护理核心制度内容

护理核心制度内容 1. 护理分级:医护人员根据患者病情和自理能力，确定并实施不同级别的护理。 由医生以医嘱的形式下达护理级别，分为特级护理、一级护理、二级护理和三 级护理四个级别。 2. 分级方法:患者入院后应根据患者病情严重程度确定病情等级;根据患者 Barthel指数总分，确定自理能力等级。依据病情等级和(或)自理能力等级， 确定患者护理分级。临床医护人员应根据患者的病情和自理能力的变化动态调 整患者护理分级。 3. 特级护理分级依据:(具备以下情况之一的患者，可以确定为特级护理) (1) 维持生命，实施抢救性治疗的重症监护患者; (2) 病情危重，随时可能发生病情变化需要进行监护、抢救的患者; (3) 各种复杂或大手术后、严重创伤或大面积烧伤的患者。 4. 特级护理护理要点: (1) 严密观察患者病情变化，监测生命体征。 (2) 根据医嘱，正确实施治疗、给药措施。 (3) 根据医嘱，准确测量并记录出入量。 (4) 根据患者病情，正确实施基础护理和专科护理，如口腔护理、压疮护理、气 道护理及管路护理等，实施安全措施。 (5) 保持患者的舒适和功能体位。 (6) 实施床旁交接班。 5. 一级护理分级依据:(具备以下情况之一的患者，可以确定为一级护理) (1) 病情趋向稳定的重症患者; (2) 病情不稳定或随时可能发生变化的患者; (3) 手术后或者治疗期间需要严格卧床的患者; (4) 自理能力重度依赖的患者。 6. 一级护理护理要点: (1) 每小时巡视患者，观察患者病情变化。 (2) 根据患者病情，测量生命体征。 (3) 根据医嘱，正确实施治疗、给药措施。 the characteristics of services for leaders. Office property determines the features of Office information work. Before the decision, to collect information, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementation, provides support for leadership judgment and sound decision-making. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic premise of this is doing a good job. At present and for a time, information report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, important social conditions and public opinion, major emergencies and of economic and social development orientation, the sign problem and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a good piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the quality of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity of information and improve the relevance of information. Information submitted to the Government departments at all levels, must come from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the information, all-round, wide-ranging and multi-angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the information depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in half months within to municipal government feedback results; on situation complex, and workload big of supervision matters, to in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, to in provides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedback a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervision, supervision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, finger-pointing, giving work to some extent, give notice of criticism. To improve the appraisal system, the future system of government supervision examination once a year, the city government offices will County (district) and the sector ranked, informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good job information. Complete control of information is both levels of Government, for decision making and to guide the work of the important means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate information to the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlight (4) 根据患者病情，正确实施基础护理和专科护理，如口腔护理、压疮护理、气 道护理及管路护理等，实施安全措施。 (5) 提供护理相关的健康指导。 7. 二级护理分级依据:(具备以下情况之一的患者，可以确定为二级护理) (1) 病情趋于稳定或未明确诊断前，仍需观察，且自理能力轻度依赖的患者; (2) 病情稳定，仍需卧床，且自理能力轻度依赖的患者; (3) 病情稳定或出于康复期，且自理能力中度依赖的患者。 8. 二级护理护理要点: (1) 每2小时巡视患者，观察患者病情变化。 (2) 根据患者病情，测量生命体征。 (3) 根据医嘱，正确实施治疗、给药措施。 (4) 根据患者病情，正确实施护理措施和安全措施。 (5) 提供护理相关的健康指导。 9. 三级护理分级依据:病情稳定或处于康复期，且自理能力轻度依赖或无需依赖 的患者。 10. 三级护理护理要点: (1) 每3小时巡视患者，观察患者病情变化。 (2) 根据患者病情，测量生命体征。 (3) 根据医嘱，正确实施治疗、给药措施。 (4) 提供护理相关的健康指导。 11. 根据病区情况安排两班制或APN排班。各护理单元在病区正常排班的基础上实 施弹性排班，合理调配护理人员。 12. 各护理单元在正常科学合理排班的情况下，根据情况设立听班，听班人员必须 保证电话24小时畅通，在接到电话后半小时内到位。 13. 每班必须按时交接班，接班者应提前15分钟进入病区，阅读交班记录及相关护 理文书。在接班者未到之前，交班者不得离开岗位。 14. 所有患者都须床头交接班。交班中发现病情、治疗、物品交代不清，应立即查 问。接班时发现问题，应由交班者负责;接班后如因交班不清，发生差错事故 或物品遗失，应由接班者负责。 15. 晨会集体交班由护士长主持，全体人员应严肃认真地听取夜班交班报告，要求 -llion, aepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the informatme from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrust coof information and improve the relevance of information. Information submitted to the Government departments at all levels, my of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity qualitood piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the em and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a gproblportant social conditions and public opinion, major emergencies and of economic and social development orientation, the sign report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, im emise of this is doing a good job. At present and for a time, informationmaking. