Orthopedic nursing safety and quality objectives
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(1) Strengthen the early identification and management of trauma patients, reduce complications, and improve survival rates. 1. Establish and implement a trauma patient rescue cooperation system, and establish a green channel. 2. Provide relevant operational guidelines for trauma rescue cooperation and implement them effectively. 3. Nurses are proficient in the operation of the four aspects of trauma, including various hemostasis methods, common bandaging techniques, key points for limb fixation, and handling precautions. 4. Strictly adhere to the principles of trauma rescue, saving lives before treating diseases, stopping bleeding before bandaging, and fixing before transportation. 5. Quickly assess the injury, maintain airway patency, promptly handle open pneumothorax, and maintain circulatory system function, and cooperate with doctors to determine and implement rescue plans. (2) Implement dynamic assessment of high-risk risks, take proactive measures to ensure patient safety. 1. Conduct a comprehensive evaluation according to the head to toe assessment mode, establish and implement nursing guidelines for bone fascial compartment syndrome and tissue blood supply for limb replantation/flap transplantation. 2. Keep the patient's respiratory tract unobstructed after cervical spine injury/surgery, and promptly detect symptoms of spinal cord/nerve compression. For patients with sputum viscosity of grade III, cervical fractures with high paraplegia, and those who experience neck swelling, difficulty breathing, or thickening of the neck circumference, and blood oxygen saturation<90% after cervical surgery, emergency preparations such as tracheotomy kits, tracheal intubation sleeves, and respiratory airbags should be prepared. 3. Promptly detect neurological compression symptoms in patients after lumbar spine surgery, including motor, sensory, autonomic dysfunction, and reflex abnormalities, and immediately report to the doctor for cooperation and treatment. 4. Correctly transport/move patients with spinal cord injuries. When critically ill patients are unaware of their condition, try not to move them, pay attention to their breathing and facial expressions, and if fractures and spinal injuries are not ruled out, it is necessary to
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Fix it properly before handling to avoid further damage. (3) Strengthen patient fall risk management, prevent fall accidents, and reduce disputes. 1. Seriously implement the anti fall and anti fall bed management system and guidelines. 2. Evaluate patients, use anti fall and anti fall bed signs and inform them, use specialized nursing forms, and implement them item by item. 3. Regularly inspect the ward environment, promptly identify potential hazards, and handle them promptly.
4. When necessary, use restraint straps and use restraint care forms, with the patient's family members agreeing and signing. (4) Strengthen the risk management of pressure ulcers in patients and reduce the occurrence of pressure ulcers in hospitals.
1. Develop a comprehensive pressure ulcer risk prediction system. 2. Inform patients and their families of the pressure ulcer risk assessment results to improve compliance. 3. Implement standardized measures for the diagnosis, treatment, and nursing of pressure ulcers. According to the evaluation content and nursing measures of the "Pressure Ulcer Risk Nursing Sheet", effective protective measures should be taken for patients at medium and high risk. (5) Implement patient positioning and mobility safety management measures to prevent safety accidents from occurring. 1. Establish and implement guidelines for the use of lathes and wheelchairs. 2. Place the affected limb in a functional position to improve comfort and reduce pain. 3. For those who have undergone tracheotomy/intubation, are unconscious, and have excessive phlegm that cannot be coughed up on their own before transportation, suction the phlegm first; Cervical spine surgery/injury patients wearing cervical braces for fixation; Patients with endotracheal tubes/tracheostomy tubes should not tilt their heads back. The carrier should place both hands on the patient's head, neck, waist, and buttocks, and move the patient's body horizontally to prevent the endotracheal tube from dislodging or dislodging. 4. Patients with limb plaster/splint fixation and special drainage tubes such as closed chest drainage tubes during transportation should have dedicated personnel to support the limbs or tubes. 5. Transportation of critically ill patients: escorted by nurses and doctors, closely observed the condition, and ensured oxygen supply and transportation
