总分采纳负责人执行时间对策编号可行性经济性圈能力固定呼吸机管道时预留的长度不足1.制定呼吸机管道的固定方法：采用“U型”悬挂式固定方法，为患者活动预留足够的长度与空间403840118★王护士XX.11.1-11.30对策二2.组织呼吸机管道固定方法的培训及考核424044126★侯护士

XX.12.1-XX.1.31对策二3.组长、护士长定期进行临床督导31383099★陈护士XX.2.1-5.15对策二呼吸机撤离的流程欠规范

1.组织圈员制定呼吸机撤离指征评估表及流程图，并进行讨论22182464★陈医师XX.11.1-XX.11.30对策三2.将拟定的评估表与流程图公示，并征求全体医务人员的修改意见22201860★陈医师王护士XX.12.1-XX.12.31对策三3.确定评估表与流程图终稿444236122★孟护士陈医师XX.1.4-2.1对策三4.组织科室相关人员进行《呼吸机撤离评估表》及《呼吸机撤离流程图》的培训26222472★陈医师王护士XX.2.2-4.30对策三3.6对策选定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415原因分析对策方案评价总分采纳负责人执行时间对策编号可行性经济性圈能力缺少有效的沟通及人文关怀，社会支持力度不足1.采用手写板、图片、手势、家属转达等多种方法,给予更多的时间和耐心与患者沟通444236122★刘护士周护士XX.11.11起对策四2.相关知识培训：护患间有效沟通的培训；危重患者心理护理的培训403840118★王护士XX.11.10-11.30对策四3.根据文化程度、接受能力等进行个性化宣教26222472★周护士XX.11.1起对策四4.随时做好患者的基础护理，满足患者的基本需求，增加患者的舒适度444238124★刘护士周护士XX.11.1起对策四5.每月召开工休会，与患者家属沟通，让家属探视时给予患者心理支持，积极配合医护人员的治疗与护理；借助家属予患者以生活意义的指导，增加病人忍耐不适、与疾病作斗争的精神力量443836118★刘护士XX.11.1起对策四6.经常询问患者的感受与不适，与护士商讨个性化的解决方案26422694★王护士XX.11.1起对策四3.6对策选定e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415原因分析对策方案评价总分采纳负责人执行时间对策编号可行性经济性圈能力缺少转移患者注意力的设施1.制定购买的计划并提出书面申请

424044126★陈护士XX.11.7-11.17对策五2.移动电视及简易床旁脚踏车购买成功，设立专人管理设施与器材484440132★王护士侯护士XX.3.18对策五3.根据患者情况合理安排使用时间444236122★王护士侯护士XX.4.1起对策五4.指导家属配合此活动的开展26222472★王护士侯护士XX.4.1起对策五3.6对策选定APDCe7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE4153.7对策实施e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415非计划拔管危险因素识别与防范培训科室内的理论培训理论考核3.7对策实施一e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415非计划拔管危险因素识别与防范培训危险因素评估防范记录表每班组长进行质控3.7对策实施一e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415非计划拔管危险因素识别与防范培训3.7对策实施一e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415呼吸机管道的U型悬挂式固定╳√3.7对策实施二e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415呼吸机管道的U型悬挂式固定床边的实践指导反复叮嘱，反馈确认3.7对策实施二e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415规范脱机流程撤机流程讨论撤机流程图3.7对策实施三e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415有效沟通，人文关怀耐心地倾听，每次多给病人一分钟借助非语言的沟通方式共情：借助咽拭子感受病人插管痛苦3.7对策实施四e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415有效沟通，人文关怀积极心态——半杯水思维人文培训照片3.7对策实施四e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415有效沟通，人文关怀弗兰克尔意义疗法“插管不是无意义的受难而是勇敢的牺牲”赋予目标与意义3.7对策实施四e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415有效沟通，人文关怀中国医师协会授予3.7对策实施四e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415转移注意力的设备插管病人床上脚踏车床上多媒体设备3.7对策实施五e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415转移注意力的设备最佳的效果：此间乐，不思蜀（苦）3.7对策实施五e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE41520%50%XX年同期气管插管非计划拔管例数8例XX年同期气管插管非计划拔管例数6例气管插管非计划拔管例数下降20%镇静或约束病人占比50%非镇静非约束病人占比50%XX.10-XX.01非计划拔管3.8活动中期评价与改进（XX.02）e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415像醉酒断片一样，外表清醒，脑内混乱NEnglJMed,1999,340:669-76休克、全身炎症反应等原因导致的大脑神经递质失衡尽管病人承诺不会拔管，但是还会自行拔管3.8活动中期评价与改进（XX.02）e7d195523061f1c0205959036996ad55c215b892a7aac5c0B9ADEF7896FB48F2EF97163A2DE1401E1875DEDC438B7864AD24CA23553DBBBD975DAF4CAD4A2592689FFB6CEE59FFA55B2702D0E5EE29CDDE744B5A58D848E290B0F3363EEEFF85AEACDB2C4783B3CFD20D9E72AC2F528B09A88B84C6E73CDEC5D6CB26D43C2398027A14BE9DBFE415谵妄的评估AnnInternMed1990;113:941–8.3.8活动中期评价与改进（XX.02）3.8活动中期改进后的效果评价品管圈活动前后半段的效果对比e7d195523061f1c0205959036996ad55c215