护理学报2017，Vol.24Issue(5)：15-18,4.DOI:10.16460/j.issn1008-9969.2017.05.015
瑞士奶酪模型在输液泵用药不良事件管理中的应用
Swiss Cheese Model in Adverse Event Management of Medication via Infusion Pump
摘要
Abstract
Objective To investigate the effects of Swiss Cheese Model in adverse event management of medication via infusion pump. Methods A retrospective analysis on 14 adverse events of medication via infusion pump was conducted. Root causes of these adverse events were analyzed from the perspective of the organization and management, unsafe monitoring, indicators of unsafe performance and unsafe operation, then corresponding measures were taken. The effects were compared before and after the intervention. Results The incidence of adverse event before and after the intervention showed statistical significance (P<0.05) and the incidence dropped from 4.68‰ to 1.20‰. Conclusion Swiss Cheese Model is effective for lowering the incidence of adverse event in medication via infusion pump and helpful for improving the management of adverse events.关键词
瑞士奶酪模型/输液泵/不良事件Key words
Swiss Cheese Model/infusion pump/adverse event分类
医药卫生引用本文复制引用
胡经文,辛霞,刘美丽,刘盈盈,阮惠琴..瑞士奶酪模型在输液泵用药不良事件管理中的应用[J].护理学报,2017,24(5):15-18,4.基金项目
陕西省自然基础研究计划项目(2016JM8116) （2016JM8116）
西安交通大学第一附属医院科研基金(2014yk48). （2014yk48）
