医院二甲复审工作计划

医院二甲复审工作计划（共6篇）

医院二甲复审工作计划 篇1

简 讯

第一期

二甲医院复审办公室

二0一二年五月四日 ————————————★——————————————

我院召开二甲医院复审工作动员会

2012年4月17日，在我院四楼会议室召开由全体班子成员、各科主任、副主任、护士长、党支部委员参加的二甲医院复审工作动员大会。此次会议的中心议题是号召动员全体干部职工高度重视、人人参与。通过评审，加强医院内涵建设，持续改进服务质量，保证医疗安全，提高医院管理水平，服务效率，转变工作思路，适应新形势下医改的发展要求及工作目标。确保第二周期二甲医院评审评价顺利通过。

会议上，高宏业副院长宣读二甲医院复审工作方案。一是成立了由院长任组长，由全体班子成员组成的医院复审工作领导组，统一部署，指挥协调此项工作的开展。二是成立了由高宏业副院长任组长的二甲医院复审办公室。制定、布置、审核相关制度、措施、方案并督促具体落实、整改，办公室设在质控办。

医院二甲复审工作计划 篇2

1 建立健全相关药事管理制度, 丰富了药事管理的内容

根据《二级综合医院评审标准 (2012) 实施细则》中的要求, 将药事管理委员会更改为药事管理与药物治疗学委员会, 明确了该委员会的职责及工作制度。在该委员会的领导下, 对医院的药事制度进行了重新修订及完善, 进一步细化了操作流程, 明确各种职责。通过审核医院药品采购品种、基本用药目录的制定, 定期开展对处方及用药医嘱的点评, 分析药品的不良反应等, 努力将药事管理由单纯的药品供应向药学专业技术转变, 从而实现患者用药安全、有效、经济。

2 加强药品管理, 保障药品供应

2.1 制定和执行严格的药品遴选及药品采购供应制度, 药品严格执行网上采购, 储备适宜。药事管理与药物治疗学委员会认真履行职责, 组织专家按照药品遴选制度及质量优先、价格合理的遴选原则, 从自治区网上药品招标采购目录中遴选出我院的采购目录。遴选期间严格落实“一品两规”及控制抗菌药物的品种及品规数, 使其符合国家相关规定。

2.2 严格执行入库验收管理制度。从科室质量与安全管理小组中抽1~2名具有丰富工作经验的工作人员对每批购进药品进行质量验收, 并做详细记录。做到医院内流通的每一个药品都能够追溯其来源及具体流向。

2.3加强麻醉、精神药品的管理完善相关管理制度及职责, 细化了流程, 如各药房麻醉、一类精神药品发放流程、空安瓿销毁流程等, 规范了患者无偿交回剩余麻醉药品登记, 每月专人对全院麻醉、精神药品使用管理进行专项督导检查, 采用追踪法对科室麻醉药品残余量的处置进行监督检查, 当场填写检查记录, 当场反馈, 及时整改并跟踪整改情况。针对人工核对医师麻醉、精神药品处方权存在困难, 利用信息系统对医师麻醉、精神药品处方权进行限定。提高了工作效率。每季度对麻醉、精神药品的使用管理情况进行汇总分析, 查找管理薄弱环节, 并针对薄弱环节提出整改措施。

2.4 规范了全院高危药品及易混淆药品的管理。参照美国药物安全使用协会 (ISMP) 的分类, 结合我院实际情况, 制定了医院的高危药品目录及管理制度, 并全院统一标识, 提醒药师、护士, 避免调配、配制错误。针对包装相似、听似、看似、药品一品多规或多剂型等易混淆药品, 制作醒目标识粘贴于药品标签处, 同时制作警示宣传栏, 张贴于各药房、配液室, 对医务人员起到警示作用。

