Mesmer R J
Shriners Hospitals for Children-Cincinnati Burns Institute, OH 45229, USA.
Semin Perioper Nurs. 1997 Oct;6(4):223-32.
Perioperative nursing care and subsequent documentation is a key component in the continuum of care for the pediatric burn and reconstructive patient. A system was developed to streamline and improve the method of documentation, avoid inconsistencies, and provide an ongoing means of performance improvement monitoring. Narrative documentation is limited to charting by exception. The preoperative and intraoperative forms were developed in conjunction with the Perioperative Standards of Nursing Practice and integrated with policies and procedures already established. These guidelines are intended to incorporate the physician orders and recommended practices of professional organizations.
围手术期护理及后续记录是小儿烧伤和重建患者连续护理的关键组成部分。开发了一个系统，以简化和改进记录方法，避免不一致情况，并提供持续的绩效改进监测手段。叙述性记录仅限于例外情况记录。术前和术中表格是根据围手术期护理实践标准制定的，并与已确立的政策和程序相结合。这些指南旨在纳入医生的医嘱和专业组织的推荐做法。