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic pr-ovides support for leadership judgment and sound decisionon, prtion, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementatiices for leaders. Office property determines the features of Office information work. Before the decision, to collect informathe characteristics of serv2o the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlighttion ttant means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate informarmation. Complete control of information is both levels of Government, for decision making and to guide the work of the imporb informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good joovernment supervision examination once a year, the city government offices will County (district) and the sector ranked, infoTo improve the appraisal system, the future system of g pointing, giving work to some extent, give notice of criticism. -, fingerrvision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, supek a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervisionrovides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedbaco in po in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, thalf months within to municipal government feedback results; on situation complex, and workload big of supervision matters, tion depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the informat-ranging and multi-round, wide 护理核心制度内容 做到交班时护理文书要写清，口头要讲清，患者床头要看清，如交代不清不得 下班。 16. 对于新入院、危重患者、抢救患者、大手术前后或有特殊检查处理、病情变化 及思想情绪波动的患者，应仔细交接。 17. 集体交班内容: (一)患者数量:住院患者总数、出入院、转科(院)、手术(分娩)、病危、病重、 死亡、压疮高危、跌倒高危、导管危险高危患者人数。 (二)病情:新入院、当日手术、明日手术、分娩、抢救、病危、病重、病情有变 化患者的诊断、病情、治疗、护理问题、护理措施及特殊检查治疗患者等内容。 (三)对危急值、请假、思想情绪波动、有争议患者实行“零”报告。 18. 床边交接内容: (一)病情。 (二)输液及滴速、穿刺周围有无渗漏、红肿。 (三)查看全身皮肤，有无红肿、皮疹、破损、压疮、烫伤等。 (四)检查各种导管是否通畅及有无脱出，观察引流液的颜色、性状和量。 (五)检查敷料包扎、渗出情况。 (六)专科需特殊观察的内容。 (七)床单位是否整洁、干燥。 19. 遇有下列情况时，不得进行交接班: (一)处理紧急事故或抢救时(但可在告一段落时，得到护士长同意，进行交接班)。 (二)交班人员因特殊情况暂时离开工作岗位时。 (三)接班人员遇意外情况无法正常接班时。 查对制度 一、医嘱查对制度 (一)医嘱下达后，值班护士必须认真审核医嘱内容，对有疑问的医嘱须与医师确 认，无误后打印各种执行单。 (二)处理长期或临时医嘱时要记录执行时间并签全名。 (三)抢救病员时，医师下达口头医嘱，执行者须复诵一遍，经双方核实无误后方 the characteristics of services for leaders. Office property determines the features of Office information work. Before the dec 3 / 10 ision, to collect information, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementation, provides support for leadership judgment and sound decision-making. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic premise of this is doing a good job. At present and for a time, information report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, important social conditions and public opinion, major emergencies and of economic and social development orientation, the sign problem and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a good piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the quality of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity of information and improve the relevance of information. Information submitted to the Government departments at all levels, must come from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the information, all-round, wide-ranging and multi-angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the information depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in half months within to municipal government feedback results; on situation complex, and workload big of supervision matters, to in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, to in provides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedback a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervision, supervision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, finger-pointing, giving work to some extent, give notice of criticism. To improve the appraisal system, the future system of government supervision examination once a year, the city government offices will County (district) and the sector ranked, informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good job information. Complete control of information is both levels of Government, for decision making and to guide the work of the important means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate information to the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlight 可执行，并保留用过的空安瓿;抢救完毕，及时补全医嘱，执行者签全名，安瓿经两人核对无误后，方可弃去。 (四)所有医嘱，应做到班班查对，均应签全名;护士长每周总查对医嘱一次。 二、服药、注射、处理查对制度 (一)服药、注射、处理前必须严格执行“三查九对”制度(三查:操作前查、操作中查、操作后查;九对:对床号、姓名、药名、剂量、浓度、时间、用法、有效期、过敏史)，有效确认患者身份后实施操作。 (二)清点药品时和使用药品前要检查药品外观、标签、有效期及批号，如不符合要求不得使用;静脉给药需注意有无变质、瓶口松动裂缝，检查溶液有无沉淀、浑浊、絮状物等(须在振动后观察)。 (三)摆药后必须经第二人核对后方可执行，口服药按时发放、指导患者服用。 (四)对易过敏药物，给药前应详细询问有无过敏史;使用毒、麻、剧、限药时，要经过反复核对，使用后保留安瓿。 (五)多种药物同时应用时，必须注意药物配伍禁忌;针剂药物宜现配现用，以免发生理化反应。 (六)发药、注射时，如患者提出疑问，应及时查对，无误方可执行。 (七)观察用药后反应，对各种原因患者未能及时用药者应及时报告医生，根据医嘱做好处理，并做好护理记录。 三、输血查对制度 (一)血标本采集查对制度 1、确定输血后，持“输血申请单”和贴好标签的试管，双人严格核对患者床号、姓名、住院号等信息。 2、采血时遵循“一对一”原则，1名护士1次只能采集1人血样，禁止同时采取两人及以上的血液标本。 3、采血时严格执行患者身份识别制度，确认无误后抽血，抽血完毕后再次核对，采血者在“输血申请单”及医嘱单上签写姓名及采血时间，将输血标本编号贴在“输血申请单”上。 4、抽血时如对输血申请单与患者身份有疑问，应与主管医生重新核对，不能在错误的输血申请单和标签上直接修改，应重新填写(打印)输血申请单及标签。 (二)取血查对制度 ranging and multi-round, wide-llion, aepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the informatme from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrust coof information and improve the relevance of information. Information submitted to the Government departments at all levels, my of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity qualitood piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the em and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a gproblportant social conditions and public opinion, major emergencies and of economic and social development orientation, the sign report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, im emise of this is doing a good job. At present and for a time, informationmaking. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic pr-ovides support for leadership judgment and sound decisionon, prtion, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementatiices for leaders. Office property determines the features of Office information work. Before the decision, to collect informathe characteristics of serv4o the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlighttion ttant means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate informarmation. Complete control of information is both levels of Government, for decision making and to guide the work of the imporb informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good joovernment supervision examination once a year, the city government offices will County (district) and the sector ranked, infoTo improve the appraisal system, the future system of g pointing, giving work to some extent, give notice of criticism. -, fingerrvision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, supek a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervisionrovides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedbaco in po in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, thalf months within to municipal government feedback results; on situation complex, and workload big of supervision matters, tion depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the informat- 护理核心制度内容 1、由医护人员或经专业培训人员持处方与取血箱到输血科取血，与发血者双方查对。 2、双方逐项核对患者信息、血袋标签和血液物理外观，无误后双签字;血液取回后交病房护士。取血时遵循“一对一”原则，每次只能取1名患者血液。 3、血液到病房后，由两名医护人员持患者病历、《输血记录单》、血袋严格执行“三查十对”。 三查:血液有效期、血液物理外观、血袋有无破损。 十对:科别、床号、姓名、性别及年龄、住院号、血型(包括RH血型)、血量、血液成分、交叉配血试验结果、血液编号。 以上核对完成后，在《输血记录单》上双签字。 (三)输血查对制度 1、输血前，检查采血日期、血袋有无外渗、血液外观质量，确认无凝血、溶血、变质后方可应用。 2、输血时，由两名医护人员持患者病历、《输血记录单》、血袋，共同到患者床旁确认受血者，严格执行“十对”内容，让患者或家属陈述姓名及血型并核对腕带，无误后将血袋标签取下，粘帖在《输血记录单》上，然后输入。 3、输血后再次核对患者身份及血型，记录输血开始时间。 4、输血过程中严密观察患者病情变化，认真填写《输血观察记录单》。如发生输血反应，应按照“输血不良反应处理预案”进行相应处理。 5、输血结束后，在《输血记录单》上记录输血结束时间。将《输血记录单》粘贴在病历中。血袋送回血库。 四、标本采集查对制度 (一)两名护理人员认真核对本班医嘱单及标本条码信息，并打印化验医嘱执行单。 (二)采集者在标本采集前认真核对化验医嘱执行单及标本条码信息，包括病人床号、姓名、性别、年龄、住院号、标本类型、检验项目及特殊要求;采集时核对患者与条码信息，无误后执行;采集完毕后，再次确认信息，无误后在医嘱单及化验医嘱执行单上签字。 五、饮食查对 (一)每日查对饮食医嘱。 (二)指导患者饮食，检查自备饮食与医嘱饮食种类是否相符。 the characteristics of services for leaders. Office property determines the features of Office information work. Before the dec 5 / 10 ision, to collect information, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementation, provides support for leadership judgment and sound decision-making. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic premise of this is doing a good job. At present and for a time, information report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, important social conditions and public opinion, major emergencies and of economic and social development orientation, the sign problem and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a good piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the quality of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity of information and improve the relevance of information. Information submitted to the Government departments at all levels, must come from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the information, all-round, wide-ranging and multi-angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the information depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in half months within to municipal government feedback results; on situation complex, and workload big of supervision matters, to in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, to in provides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedback a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervision, supervision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, finger-pointing, giving work to some extent, give notice of criticism. To improve the appraisal system, the future system of government supervision examination once a year, the city government offices will County (district) and the sector ranked, informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good job information. Complete control of information is both levels of Government, for decision making and to guide the work of the important means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate information to the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlight (三)对特殊治疗饮食、检查饮食，护士应查对落实。 六、消毒供应室查对。(见消毒供应室查对制度) 七、手术患者查对。(见麻醉手术部查对制度) 安全输血制度 一、患者输血种类及剂量由医师根据病情决定。采集两人以上血标本时，要严格查对，逐一分别采集血标本，严禁同时采集两人或以上患者的血标本。 二、严格执行输血查对制度。输血前将血袋内的成分轻轻混匀，使用 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 输血器进行输血，血液需在离库30分钟内输注。 三、血液内不得加入任何药物，以防止血液变质。如需稀释只能用生理盐水。 四、输血前后用生理盐水冲洗输血管道，确认静脉通路通畅，连续输注不同献血者的血液时，两袋血之间需用生理盐水将输血管路冲洗干净。调换每袋血液时，必须坚持双人查对制度。输血器连续使用12小时以上，必须更换新的输血器。 五、输血过程中严密观察患者病情变化，认真填写《输血观察记录单》。 六、输血时要遵循“先慢后快”的原则，开始输入速度宜慢，一般速度不超过20滴/分，观察15分钟无不良反应，再根据病情及血液种类调节滴速，成人一般为40—60滴/分，老年人、儿童、心功能不全者酌减。原则在4小时内输注完毕。 七、输血过程中，应加强巡视，严密观察患者情况及穿刺部位有无血肿或渗出，尤其对婴幼儿、意识不清、全麻、用大量镇静剂等不能表述自我感受的受血者，应注意有无输血反应发生。如发生输血反应，应按照“输血不良反应处理预案”进行相应处理。 八、血液输完后，空血袋送回血库，《输血记录单》粘贴在病历中。 各种血液制品从发血到输血结束的时限为: 成 分 开 始 结 束 离开冰箱后30分钟4小时内(如室内温度增高红细胞 以内 则需在更短时间内结束) 血小板 立即 30分钟 血浆 立即 30分钟 冷沉淀 立即 10分钟 ust coof information and improve the relevance of information. Information submitted to the Government departments at all levels, my of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity qualitood piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the em and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a gproblportant social conditions and public opinion, major emergencies and of economic and social development orientation, the sign report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, im emise of this is doing a good job. At present and for a time, informationmaking. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic pr-ovides support for leadership judgment and sound decisionon, prtion, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementatiices for leaders. Office property determines the features of Office information work. Before the decision, to collect informathe characteristics of serv6o the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlighttion ttant means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate informarmation. Complete control of information is both levels of Government, for decision making and to guide the work of the imporb informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good joovernment supervision examination once a year, the city government offices will County (district) and the sector ranked, infoTo improve the appraisal system, the future system of g pointing, giving work to some extent, give notice of criticism. -, fingerrvision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, supek a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervisionrovides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedbaco in po in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, thalf months within to municipal government feedback results; on situation complex, and workload big of supervision matters, tion depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the informat-ranging and multi-round, wide-llion, aepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the informatme from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misr 护理核心制度内容 抢救工作制度 一、定期组织急救知识培训，提高护理人员抢救意识和抢救水平，抢救患者时，做到人员到位、分工明确、有条不紊、分秒必争。 