2.5 规范了药品管理。 (1) 通过与医务科及护理部的沟通与协作, 制定了各科室的备用药品目录, 统一了清单格式及备用药品的品种及数量, 并制订了领用流程。 (2) 为保证药品在合理储存条件下储存, 医院为各科室配备了药品冷藏柜, 在药库增设了阴凉库, 做到了全院药品统一储存条件。各临床科室及药剂部门, 每天两次对冷藏设施内的温湿度进行检查登记, 保障药品储存条件在规定范围内。 (3) 利用信息系统对有温度限制的药品进行警示。将药品的储存温度在药品基本信息中进行先行维护, 并在药品请领单及处方中予以显示, 以提醒药师及护士注意按照要求进行存储及给患者必要的发药交代。同时, 通过短信平台, 给取药的患者发送温馨提示。 (4) 药师将我院所有药品的储存条件 (温度要求、避光、遮光) 进行统计, 并通过OA发至各个科室, 提醒医务人员按照要求对药品采取必要的措施, 如各部门针对需遮光药品自制了遮光布 (盒) 以保证药品的质量安全, 治疗有效。 (5) 严格执行效期药品管理制度药剂科各部门同时采取多种形式加强对效期药品的管理, 如效期药品一览表、鱼骨图、效期药品登记本, 同时通过信息系统对不同效期内的药品进行色标显示:效期在1个月内 (含1个月) 的药品显示红色, 效期在3个月内 (含3个月) 的药品显示黄色, 效期在6个月内 (含6个月) 显示蓝色等。各临床科室的备用药品均建立效期药品登记本, 便于管理。 (6) 药剂科每月组织质控人员, 对全院的药品质量、效期、储存环境、管理等进行督导检查。对科室备用药品管理不当造成的结果:变色、失效、不同批号药品混放、药品外包装与内装实物信息不符、不同效期药品混放标识不清、基数与实物不符等, 当场与科室药品专管人员进行原因分析:药品养护措施未到位 (遮光、避光、冷藏、阴凉) 、管理混乱, 并对护理人员进行药品养护知识的培训, 及时的追踪督导, 以提高护理人员药品保管知识, 保证科室备用药品的有效, 保障了患者的用药安全。

3 临床药学服务的开展与探索

3.1 成立临床药师组, 培养临床药师。

虽然国家卫生部、国家中医药管理局2011年1月30日颁布的《医疗机构药事管理规定》中第十九条:医疗机构应当配备临床药师;第三十四条:二级医院临床药师不少于3名。临床药师应当具有高等学校临床药学专业或者药学专业本科毕业以上学历, 并应当经过规范化培训[3]。但我院在评审前的状况是只有一名兼职药师, 具有高等学校药学专业本科毕业的人员很少且为刚参加工作的毕业生。根据评审要求, 院方积极引进药学人才及高校本科毕业以上的学生, 同时加大对药师的培训, 从中选出专业素质高, 热爱临床药学工作的同志, 组成临床药学组, 并对临床药师设定其服务临床科室, 以此逐渐丰富临床药师的临床知识以及与临床医师的沟通能力, 从而向实现药学服务与临床的有机结合过渡。院方还多方努力选派符合条件的药师赴区内临床药师培训基地进行为期半年的抗感染专业的学习。

根据我院目前的工作特点, 临床药师主要工作任务有: (1) 定期参加服务临床科室的业务查房, 做好查房记录, 发现临床潜在的或实际存在的用药问题, 提出建议; (2) 处方及用药医嘱点评; (3) 抽查病历, 进行抗菌药物使用分析, 并对医师进行督导; (4) 对不合理用药的医师发放沟通单, 进行面对面的交流; (5) 跟踪药品不良反应/不良事件, 分析并向上级部门承报; (6) 定期编辑《药讯》, 并向全院临床科室发放。经过临床药师的不懈努力, 临床药学工作得到了我院医务人员的认可, 但离参与临床用药方案的制定、会诊还有很大的距离, 相信只要我们不懈的努力学习, 我们会越来越接近目标的。

3.2 加强管理抗菌药物临床合理使用。

利用信息系统对抗菌药物使用的相关节点进行有效控制。如对抗菌药物处方权、分级管理、清洁切口预防使用抗菌药物的品种选择及使用时机、使用天数等进行有效的控制, 大大提高了我院抗菌药物管理的成效。实施后, 抗菌药物越级使用率由27.8%降为0, 清洁切口预防使用抗菌药物的品种选择合理率由65.2%提高为84.7%, 清洁切口预防使用抗菌药物使用时机合理率由55%提高为91%;清洁切口预防使用抗菌药物使用天数由1.9 d降为1.6 d。

