Application of nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards_West China Medical Journal

Authors：

WANG Yang ,  SUN Bei , LI Mengqi , SUN Yingming

1. Department of Day Care Ward, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P. R. China;

Corresponding?author：

SUN Bei, Email: sunpei@tjmuch.com

Keywords：

Swiss cheese model; daytime ward; chemotherapy; medication safety; management

DOI：

10.7507/1002-0179.202309203

Video：

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Objective To explore the application effect of a nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards. Methods The study included chemotherapy patients in the Department of Day Care Ward of Tianjin Medical University Cancer Institute & Hospital between February and March 2023 (before improvement) and between June and July 2023 (after improvement). Before the improvement, a conventional nursing management mode was adopted, and after the improvement, a nursing management mode based on the Swiss cheese model was adopted. The medication safety ability of nurses, adverse drug events, and patients’ satisfaction of nursing before and after improvement were compared. Results Finally 150 patients were included before and after improvement, respectively. There was no statistically significant difference in age, gender, educational level, per capita monthly household income, tumor staging, and disease diagnosis between the two groups of patients (P>0.05). The total score of patients’ satisfaction of nursing after improvement was higher than before improvement (22.99±1.52 vs. 20.45±2.14, P<0.05), but there was no statistically significant difference in the dimensions of treatment environment and service attitude (P>0.05). There was no change in the nursing staff before and after the improvement, and a total of 34 nurses were included in the Department of Day Care Ward. The total score of the nurses’ medication safety ability was higher than before improvement [162.00 (160.75, 166.25) vs. 136.00 (135.00, 138.00), P<0.05], but there was no statistically significant difference in the dimensions of improving medication safety issues, multidisciplinary collaboration ability, and nursing professional responsibility (P>0.05). The incidences of adverse events during daytime chemotherapy after improvement were lower than before improvement (P<0.05). Conclusion The nursing management mode based on Swiss cheese model can improve the safety medication ability of nurses, reduce adverse events of chemotherapy medication in daytime wards, and improve patient satisfaction, which can be promoted in clinical practice.

Citation： WANG Yang, SUN Bei, LI Mengqi, SUN Yingming. Application of nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards. West China Medical Journal, 2024, 39(2): 229-233. doi: 10.7507/1002-0179.202309203 Copy

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2.	唐衛中. 腫瘤專科醫院日間病房的運行模式及管理實踐. 中國癌癥防治雜志, 2020, 12(4): 367-369.
3.	蔡澤君, 謝浩芬, 徐琴鴻, 等. 胃癌術后日間化療患者集束化延續護理措施制訂及應用. 中華現代護理雜志, 2020, 26(23): 3177-3182.
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5.	Dirik HF, Samur M, Seren Intepeler S, et al. Nurses’ identification and reporting of medication errors. J Clin Nurs, 2019, 28(5/6): 931-938.
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11.	王素萍, 游錦燕, 謝玉英, 等. 家屬協同健康教育在肺癌患者康復中的效果評價. 中國健康教育, 2022, 38(1): 89-92.
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13.	姚常房. 日間醫療: 尋找質效兼顧之路. 健康報, 2023-04-07(4).
14.	曾海燕, 張艷紅, 孫妙艷. 項目管理在降低淺靜脈留置針導管回血發生率中的應用. 廣州醫科大學學報, 2019, 47(4): 130-132.
15.	Collins SJ, Newhouse R, Porter J, et al. Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason’s Swiss cheese model. AORN J, 2014, 100(1): 65-79. e5.
16.	胡經文, 辛霞, 劉美麗, 等. 瑞士奶酪模型在輸液泵用藥不良事件管理中的應用. 護理學報, 2017, 24(5): 15-18.
17.	程杰, 于奚. 用藥環境對護士用藥不安全行為影響的路徑分析. 中華現代護理雜志, 2020, 26(5): 583-588.
18.	王丹, 莫陶欣, 李晨雄, 等. 日間化療質量與安全評價指標體系構建研究. 中國醫院管理, 2023, 43(3): 51-54.
19.	王莉莉, 王蓓, 韓玲, 等. 乳腺日間化療病房的運行模式與護理安全管理. 護理管理雜志, 2017, 17(11): 844-846.
20.	劉盼盼, 馮倩, 蔡盼, 等. 臨床護士用藥安全能力現狀及影響因素. 護理研究, 2023, 37(17): 3106-3110.
21.	田慧, 王曉彥. 瑞士奶酪模型在心內科安全用藥管理中的運用. 中醫藥管理雜志, 2021, 29(18): 120-122.
22.	王麗, 劉淑賢, 倪如暘, 等. 延伸護理干預在眼球摘除日間手術患者中的應用效果評價. 華西醫學, 2022, 37(9): 1347-1351.
23.	張紅, 陸宇晗, 于文華. 腫瘤專科醫院日間化療模式的探索與實踐. 中國護理管理, 2020, 20(1): 7-10.

