目的 评价根本原因分析法(root cause analysis,RCA)在护理不良事件持续改进中的成效与作用,减少护理不良事件的发生,提高护理安全.方法 成立根本原因分析小组,运用根本原因分析法分析2015年1—12月医院发生的护理不良事件根本原因,并对根本原因提出整改措施,落实改进措施.结果 改进措施落实后,护理不良事件总体发生率由2015年的0.27‰降低至2016年的0.12‰,护理安全隐患上报率由2015年的3.6‰提升至2016年的4.5‰,差异具有统计学意义(P<0.05).结论 根本原因分析法可以降低护理不良事件发生率,确保患者安全.%Objective To evaluate the effects and functions of root cause analysis(RCA) in the continu-ous reduction of nursing adverse events and to improve the safety of nursing care.Methods The root analysis team was established and the root causes of adverse events in a hospital from January to December in 2015 were ana-lyzed. A number of rectification measures were proposed and applied accordingly. Results After the implementa-tion of the rectification measures,the incidence of nursing adverse events in the hospital declined from 0.27‰ in 2015 to 0.12‰ in 2016,and the reporting rate of nursing safety hazard increased from 3.6‰in 2015 to 4.5‰in 2016 (P<0.05). Conclusion Root cause analysis can help reduce the incidence of nursing adverse events and ensure the safety of patients.
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