3.3 规范活血化瘀药物的合理使用。

近年来, 活血化瘀中药注射剂在临床上得到了广泛的应用, 在治疗高血压、冠心病、糖尿病、肾病综合征、类风湿关节炎、骨折、颈椎病等多种疾病中取得了一定的疗效[4]。我院是一所二级综合医疗机构, 活血化瘀中药注射剂使用量占西成药药品使用金额的1/10。为规范该类药物的使用管理, 我院于2012年7月1日起实施活血化瘀药物管理办法, 临床药师每季度抽查该类药物使用金额及数量排名前五位品种使用医师的病历进行点评, 对不合理使用病历提交药事管理与药物治疗学委员会专家组复议, 确定不合理按照相关规定予以处罚。经过一年半的持续改进, 与2012相比, 2013年活血化瘀药物药品使用金额下降了25.73万元, 同比降低了6.13%;该类药品的联合使用率降为零, 规范了临床合理用药。

3.4 建立患者自备药管理规定。

患者在入院时, 医师应对患者当时服用药物情况进行了解及评估, 确需服用, 患者需签订自备药品知情同意书。医师或护士、药师对患者药品的质量进行检查时, 如发现其来源不明、药品包装破损、变色等质量问题, 应拒绝使用。对需代保管的患者自备药品, 科室建立患者自备药品保管使用登记, 记录药品名称、规格、数量、批号、效期、生产厂家等基本信息, 同时记录使用信息:使用剂量、数量、结余数、给药护士签名、患者/家属签名等。3.5建立超说明书用药管理规定。由临床药师汇总临床超说明书药品, 通知使用科室, 在限期内收集、整理超说明书用药的循证医学证据, 并向药事管理与药物治疗学委员会、伦理委员会提出申请, 讨论通过的药品, 在给患者使用时, 患者应签署超说明书用药知情同意书, 同意书与病历一同保存备查。经过反复的培训、督查、沟通, 超说明书用药情况大幅降低。

等级医院评审的中心内容是围绕质量、安全、服务、管理、绩效, 体现以患者为中心。通过此次评审, 全院在药品的管理、使用方面更加规范合理, 加快了完善硬件设施 (如阴凉库) 的步伐, 使临床药师培养及药学人才引进问题得到院领导的更进一步重视。总之, 等级医院评审工作促进了基层医院的药事管理工作的发展。

摘要：结合工作实际, 总结等级医院评审工作中药事工作的做法和经验, 持续改进药事工作, 更好的为患者服务。

关键词：等级医院评审,药事管理,药学服务

参考文献

[1]王继红.基层医院药事管理的现状与对策[J].中国当代医药, 2012, 17 (18) :133.

[2]张斌.金鑫.王志睿, 等.医院药事管理思考[J].解放军医院管理杂志, 2010, 17 (9) :899.

[3]医疗机构药事管理规定[S].卫医政发[2011]11号.

医院二甲复审工作计划 篇3

1．发现病人有自杀倾向时，立即报告护士长及分管医生。

2．移去病房内一切可用作自伤的物品;检查病人病室内环境，若发现私藏药品、锐利器械等危险物品给予没收；锁好门窗，防止意外。

3．告知家属床旁监护，不得离开。如患者有宗教信仰,可联络有关神职人员等前来探望。

4．详细交接班，密切注意病人心理变化，准确掌握心理状态。

5．查找病人自杀原因，有针对性的做好心理护理，尽量减少不良刺激对病人的影响。

6．若发现病人自杀，立即通知医生赶赴现场，立即抢救。

7．通知保卫科或总值班，听从安排处理。

太原市类风湿病医院二甲复审制度 篇4

随着医药卫生体制改革，促进我院管理理念更新，使我院推行标准化、规范化、精细化管理，提高我院管理水平，建立正常工作秩序，改善服务态度，提高医疗护理质量，防止医疗差错事故，使我院工作适应社会主义建设的要求，在总结《医院工作制度与人员岗位职责等规定汇编》的基础上，结合我院的实际情况，重新修订了《医院工作制度及人员岗位职责》。