1. 韓勝昔, 季皓, 潘常青, 等. 基于專科特色的日間病房建設與思考. 中國醫院管理, 2019, 39(3): 40-41.
2. 唐衛中. 腫瘤專科醫院日間病房的運行模式及管理實踐. 中國癌癥防治雜志, 2020, 12(4): 367-369.
3. 蔡澤君, 謝浩芬, 徐琴鴻, 等. 胃癌術后日間化療患者集束化延續護理措施制訂及應用. 中華現代護理雜志, 2020, 26(23): 3177-3182.
4. Schwappach DL, Wernli M. Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature. Eur J Cancer Care (Engl), 2010, 19(3): 285-292.
5. Dirik HF, Samur M, Seren Intepeler S, et al. Nurses’ identification and reporting of medication errors. J Clin Nurs, 2019, 28(5/6): 931-938.
6. 薄麗妹, 魏云海, 卞媛媛. 風險護理聯合持續質量改進在日間化療靜脈用藥安全管理中的應用. 中華全科醫學, 2021, 19(6): 1053-1056.
7. Reason J. Understanding adverse events: human factors. Qual Health Care, 1995, 4(2): 80-89.
8. 周子娟. 城市社區火災突發事件情景分析與風險防范研究. 北京: 北京交通大學, 2021.
9. 鄭曉紅, 張美莉, 王巧白. 三級質控網對新生兒重癥監護室護理管理質量的改善效果. 中國衛生標準管理, 2023, 14(15): 195-198.
10. 譚文麗, 朱遠平, 王娟. 基于群體需求的中小學教師分層分類分崗培訓. 教育科學論壇, 2020, 505(19): 58-63.
11. 王素萍, 游錦燕, 謝玉英, 等. 家屬協同健康教育在肺癌患者康復中的效果評價. 中國健康教育, 2022, 38(1): 89-92.
12. Yang Z, Chen F, Lu Y, et al. Psychometric evaluation of medication safety competence scale for clinical nurses. BMC Nurs, 2021, 20(1): 165.
13. 姚常房. 日間醫療: 尋找質效兼顧之路. 健康報, 2023-04-07(4).
14. 曾海燕, 張艷紅, 孫妙艷. 項目管理在降低淺靜脈留置針導管回血發生率中的應用. 廣州醫科大學學報, 2019, 47(4): 130-132.
15. Collins SJ, Newhouse R, Porter J, et al. Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason’s Swiss cheese model. AORN J, 2014, 100(1): 65-79. e5.
16. 胡經文, 辛霞, 劉美麗, 等. 瑞士奶酪模型在輸液泵用藥不良事件管理中的應用. 護理學報, 2017, 24(5): 15-18.
17. 程杰, 于奚. 用藥環境對護士用藥不安全行為影響的路徑分析. 中華現代護理雜志, 2020, 26(5): 583-588.
18. 王丹, 莫陶欣, 李晨雄, 等. 日間化療質量與安全評價指標體系構建研究. 中國醫院管理, 2023, 43(3): 51-54.
19. 王莉莉, 王蓓, 韓玲, 等. 乳腺日間化療病房的運行模式與護理安全管理. 護理管理雜志, 2017, 17(11): 844-846.
20. 劉盼盼, 馮倩, 蔡盼, 等. 臨床護士用藥安全能力現狀及影響因素. 護理研究, 2023, 37(17): 3106-3110.
21. 田慧, 王曉彥. 瑞士奶酪模型在心內科安全用藥管理中的運用. 中醫藥管理雜志, 2021, 29(18): 120-122.
22. 王麗, 劉淑賢, 倪如暘, 等. 延伸護理干預在眼球摘除日間手術患者中的應用效果評價. 華西醫學, 2022, 37(9): 1347-1351.
23. 張紅, 陸宇晗, 于文華. 腫瘤專科醫院日間化療模式的探索與實踐. 中國護理管理, 2020, 20(1): 7-10.

West China Medical Journal

Application of nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards

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