Analysis and countermeasures of the 282 cases of nursing adverse events with non-punitive network reported

2015 
Objective To understand the characteristics of the nursing adverse events through analysis the 282 cases of nursing adverse events, and make countermeasures to reduce the incidence of adverse events. Methods A total of 282 nursing adverse events of non-punitive network reported were collected from June 2013 to June 2014 with retrospective analysis, then we analyzed and summarized them, in order to find out the relationship between occurred characteristics, reasons, age group with the nurse hierarchy, etc. Results No consequence nursing adverse events (level Ⅲ) accounted for 67.38% of all events cases, while potential hazard nursing adverse events (level Ⅳ) accounted for 26.95%. Nursing adverse events accounted for 26.60% happened from 23: 00 to 8: 00. And 33.3% of warning events (level Ⅰ) happened in 15: 00—23: 00 and 66.7% took place in 23: 00—8: 00. Hence, the adverse events occurred from 8: 00 to 15: 00 occupying 52.84% (149/282). Then over 60 years old cases of nursing adverse events accounted for 49.29%. Nursing hierarchy and its adverse events accounted for the highest rate, which was 59.93% (169/282). In the distribution of age group about nursing adverse events, age group of beyond 60 years old was 49.29%. For the reasons of nursing adverse events, without strictly carrying out checking system accounted for 30.85%, lacking responsibility occupying 24.11%, not strong risk awareness possessing 23.76%. Conclusions It is remarkable to improve the consciousness of reporting adverse events in each nursing unit after implementation of network reported no-punitive nursing adverse events. There is a high percentage of nursing hierarchy adverse events and over 60 years old patients occurred. Warning events (level Ⅰ) frequently happen in 15: 00-8: 00. Therefore, we should strengthen the young nurses′ training, management of senile inpatients, 15: 00—8: 00 period nursing duty management, in order to reduce the incidence of nursing adverse events. Key words: Patient′s safety management; Nursing adverse event; Non-punitive; Countermeasure
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