本书共收录医院工作制度

项，人员岗位职责

项，十五项核心制度是要求医务人员必须熟练掌握，同时各部门根据本制度和职责的原则要求，认真贯彻执行。

太原市类风湿病医院 二O一一年九月

目录

上篇

太原市类风湿病医院工作制度

行政管理工作制度········································································1

一、院领导干部深入科室制度·································································1

二、会议制度···············································································1

三、院长查房制度···········································································2

四、请示报告制度···········································································2

五、总值班制度·········································································2

六、卫生工作制度···········································································3

七、病历管理制度···········································································3

八、医院统计制度···········································································4

九、医院图书馆/室管理制度···································································4

十、进修工作管理制度·······································································4

十一、患者入院、出院工作管理制度····························································5

十二、住院处工作制度.······································································5

十三、挂号工作度···········································································6

十四、职工上岗前教育制度…·································································6

十五、在岗职工规范化培训制度·······························································6

十六、请假考勤制度·········································································6

十七、社会监督制度·········································································7

十八、医德教育和医德考核制度·······························································7

十九、档案管理制度·········································································7

二十、信息部门管理制度·····································································8 二

十一、医院应急管理制度···································································8 二

十二、卫生技术人力资源管理制度···························································9 二

十三、医院标识管理制度···································································9 二

十四、消防与安全管理制度································································10 二

十五、投诉处理管理制度··································································10 二

十六、信息公示制度······································································11 二

十七、员工意外伤害（含感染、化学、放射等）管理制度··········································11 二

十八、患者知情同意告知制度······························································11 二

十九、医院院务公开制度··································································12 医院各委员会工作制度·································································

一、院务委员会工作制度···································································

二、医院医疗质量管理委员会工作制度························································

三、医院护理质量委员会工作制度···························································

四、医院学术委员会工作制度·······························································

五、医疗技术管理委员会工作制度···························································

六、医院感染管理委员会工作制度···························································

七、药物与治疗学委员会工作制度···························································

八、临床用血管理委员会工作制度···························································

九、医院病案管理委员会工作制度···························································

十、医学伦理委员会工作制度工作制度························································

十一、医院医疗事故鉴定委员会工作制度·····················································

十二、医院安全委员会工作制度···························································

十三、实验室生物安全管理委员会工作制度····················································

十四、医疗器械临床使用安全管理委员会工作制度················································

十五、医院后勤管理委员会工作制度···························································

十六、信息安全管理委员会工作制度···························································

医疗管理制度············································································12

一、抢救室工作制度········································································12

二、门诊工作制度··········································································12

三、处方制度··············································································13

四、病历书写制度··········································································14

五、查房制度··············································································16

六、医嘱制度··············································································16

七、医疗质量管理制度······································································17

八、查对制度··············································································18

九、会诊制度··············································································22

十、转院转科制度··········································································22

十一、双向转诊制度········································································22

十二、病例讨论制度········································································24

十三、值班与交接班制度····································································25

十四、手术室管理制度······································································26

十五、麻醉科工作制度······································································26

十六、重大医疗过失行为和医疗事故报告制度··················································27

十七、医疗技术管理制度····································································27

十八、临床检验危急值报告与应用制度························································28

十九、临床实验（检验、病理）标本采集、储存运送制度········································28

二十、患者评估管理制度····································································29 二

十一、手术（有创操作）分级管理制度························································30 二

十二、危重患者进行高风险诊疗操作的资格许可授权制度······································31 二

十三、首诊负责制度······································································31 二

十四、约束器具使用制度··································································32 二

十五、急危重患者抢救及报告制度··························································32 二

十六、住院病历环节质量与时限基本要求····················································32 二

十七、病房小药柜管理制度································································34 二

十八、中医科工作制度····································································35 二

