University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK.
J R Soc Med. 2012 Sep;105(9):377-83. doi: 10.1258/jrsm.2012.120098.
The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional 'ward round' presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. This paper describes the design and implementation of a 'ward safety checklist' that defines a set of potential risk factors that should be checked on a daily basis, and offers multidisciplinary teams a number of prompts for sharing and clarifying information between themselves, and with the patient, during a round. The concept of the checklist and the desire to improve ward rounds were well received in many teams, but the barriers to adoption were informative about the current culture on many inpatient wards. Although the 'multidisciplinary ward round' is widely accepted as good practice, the medical and nursing staff in many teams are failing to coordinate their workloads well enough to make multidisciplinary rounds a working reality. 'Nursing' and 'medical' care on the ward have become 'de-coupled' and the potential consequences for patient safety and good communication are largely self-evident. This problem is further complicated by a medical culture which values the primacy of clinical autonomy and as a result can be resistant to perceived attempts to 'systematize' medical care through instruments such as checklists.
最近，医院住院患者所接受的护理的安全性和一致性成为了一个特别的政治和公众关注的问题。传统的“病房查房”为系统地、集体地确保为每个患者实现适当的护理标准提供了明显的机会。本文描述了一种“病房安全检查表”的设计和实施，该检查表定义了一组每日应检查的潜在风险因素，并为多学科团队提供了一些提示，以便在查房期间彼此之间以及与患者之间共享和澄清信息。检查表的概念和改进病房查房的愿望在许多团队中得到了很好的认可，但采用的障碍反映了许多住院病房当前的文化。尽管“多学科病房查房”被广泛认为是良好的实践，但许多团队中的医护人员未能很好地协调他们的工作量，以使多学科查房成为现实。病房中的“护理”和“医疗”护理已经“脱钩”，对患者安全和良好沟通的潜在后果是显而易见的。这种问题进一步复杂化了一种医疗文化，这种文化重视临床自主性的首要地位，因此可能会抵制通过检查表等工具对医疗保健进行“系统化”的尝试。