二、各种急救药品和器材定位放置、定数量品种、定岗管理、定期检查，处于备用状态。 三、护士紧密配合医生参加抢救。医生未到前，护士应根据病情采取应急措施，包括给氧、吸痰、测量生命体征、建立静脉通道、进行胸外心脏按压、配血、止血等，并提供诊疗依据。 四、密切观察病情变化，保持呼吸道和各种管道通畅，准确及时填写《危重患者评估护理记录单》。 五、在抢救患者过程中，正确执行医嘱。在执行口头医嘱时，执行者须复诵一遍，经双方核实无误后方可执行;保留安瓿，两人核对无误后弃去。抢救结束6小时内据实补写医嘱并签名。 六、患者需做辅助检查时，必须有医护人员陪同。 七、认真做好患者的各项基础护理及生活护理。烦躁、昏迷及神志不清者，加床档和采取保护性约束，确保患者安全。 八、做好抢救后的清理、补充、检查及家属安抚工作。 危重患者护理 管理制度 档案管理制度下载食品安全管理制度下载三类维修管理制度下载财务管理制度免费下载安全设施管理制度下载 一、危重患者的护理应由工作能力强、临床经验丰富的护士负责，根据医嘱及患者病情做好患者的各项护理工作，随时观察患者病情。 二、严密观察病情变化，及时与医师沟通，必要时设专人护理，备齐急救药品、器材，随时准备抢救。 三、严格执行医嘱，及时落实各项治疗护理措施。 四、认真、细致做好各项生活护理及基础护理，严防并发症，确保患者安全。 五、严格执行床边交接班制度，对病情变化及特殊用药要进行交待，并作相应记录。 六、每日对危重患者进行风险评估，根据评估情况采取相应护理措施。对于压疮、跌倒/坠床评估存在危险的患者悬挂相应警示牌，对于深静脉血栓、误吸/窒息、非 计划 项目进度计划表范例计划下载计划下载计划下载课程教学计划下载 性拔管、泌尿系感染等评估存在高度风险的患者，告知风险评估结果及防范措施。 七、对存在疑难护理问题的危重患者，由所在科室向相应专业提出会诊申请，协助 the characteristics of services for leaders. Office property determines the features of Office information work. Before the dec 7 / 10 ision, to collect information, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementation, provides support for leadership judgment and sound decision-making. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic premise of this is doing a good job. At present and for a time, information report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, important social conditions and public opinion, major emergencies and of economic and social development orientation, the sign problem and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a good piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the quality of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity of information and improve the relevance of information. Information submitted to the Government departments at all levels, must come from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the information, all-round, wide-ranging and multi-angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the information depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in half months within to municipal government feedback results; on situation complex, and workload big of supervision matters, to in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, to in provides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedback a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervision, supervision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, finger-pointing, giving work to some extent, give notice of criticism. To improve the appraisal system, the future system of government supervision examination once a year, the city government offices will County (district) and the sector ranked, informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good job information. Complete control of information is both levels of Government, for decision making and to guide the work of the important means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate information to the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlight 解决。 八、危重患者病情变化需要抢救时，参加抢救工作的护理人员必须遵守《抢救工作制度》。 九、做好危重患者访视 (一)护理部、科护士长通过网络信息平台，掌握院内危重患者情况。 (二)护士长每天至少查看危重患者一次，病情变化时，随时在床边参与护理、抢救。每月分析危重患者护理质量，制定整改措施并加强落实。 (三)科护士长每周至少查看危重患者一次，帮助解决危重患者护理中存在的困难和问题。 (四)护理部每季度分析危重患者护理质量，提出改进措施，保证危重患者护理质量的持续提高。 十、当危重患者需院内检查或转运时，要做好以下工作: (一)充分评估患者，备齐相应药品及物品，做好人力准备，有效应对意外发生。 (二)根据患者病情选择合适的搬运方式，保持患者体位舒适，做好保暖。 (三)途中密切观察患者病情变化，与患者进行有效的沟通。 (四)保持呼吸道通畅，发现问题及时处理。 (五)保持输液及各种管道的通畅，妥善固定，防止脱出、扭曲、返流。 (六)与接收科室医护人员认真交接患者病情、注意事项等。 护理查房制度 一、护理查房有教学查房、个案护理、危重疑难患者护理查房等形式，采用多媒体、幻灯片、实物模型、患者床边等方法进行。 二、病区护理查房每2月?1次，由护士长主持。需多专业协作讨论的病例，上报护理部，由护理部组织、协调。 三、查房时由责任护士 汇报 关于vocs治理的情况汇报每日工作汇报下载教师国培汇报文档下载思想汇报Word下载qcc成果汇报ppt免费下载 病历，介绍患者病情、目前存在的护理问题、采取的护理措施等。针对患者的治疗、护理、心理方面存在的问题，与会的护理人员进行综合分析、全面讨论，提出改进措施，并起到相互学习提高的目的。 四、临床护理查房要做到有组织、有计划、有重点、有准备。参加护理查房的护理人员应查阅相关资料，积极参与讨论，解决问题，总结经验，由专人做好全过程的记录。 五、护理部每季度对科室护理查房落实情况进行督导。 