十九、针灸室工作制度····································································35 三

十、医学工程/医疗器械科（组）工作制度······················································35 护理管理工作制度·······································································36

一、护理部工作制度········································································36

二、病房管理制度··········································································36

三、早会制度··············································································37

四、交接班制度············································································37

五、夜班督导工作制度······································································38

六、执行医嘱制度··········································································38

七、分级护理制度··········································································39

八、护理会诊制度··········································································41

九、病房药品管理制度······································································41

十、病房消毒隔离制度······································································42

十一、皮肤压力伤登记报告制度······························································43

十二、导管滑脱登记报告制度（中心静脉插管、气管插管等）·······································.43

十三、病房安全制度········································································43

十四、患者膳食管理制度····································································44

十五、健康教育制度········································································44

十六、探视、陪伴管理制度···································································45

十七、注射室工作制度······································································45

十八、治疗室工作制度······································································46

十九、换药室工作制度······································································46

二十、患者入院、出院、转院、转科护理工作制度·················································46 二

十一、物资、器材管理制度·································································47 二

十二、病人外出检查制度··································································48 二

十三、护理查房制度······································································49 二

十四、护理查对制度······································································49 二

十五、护理人员技能定期评估制度··························································51 二

十六、护理新技术准入制度································································51 二

十七、护理制度、操作常规变更批准制度·····················································52 二

十八、护理人员继续教育制度······························································52 二

十九、护理应急管理预案··································································53 三

十、护理差错、事故登记报告制度···························································58 三

十一、病房医嘱计算机录入管理制度························································59 三

十二、护理文书书写基本规范与质量监管制度················································59 三

十三、特殊科室管理制度··································································62 三

十四、手部卫生规范与质量监管制度························································68 医院感染管理制度·······································································69

一、医院感染监测管理制度·································································69

二、医院感染消毒隔离制度·································································70

三、消毒药械管理制度·····································································70 四、一次性使用无菌医疗用品管理制度·······················································71

五、医疗废物管理制度·····································································71

六、医院感染的分级防护管理制度···························································71

七、预防重点部位医院感染制度·····························································72

八、医院感染管理委员会工作制度···························································73 药剂部门工作制度·······································································73

一、医院药事管理委员会工作制度···························································74

二、临床用药管理制度·····································································74

三、药剂科工作制度·······································································75

四、调剂室工作制度·······································································75

五、制剂室工作制度·······································································76

六、静脉用药配置中心（室）工作制度·························································77

七、临床药师工作制度·····································································78

八、药房值班工作制度·····································································79

九、药库工作制度·········································································80

十、药品采购工作制度·····································································80

十一、药品验收和保管制度·······························································81

十二、药品质量监控制度·································································81

十三、住院患者自备药品制度·····························································83

十四、麻醉药品、一类精神药品管理制度····················································83

十五、第二类精神药品管理制度···························································85 医技科室工作制度·······································································85

一、检验科工作制度········································································85

二、输血科/血库工作制度····································································86

三、中心实验室管理制度····································································87

四、临床检验危急值报告制度································································89

五、医学影像科（室）工作制度································································90

六、特殊检查室工作制······································································90

七、理疗科工作制度········································································91

八、针灸室工作制度········································································91 财务与物价工作制度·····································································92

一、财务部门工作制度······································································92

二、经费审批及报销制度····································································92

三、医疗收费制度··········································································93

四、财产物资管理制度······································································93

五、票据管理制度··········································································94

六、固定资产管理制度······································································94

七、门诊收费处工作制度····································································94

八、住院处收费工作制度····································································95

九、住院患者退费管理制度··································································95

十、财务会计档案管理制度··································································95

十一、仪器设备、耗材妥购制度·······························································96

十二、物价工作管理制度····································································96

十三、医疗服务价格公示制度································································97

十四、医疗服务项目的病例记录和费用核查制度················································97

十五、住院患者“每日情”制度································································97

十六、绩效工资分配管理制度································································97

十七、内部审计工作制度····································································98

下 篇

太原市类风湿病医院人员岗位职责

管理工作人员职责······································································100

