CAJ | 학술논문

目的：了解目前临床用药中护理差错发生的原因，探索相应的对策以确保用药安全。方法针对2011年医院41个护理单元上报用药不良事件及11月开展用药安全专项检查存在的问题进行原因分析，制定用药安全手册，包括健全各种用药安全管理组织及制度，收集临床多品种、多规格、看似听似药品拍成图片进行比对，临床应控制滴速、接触易发生反应药物，药物配制信息，药物配伍禁忌，宜从中心静脉输注的药物，高危药物外渗紧急处理，抢救药物药理知识，以表格形式进行罗列。规范使用药物流程、组织培训与考核等一系列措施。结果2012年护理用药不良事件总数较2011年减少15起，下降18．5％。与2011年相比，2012年用药专项月检查存在问题，通过护理用药安全手册的制作与应用，加强了用药安全管理，促进护理人员掌握药品管理及用药知识，有效提高了护理人员用药安全能力，保障了患者用药安全。结论该手册为护士临床用药安全提供参考，起到临床用药指引作用，有效提高了护理人员用药能力。
목적：료해목전림상용약중호리차착발생적원인，탐색상응적대책이학보용약안전。방법침대2011년의원41개호리단원상보용약불량사건급11월개전용약안전전항검사존재적문제진행원인분석，제정용약안전수책，포괄건전각충용약안전관리조직급제도，수집림상다품충、다규격、간사은사약품박성도편진행비대，림상응공제적속、접촉역발생반응약물，약물배제신식，약물배오금기，의종중심정맥수주적약물，고위약물외삼긴급처리，창구약물약리지식，이표격형식진행라렬。규범사용약물류정、조직배훈여고핵등일계렬조시。결과2012년호리용약불량사건총수교2011년감소15기，하강18．5％。여2011년상비，2012년용약전항월검사존재문제，통과호리용약안전수책적제작여응용，가강료용약안전관리，촉진호리인원장악약품관리급용약지식，유효제고료호리인원용약안전능력，보장료환자용약안전。결론해수책위호사림상용약안전제공삼고，기도림상용약지인작용，유효제고료호리인원용약능력。
Objective To investigate the reasons of medication errors in clinical nursing , so as to explore corresponding measure to ensure medication safety .Methods Reported medication errors from 41 nursing units in 2011 and problems discovered from drug safety special inspection in November were analyzed , and safety manual for nursing medication was designed and listed in tabular form , which included perfecting a variety of drug safety management organizations and systems , collecting clinical multi-product, multi-gauge, seemingly and sounding drugs into a picture for comparison , clinical control of drip rate and drugs prone to sickness, drug preparation information, drug incompatibility, drug favorable for intravenous infusion , emergency handling of high-risk drug extravasation , pharmacological knowledge of rescue medication and so on . Medication procedure , organization of training and assessment were also regulated by a series of measures . Results Medication errors in 2012 were 15 cases less than those in 2011, with the rate of 18.5%.Compared with 2011 , drug safety management was strengthened and nurses ’ drug management skills , medication knowledge as well as ability were improved by the production and application of safety manual for nursing medication in 2012 to ensure patients ’ medication safety .Conclusions The safety manual can provide reference for clinical nursing medication, guide clinical medication and effectively improve nurses’ medication ability.