Investigation And Strategy Research On Safety Management Of Emergency Medical Equipments By Nurses

Objectives:To improve the safety of medical devices using,we investigate the safe state quo of emergency equipments used frequently and general influence factors of medical devices incident event;to explore the more scientific and more effective medical equipment management system on the basis of the survey and papers at home and abroad.Method:A questionnaire finished with good reliability and validity.308 registered nurses in intensive care unit from eight tertiary hospital in Shanghai are interviewed to find out the consequences of equipments use both for patients and staff from September 2007 to September 2008,what and how they learn about the twelve medical equipments they use in direct patient care,as well as the management for using of emergency equipments.To find the difference between ICU and other units and validated the useful of that questionnaire,we interviewed large-volume infusion pump especially between 102 registered nurses after the questionnaire being revised,for it is one generally used in the whole hospital,and it's connected with drug safety.The content of interviewed is as the same as before.The data is data based and analyzed by SPSS13.0.According to the statistical result,refer some international management of medical equipments,and explore management system adapted for our country.Results:(1) The survey of emergency equipment in ICU:we receive 297 questionnaires with recovery rate of 96.43%,94.61%of which are effective.The test-retest reliability and internal consistency reliability of questionnaires is credible(reliability coefficients＞0.7).In the last year,of the 12 kinds emergency equipment,the top three of the most injuries in patients were defibrillator(17.3%),ice blanket machines(13.4%),continuous renal replacement therapy machine(13.2%);the top three of most injuries in nurses were defibrillator(9.4%),aspirator(6.8%),continuous renal replacement therapy machine (5.7%);the top three of most damage in equipment were infusion pump(31.8%),blood gas analyzer(29.3%),smart pump(28%);the top three equipment with no harm were ECG(21.7%),ECG monitoring(20.7%),anesthesia machine(18.9%).There is no difference between General hospital special hospital,between General Intensive Care Unit and special intensive care unit.For the reason of patients' injuries,the top three accounts for equipment failure(82.5%),errors(62.8%) and patients with(62.8%);68.3% of nurses feel stress when using these equipment,83.8%of which are not commonly used.The reasons causing the most stress are the fear of sudden failure of equipment with not dealing with their own(74.5%),fear of harm to patients(51.6%),not familiar with equipment operation flow(47.4%);the Logistic regression analysis of adverse events showed that training,equipment management experience,checked regularly, adverse events reporting,environmental management et al are protective factors(OR＜1), no prevention equipment,no examination are the risk factors of adverse events(OR＞1).(2) The survey of large-volume infusion pumps:we received 102 questionnaires,with recovery rate of 98%,effective rate of 98%.Between the Intensive care unit and general department,there was no significant difference in the incidence of patient adverse events, the incidence of damage to equipment,training before first using,special examination, check regularly,cleaning and disinfection and so on;there are more nurses stress on the use of intravenous infusion pumps in the intensive care unit nurses than the general department;In the aspect of safety device,explanation after introducing,ICU are not as good as general units.On the cognition of adverse event reporting,the cognition of environment affecting safety,operation flow-sheet,general units are not as good as ICU.(3)Based the problem of safety revealed by survey,with the management experience at home and abroad,We have analysised the management modes during the equipment using from the formulation of policies and regulations,improving of learning modes, detailing of nurses participate in the process of equipment use and management respectively.Conclusion:①Nursing staffas the main user of emergency equipment,there are medical device adverse events and pressure on nurses,with no difference between general and special hospital,between general ICU and special ICU.Managers should think highly of safe using among medical devices by nurses.②When using equipments,nurses in ICU have more stress than the general departments.Hospital should give more support on nurses.③Nurses training is an important factor that affects the safety,so studying program on equipment using should be set up.④Management for devices is one of the factors that affect safety,so we should pay more attention to using management of nurses in every units.Because of the limitations in the existing monitoring system and medical device adverse event reporting system,nurses' cognitive rate should be strengthened. Besides,nurses should be encouraged to participate in the use and management of the apparatus initiatively and actively.Set up detail ways of nurses participating in clinical and management system.Provide more protection for nurses and patients.