一、院长职责············································································100

二、行政副院长职责······································································100

三、办公室主任职责······································································100

四、医务科/处主任职责····································································101

五、医用图书管理员职责··································································101

六、病案管理员职责······································································101

七、医疗统计人员职责····································································102

八、人事（或人力资源管理）科科长职责······················································102

九、总务科科长职责······································································102

十、医学装备管理部门主任职责····························································103

十一、信息管理部门负责人职责··························································103

十一、医疗保险管理部门负责人职责·························································103 医疗工作人员职责······································································104

一、临床科主任职责·······································································104

二、临床主任医师职责·····································································105

三、临床主治医师职责·····································································105

四、总住院医师职责·······································································105

五、临床住院医师职责·····································································106

六、门诊部主任职责·······································································106

七、麻醉科主任职责·······································································107

八、麻醉科主任医师职责···································································107

九、麻醉科主治医师职责···································································107

十、麻醉科医师职责·······································································107 护理部工作人员职责····································································108

一、护理部主任职责·······································································108

二、护理部副主任职责·····································································108

三、护士长职责···········································································109

四、主任（副主任）护师职责·································································109

五、主管护师职责·········································································110

六、护师职责·············································································110

七、护士职责·············································································110

八、护理员职责···········································································111

九、门诊护士长职责·······································································111 十、门诊护士职责········································································111

十一、手术室护士长职责···································································112

十二、手术室护士职责·····································································112

十三、消毒供应中心（室）护士长职责·························································112

十四、消毒供应中心（室）护士职责···························································113 药学工作人员职责······································································113

一、药剂科主任职责······································································113

二、药剂科各室、组负责人职责·····························································114

三、主任(中、西)药师职责··································································114

四、主管（中、西）药师职责·································································114

五、药剂师（中药师）职责··································································114

六、药剂士（中药药剂士）职责······························································115

七、临床药师职责 ·······································································115

八、调剂人员职责········································································115

九、制剂人员职责········································································116

十、药品采购人员职责····································································116

十一、药品验收保管人员职责····························································116

十二、药学信息咨询服务人员职责························································116 医技工作人员职责······································································117

一、医学影像/放射科主任职责······························································117

二、医学影像/放射科主任医师职责··························································117

三、医学影像/放射科主治医师职责··························································117

四、医学影像/放射科医师职责······························································118

五、医学影像/放射科技师职责······························································118

六、医学影像/放射科技士、技术员职责·······················································118

七、物理治疗科主任职责··································································118

八、理疗科主治医师职责··································································119

九、理疗科医师职责······································································119

十、理疗科技师、技士、见习员职责··························································119

十一、医院感染管理部门主任/负责人职责··················································119

十二、检验科主任职责··································································120

十三、主任（副主任）检验师职责··························································121

十四、主管检验师职责··································································122

十五、检验师职责······································································122

十六、检验士职责······································································122

十七、临床检验医师职责································································123

十八、检验科质量主管职责······························································123

十九、检验科技术主管职责······························································123 财务工作人员职责······································································124

一、财务部门负责人职责··································································124

二、财务部门会计职责····································································125

三、财务部门出纳职责····································································125

四、财务部门成本及奖金核算人员职责······················································125

五、住院处、门急诊收费处收费员职责·······················································126

六、住院、门急诊收费处审核人员职责·······················································126

医院二甲复审工作计划 篇5

1．在科主任领导下，负责指导并参与急诊抢救、教学和科研工作，严格执行各项医疗制度。

2．每周查房1-2次，并亲自参加指导急症危重症病人的诊断、治疗与抢救，解决本科复杂、疑难技术问题和死亡病例讨论和会诊。3．指导下级医师做好各项医疗工作，提高专业理论、技术操作和解决较复杂疑难技术问题的能力。