ranging and multi-round, wide-llion, aepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the informatme from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrust coof information and improve the relevance of information. Information submitted to the Government departments at all levels, my of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity qualitood piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the em and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a gproblportant social conditions and public opinion, major emergencies and of economic and social development orientation, the sign report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, im emise of this is doing a good job. At present and for a time, informationmaking. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic pr-ovides support for leadership judgment and sound decisionon, prtion, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementatiices for leaders. Office property determines the features of Office information work. Before the decision, to collect informathe characteristics of serv8o the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlighttion ttant means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate informarmation. Complete control of information is both levels of Government, for decision making and to guide the work of the imporb informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good joovernment supervision examination once a year, the city government offices will County (district) and the sector ranked, infoTo improve the appraisal system, the future system of g pointing, giving work to some extent, give notice of criticism. -, fingerrvision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, supek a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervisionrovides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedbaco in po in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, thalf months within to municipal government feedback results; on situation complex, and workload big of supervision matters, tion depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the informat- 护理核心制度内容 护理病例讨论制度 一、护理病例讨论范围包括:病情危重抢救病例、疑难病例、特殊和罕见病例、重大手术和新开展的手术、新业务、新技术及死亡病例等。 二、科室定期或不定期的举行护理病例讨论，形式采用科室、大科或几个相关科室联合举行，需多专业协作讨论的病例，上报护理部，由护理部组织、协调。 三、病例讨论要做到有组织、有计划、有重点、有准备，要明确讨论目的及重要性，由护士长或责任护士准备好患者及相关资料， 通知 关于发布提成方案的通知关于xx通知关于成立公司筹建组的通知关于红头文件的使用公开通知关于计发全勤奖的通知 相关人员参加，做好发言准备。 四、讨论会由护士长主持，责任护士汇报病历，介绍患者病情，目前存在的护理问题、采取的护理措施及效果评价等，并提出需解决的护理问题，参加人员充分发表意见，综合讨论分析后，提出改进措施，由主持人进行总结。 五、责任护士做好护理病例讨论记录，讨论资料由科室归档。 护理会诊制度 一、对于本病区不能解决的护理问题，应及时申请会诊。 二、申请病区应认真填写《护理会诊记录单》，要把患者的主要病史、原有护理问题、护理措施及效果，会诊目的要求等简明扼要地写出，以便会诊者参考。 三、护理会诊人员资质要求(具备其一): (一)具有主管护师以上职称。 (二)取得省级以上专科护士资格证书或接受省级以上医疗机构培训的专业或专科护士。 (三)专业学科带头人或专科护理小组成员。 四、会诊形式及要求: (一)病区间会诊:由申请会诊病区提出，责任护士填写《护理会诊记录单》，应邀病区具有会诊资质的护士前往，一般会诊应在24小时内完成;急会诊应在10分钟内到达，并将会诊意见和建议记录于《护理会诊记录单》。 (二)全院护理会诊:疑难病例或病情需要多科会诊讨论时，病区护士长上报护理部，护理部通知有关病区，选派具备资质的人员参加。会诊时，由申请病区的护士长主持，护理部及应邀人员参加，责任护士做病例报告和会诊记录。 (三)院外护理会诊:疑难或病情需要院外专家进行护理会诊时，病区护士长报护 the characteristics of services for leaders. Office property determines the features of Office information work. Before the dec 9 / 10 ision, to collect information, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementation, provides support for leadership judgment and sound decision-making. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic premise of this is doing a good job. At present and for a time, information report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, important social conditions and public opinion, major emergencies and of economic and social development orientation, the sign problem and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a good piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the quality of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity of information and improve the relevance of information. Information submitted to the Government departments at all levels, must come from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the information, all-round, wide-ranging and multi-angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the information depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in half months within to municipal government feedback results; on situation complex, and workload big of supervision matters, to in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, to in provides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedback a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervision, supervision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, finger-pointing, giving work to some extent, give notice of criticism. To improve the appraisal system, the future system of government supervision examination once a year, the city government offices will County (district) and the sector ranked, informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good job information. Complete control of information is both levels of Government, for decision making and to guide the work of the important means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate information to the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlight 理部，由护理部确定并联系相关医院选派专家进行会诊。