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Ensure smooth flow of liquid pipelines, carry necessary rescue drugs and items, and complete shift handover. (6) Correctly use auxiliary tools to ensure their effectiveness and safety. 1. Establish and implement nursing guidelines for the use of various auxiliary tools. 2. According to the "Elbow Staff Care Form" assessment, the muscle strength of both upper limbs should reach level four or above, and the muscle strength of both lower limbs should reach level three or above before use. 3. Assist and guide patients to leave the bed correctly: patients with lower limb fractures, paraplegia, incomplete paraplegia, or unilateral weakness of the lower limb should leave the bed on the healthy side. 4. Proper wearing of thoracolumbar braces: The position of the brace should be accurate, and the tightness should be such that one palm is placed flat between the brace and the patient's chest. The patient should be instructed to take a deep breath, as long as it does not affect their breathing. 5. Use of neck brace: The elasticity should be such that the neck and shoulders rotate synchronously after wearing the neck brace. A soft small towel should be placed flat between the neck brace and the skin to prevent local pressure sores and contamination, making it easy to replace. (7) Strengthen patient pain management, reduce complications, and improve quality of life. 1. Set comfortable goals together with patients and encourage them to participate in pain treatment. 2. Choose the correct pain assessment scale, and based on the assessment results, jointly agree on a treatment and nursing plan with the doctor. 3. Evaluate at least once every 30 minutes after pain treatment intervention, and promptly record the grading of pain assessment, analgesic measures, and effectiveness. 4. After intervention, if the effect is not significant, the pain treatment plan should be revised in a timely manner. (8) Strengthen patient psychological safety management and prevent the occurrence of adverse events. 1. Fully evaluate the patient's mental and psychological status, as well as their family composition, economic status, etc. 2. For patients with psychological abnormalities, such as depression, mania, and irritability, appropriate measures must be taken
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Psychological nursing measures and cooperation with doctors to implement treatment. 3. For patients with recurrent attacks (such as gout, osteoporosis pain) or functional disorders (such as paraplegia, cauda equina injury leading to constipation, sexual dysfunction, etc.), seek the cooperation of family members to encourage patients to actively respond to treatment and life. 4. For patients with complex family situations and poor economic conditions, timely detect their abnormal psychology and behavior, do a good job of comforting and handing over shifts, and inform their families to seek help. Timely detect and handle dangerous self harm items in the ward, strengthen patrols, and assist patients in seeking help from society when necessary. (9) Prevent or reduce the occurrence of high-risk complications in orthopedics. 1. Able to accurately use the AUTAR DVT risk score to assess patients at risk of developing deep vein thrombosis. When raising the lower limbs after surgery, do not place individual pillows under the groin or calf to avoid affecting deep venous return. Encourage early ankle pump exercise and early withdrawal from bed as much as possible. Encourage smokers to quit smoking and avoid nicotine stimulation that can cause vasoconstriction and increase blood viscosity. Avoid lower limb venipuncture. Take mechanical preventive measures such as plantar vein pumps, intermittent inflation and compression devices, and graded compression elastic socks. 2. Prevent hip dislocation. Maintain the affected limb in a 15 degree abduction neutral position. Teach patients to straighten their affected limb before leaving the bed; When sitting off the bed, the angle between the affected limb and the body should be greater than 90 degrees. Guide patients not to squat/cross their legs/bend down to pick up objects/sit on low stools or soft sofas. 3. Avoid damage to the common peroneal nerve. All kinds of plaster and small splints for external fixation require thick cushions to protect the common peroneal nerve; During the fixation process of fresh lower limb fractures, if there is abnormal pain in the injured limb, the pain in the lower leg and outer back of the foot is reduced or disappears, and the ankle dorsiflexion, foot eversion, thumb extension, and toe extension force are weakened, it is necessary to attach great importance to and find the cause, and promptly relieve the compression of the common peroneal nerve. The traction time of tibial tuberosity should be avoided for too long. After the fracture end is stabilized, it is advisable to change to intermittent traction and massage the injured limb.
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4. Patients undergoing limb replantation/flap transplantation are required to maintain a room temperature between 20-25 ℃, raise the affected limb to the same level as the heart, and protect the affected area with a cotton sleeve or towel when going out. Smoking is not allowed, and it is not allowed to enter smoking areas and gather with smokers. (10) Strengthen patient rehabilitation safety management, improve patients' social adaptability, and enhance their quality of life. 1. Establish and implement rehabilitation exercise guidelines and standards for specialized diseases. 2. The principle of functional exercise: gradual and orderly, with activity range increasing from small to large, frequency increasing from few to many, time increasing from short to long, and intensity increasing from weak to strong. 3. The degree of activity is based on the patient not feeling fatigue and not feeling pain at the fracture site. 4. Develop exercise plans based on each patient's physical ability, nature of injury, location and type of fracture, age, and physical fitness, and determine exercise methods and amounts. The plan should be personalized. 5. Develop various health education manuals, with illustrated explanations, to enhance patients' and their families' knowledge and adaptability to rehabilitation training. 6. Further implement continuity of care and strengthen discharge follow-up.