4．承担临床教学工作及进修、实习医师的培训工作。5．定期参加专家门诊。

6．掌握国内外先进诊疗技术，开展科学研究，中西医结合，及时总结经验，撰写学术论文。

7．督促下级医师认真贯彻执行各项规章制度和医疗操作规范。8．严格执行传染病报告和管理制度。

副主任医师参照主任医师执行，参加急诊值班工作.急诊科主治医师岗位职责

1．在科主任领导下，具体负责本科的急诊诊疗工作以及复杂、危重病人的抢救工作。急诊组长由主治医师以上人员担任。

2．有留观病人的科室，主治医师每日上午查房一次，下班前巡视一次，并向值班医师交待注意事项。

3．每月底召集下月急诊医师会议，总结本月工作，提出要求，对新到急诊科的医师要加强指导和帮助。

4．坚守工作岗位，因事离开需向值班医师和护士告知去向，并保证抢救病人时5分钟内到位。

5．在班期间，主持危重病人抢救、会诊，指导下级医师工作。6．遇有危重疑难病人，需及时向科主任请示汇报，凡涉及法律纠纷的病人，在积极救治的同时，及时向院总值班或有关部门汇报。7．积极预防医疗事故和严重差错，一旦发生问题应积极处理，并立即报告科主任及医务处。

8．经常检查本科室抢救器材（每周至少一次），如有损坏及时提出修理、补充或更新。

急诊科住院医师岗位职责

1．参加急诊工作的医师应具备以下条件：责任心强,具备三年以上临床工作经验，能独立处理本科常见病、多发病，并经本科主任审查合格者。

2．在科主任及上级医师的领导下，负责本科急诊病人的诊疗工作，实施对危重病人的抢救；对本科留观病人的观察处置；负责科间急诊会诊。

3．严格执行首诊负责制，认真执行规章制度和操作常规，严防医疗事故和差错发生。

4．遇有急诊危重病人抢救，应立即抢救急诊危重患者，待病情稳定后收住院，住院时应有专人护送，做好急诊医疗文件的书写工作。5．遇疑难重症或处理困难的病人时，应及时请上级医师共同诊治或请会诊，在上级医师到来之前，要给予必要的处置和抢救，不得借故推诿，延误救治。

6．认真交接班，对危重病人应实行床边交接班制度，并有书面记录。7．认真听取病人或家属的陈述，病史询问应掌握重点，病史记录应包括主诉、简要病史、重要体征（危重病人生命体征）、基本检查、初步诊治意见。各项医疗文书书写规范，诊断、签名清晰，病情变化应及时处理，各项处理均应记录。

8．坚守工作岗位，值班期间不得擅离职守，按照科室安排，参加值班、急诊、出诊等医疗工作，不迟到，不早退，不脱岗，不吸烟，不得随意换班。

9．热情认真地做好病情解释和医患沟通工作（包括目前病情、并发症和预后情况），必要时履行告知手续。10．检查、用药，合理、规范。

11.遇重大抢救和灾难性事件应及时向上级主管部门汇报。12.掌握本科常见病的诊断与处理及掌握本科有关的检查操作、治疗技术，熟悉本科理论和基础医学知识。

医院二甲复审工作计划 篇6

关键词：儿科患者,发病率,分析

我院为珠三角镇级二级甲等医院, 医疗预防辐射人口有一百万左右。为了解儿科住院患者的发病情况, 对我院儿科2006年1月~2008年12月收治的16 064例患者进行统计分析, 显示出其特点, 以期为儿科疾病的防治提供参考。