会诊时，由护理部主持，责任护士汇报病历并做好相关记录。 患者健康教育制度 护理健康教育是一项有组织、有计划、有评价的教育活动，目的是改变患者不良健康行为和生活方式，提高自我护理能力。健康教育方式包括个别指导、集体讲解、文字宣传与图片资料等，健康教育内容: 一、门诊健康教育 门诊护理人员以口头讲解、发放健康教育资料等形式，对患者的行为和生活方式给予指导。 二、住院患者护理健康教育 (一)各科护士长应重视住院患者护理健康教育，将此项工作纳入岗位职责，定期举办健康教育讲座;督促护理人员对患者进行入院、住院及出院过程中的健康指导。 (二)根据病人所患疾病由责任护士对其进行护理健康教育指导，护士长定期对护理健康教育进行效果评价。 (三)责任护士按护理程序系统收集资料，评估病人健康状况。了解其心理需求，进行心理护理及遵医行为教育，协助医生开展综合性健康教育，如疾病复发的预防和护理、活动、饮食、用药指导等。 三、出院患者护理健康教育: 责任护士以口头或书面的形式向出院患者提供自我保健和自我照顾、合理饮食、定时休息、适当活动、按时服药及定期复查等方法。 (一)出院后继续用药方法。 (二)饮食、活动、休息的要求及注意事项。 (三)心理调节方法和重要性。 (四)复诊时间安排及重要性。 llion, aepresent and false positives, as well as news, more news. "Full" is to pay attention to the comprehensiveness of the informatme from objective reality and reflect things as they are, must be realistic and must not have any false contents, not to misrust coof information and improve the relevance of information. Information submitted to the Government departments at all levels, my of information, our focus is "accurate, full and deep, precise, fast" on hard work. "Quasi", is to ensure the authenticity qualitood piece of information to help decision making, a distortion of the information could lead to wrong decisions. Improve the em and forecast information. Second, to strive to improve the quality of information. Quality is the life of information, a gproblportant social conditions and public opinion, major emergencies and of economic and social development orientation, the sign report focuses on, the city's economic and social development of, new ideas, new initiatives, new experiences, new issues, im emise of this is doing a good job. At present and for a time, informationmaking. Therefore, comrades from the policy makers working in the information point of view and research issues, the basic pr-ovides support for leadership judgment and sound decisionon, prtion, provide the basis for scientific leadership decision; after the decision to collect various reflecting and implementatiices for leaders. Office property determines the features of Office information work. Before the decision, to collect informathe characteristics of serv10o the municipal government, and departments at all levels is an important work of the Office. At work, one is to highlighttion ttant means of leading organs with practice, social, the masses, improved style of important content. Timely, accurate informarmation. Complete control of information is both levels of Government, for decision making and to guide the work of the imporb informed the assessment results, give recognition to outstanding achievements. 2, stick to the Center, improving quality, good joovernment supervision examination once a year, the city government offices will County (district) and the sector ranked, infoTo improve the appraisal system, the future system of g pointing, giving work to some extent, give notice of criticism. -, fingerrvision of the Municipal Government will inform the quarterly summary, not paying attention to the supervision work attitudes, supek a pieces, not drag not pressure. To implement the reporting system, on the County (district) and departments of supervisionrovides time within settles and report; on NPC Representative recommends, and CPPCC members proposal to handle a, and feedbaco in po in January within will implementation situation to municipal government feedback; on proposed clear time requirements of, thalf months within to municipal government feedback results; on situation complex, and workload big of supervision matters, tion depth. Should be good through the phenomena of nature, things hidden behind deepmatters to in angle to collect and report information, reflecting not only the phenomenon also reflects the essence. "Deep" is the informat-ranging and multi-round, wide-