1 资料与方法

1.1 一般资料

我院儿科2006年1月~2008年12月收治的16 064例住院患者。

1.2 儿科疾病名称及分类

疾病名称及分类以国际疾病分类 (ICD-10) 编码为标准。

1.3 统计学分析

用Excel输入数据进行分类汇总, 1例患儿同时患数种疾病时均按出院第一诊断进行统计。

2 结果

2.1 性别分布

见表1。

2.2 季节分布

见表2。

2.3 各年龄组患病情况及主要疾病构成

2.3.1 各年龄组患病情况, 见表3。

2.3.2 各年龄组主要疾病构成, 见表4。

2.4 各系统疾病病发病情况及主要疾病构成

2.4.1 各系统疾病发病情况, 见表5。

2.4.2 16 064例患儿各系统主要疾病构成, 见表6。

*其他:中毒、营养性疾病、内分泌、结缔组织疾病、意外伤害、先天性疾病等

2.5 前5位疾病的发病情况

见表7。

2.6 各年龄阶段的病死率

见表8。

3 讨论

儿童疾病分类构成变化的研究可以了解儿科病种变迁, 为临床治疗提供指导和合理配置医疗资源提供依据。由于各地区不同因素的差异, 儿童疾病构成的情况也有区别。

本次统计显示, 3年来住院患儿中, 男性发病均高于女性, 男∶女为1.79~1.95∶1。夏秋季发病患者数高于冬春季, 这可能与珠三角地区气候炎热、高温时间长、经济发达、空调使用率高、易受凉生病有关。

从表3可以看出, 婴幼儿是住院的高峰年龄段。这是由于婴幼儿时期生长发育迅速, 来自母体的抗体逐渐减少, 而各器官系统发育还不够成熟, 特别是自身免疫功能不成熟, 抗感染能力较弱, 容易发生各种感染性疾病。

从表4可以看出, 新生儿时期主要疾病是新生儿高胆红素血症和新生儿肺炎。婴幼儿时期主要是呼吸系统感染和小儿腹泻病。学龄前和学龄期儿童主要是呼吸系统感染和传染病。本地区人口构成主要为外来务工人员, 居住环境及卫生条件较差, 文化程度偏低, 产前、围生期保健和疾病的自我保健意识薄弱, 致各种感染性和传染性疾病的发病率较高。

从表5、6、7可以看出, 呼吸系统疾病占第1位 (48.82%) , 主要为支气管炎、上呼吸道感染和肺炎。婴幼儿呼吸系统疾病7 121例 (7 121/7 842) , 占了呼吸系统疾病的90.81%, 这与婴幼儿气管、支气管管腔狭窄, 黏液分泌少, 纤毛运动差, 肺弹力组织发育差, 血管丰富, 易于充血, 间质发育旺盛, 肺泡数少, 肺含气量少, 易为黏液所阻塞, 以及此年龄段免疫学上的弱点等有关。第2位是消化系统疾病 (23.65%) , 主要为小儿腹泻病, 主要发生在婴幼儿, 这与婴幼儿生长发育迅速, 代谢旺盛, 所需的营养物质和液体总量相对比成人高, 但婴幼儿脏腑娇嫩, 消化能力低下, 极易出现消化系统疾病有关。第3位是新生儿疾病 (19.65%) , 主要是高胆红素血症和肺炎, 说明本地区为新生儿高胆红素血症高发区。虽然患者量总体呈上升趋势, 但表7中的5种疾病发病患者数约占儿科住院患者的90%, 并且3年来没有明显变化, 说明这仍然是今后治疗和预防工作的重点。

从表8可以看出, 1岁以内的患儿是儿童住院的死亡高峰年龄段。儿童年病死率为0.12%~0.23%。我院儿科病死率低与基层医院一些危重患儿放弃治疗或转上级医院有关。

综上所述, 本次统计分析提示: (1) 住院患儿男多于女, 夏秋季发病率高于冬春季, 重点要加强婴幼儿及围生儿的管理, 对孩子的父母进行健康教育, 改善居住环境, 改变不良卫生习惯, 提高家长早期识别疾病的能力, 增强家庭保健意识, 使疾病能够早期发现、早期就诊, 并且要按时预防接种, 除计划免疫中的基础免疫和加强免疫外, 还应根据本地区流动人口量大、务工人员多的情况, 扩大免疫计划及免疫实施监管;按儿童急性呼吸道感染及小儿腹泻病防治规划来进行病例管理, 把降低支气管炎、上呼吸道感染、肺炎、小儿腹泻病、新生儿疾病的发病率作为临床工作的重点; (2) 住院患儿的病种主要集中在常见病、多发病上, 今后要拓宽服务范围, 提高疑难及少见病的诊疗水平, 使珠三角镇级二甲医院对于儿科疾病的诊疗水平向更深层次发展。

参考文献

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