醫(yī)療質(zhì)量管理實施方案、考核體系及管理流程

醫(yī)療質(zhì)量管理實施方案、考核體系及管理流程醫(yī)療質(zhì)量管理控制方案、考核體系及管理流程醫(yī)療質(zhì)量是醫(yī)院發(fā)展之本，優(yōu)質(zhì)的醫(yī)療質(zhì)量必然產(chǎn)生良好的社會效益和經(jīng)濟效益。為提升我院的醫(yī)療質(zhì)量和確保醫(yī)療安全，特此制定全程醫(yī)療質(zhì)量控制方案，以求正確有效地實施標準化醫(yī)療質(zhì)量管理。一、指導思想（一）、實行全面質(zhì)量管理和全程質(zhì)量控制。建立從患者就醫(yī)到離院，包括門診醫(yī)療、病房醫(yī)療和部分院外醫(yī)療活動的全程質(zhì)量控制流程和全程質(zhì)量管理體系。明確管控內(nèi)容并將其納入醫(yī)療管理部門的日常工作，實施動態(tài)監(jiān)控并與科室目標責任制結合，保證質(zhì)控措施的落實。（二）、以規(guī)章制度和醫(yī)療常規(guī)為依據(jù)，并不斷修（三）、強化十三項醫(yī)療核心制度，如三級醫(yī)師負責制度、會診制度和病例討論制度等，將醫(yī)務人員個人醫(yī)療行為最大限度地引導到正確的診療方案中。（四）、質(zhì)量控制部門有計劃、有針對性地進行干預，對多因素影響或多項診療活動協(xié)同作用的質(zhì)量問題，進行專門調(diào)研，并制定全面的干預措施。二、管理體系全程醫(yī)療質(zhì)量控制系統(tǒng)的人員組成可分為醫(yī)院醫(yī)療質(zhì)量管理委員會、科室醫(yī)療質(zhì)量控制小組和各級醫(yī)務人員自我管理三級管理體系。（一）、醫(yī)院醫(yī)療質(zhì)量管理委員會醫(yī)院醫(yī)療質(zhì)量管理委員會由院領導、醫(yī)療護理部負責人和科主任組成，業(yè)務院長任組長，院長是醫(yī)療質(zhì)量管理工作的第一責任者。醫(yī)療護理部作為醫(yī)療質(zhì)量控制常設的辦事機構。其職責分述如下:1、醫(yī)療質(zhì)量管理委員會職責、教育各級醫(yī)務人員樹立全心全意為患者服務的思想，改進醫(yī)療作風，改善服務態(tài)度，增強質(zhì)量意識。保證醫(yī)療安全，嚴防差錯事故。審核醫(yī)院內(nèi)醫(yī)療、護理方面的規(guī)章制度，并制定各項質(zhì)量評審要求和獎懲制度。(3)、掌握各科室診斷、治療、護理等醫(yī)療質(zhì)量情況(及時制定措施，不斷提高醫(yī)療護理質(zhì)量。、對重大醫(yī)療、護理質(zhì)量問題進行鑒定，對醫(yī)療護理質(zhì)量中存在的問題，提出整改要求。、定期向全院通報重大醫(yī)療、護理質(zhì)量情況和處理決定。、對院內(nèi)有關醫(yī)療管理的體制變動，質(zhì)量標準的修定進行討論，提出建議，提交院長辦公會義審議。2、醫(yī)療護理部職責、醫(yī)療護理部接受主管院長和醫(yī)療質(zhì)量管理委員會的領導，對醫(yī)院全程醫(yī)療質(zhì)量進行監(jiān)控。、定期組織會議收集科室主任和質(zhì)控小組反映的醫(yī)療質(zhì)量問題，協(xié)調(diào)各科室質(zhì)量控制過程中存在的問題和矛盾。、抽查各科室住院環(huán)節(jié)質(zhì)量，提出干預措施并向主管院長或醫(yī)院醫(yī)療質(zhì)量管理委員會匯報。收集門診和病案質(zhì)控組反饋的各科室終未醫(yī)療質(zhì)量統(tǒng)計結果，分析、確認后，通報相應科室人員并提出整改意見。、每月向醫(yī)院提出全程醫(yī)療質(zhì)量量化考核結果，以便與績效工資掛鉤。、定期編輯醫(yī)療質(zhì)量簡報和不良醫(yī)療文件公示欄。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds一、指導思想（一）、實行全面質(zhì)量管理和全程質(zhì)量控制。建立從患者就醫(yī)到離院，包括門診醫(yī)療、病房醫(yī)療和部分院外醫(yī)療活動的全程質(zhì)量控制流程和全程質(zhì)量管理體系。明確管控內(nèi)容并將其納入醫(yī)療管理部門的日常工作，實施動態(tài)監(jiān)控并與科室目標責任制結合，保證質(zhì)控措施的落實。（二）、以規(guī)章制度和醫(yī)療常規(guī)為依據(jù)，并不斷修（三）、強化十三項醫(yī)療核心制度，如三級醫(yī)師負責制度、會診制度和病例討論制度等，將醫(yī)務人員個人醫(yī)療行為最大限度地引導到正確的診療方案中。（四）、質(zhì)量控制部門有計劃、有針對性地進行干預，對多因素影響或多項診療活動協(xié)同作用的質(zhì)量問題，進行專門調(diào)研，并制定全面的干預措施。二、管理體系全程醫(yī)療質(zhì)量控制系統(tǒng)的人員組成可分為醫(yī)院醫(yī)療質(zhì)量管理委員會、科室醫(yī)療質(zhì)量控制小組和各級醫(yī)務人員自我管理三級管理體系。（一）、醫(yī)院醫(yī)療質(zhì)量管理委員會醫(yī)院醫(yī)療質(zhì)量管理委員會由院領導、醫(yī)療護理部負責人和科主任組成，業(yè)務院長任組長，院長是醫(yī)療質(zhì)量管理工作的第一責任者。醫(yī)療護理部作為醫(yī)療質(zhì)量控制常設的辦事機構。其職責分述如下:1、醫(yī)療質(zhì)量管理委員會職責（1）、教育各級醫(yī)務人員樹立全心全意為患者服務的思想，改進醫(yī)療作風，改善服務態(tài)度，增強質(zhì)量意識。保證醫(yī)療安全，嚴防差錯事故。（2）審核醫(yī)院內(nèi)醫(yī)療、護理方面的規(guī)章制度，并制定各項質(zhì)量評審要求和獎懲制度。（3）、掌握各科室診斷、治療、護理等醫(yī)療質(zhì)量情況（及時制定措施，不斷提高醫(yī)療護理質(zhì)量。（4）、對重大醫(yī)療、護理質(zhì)量問題進行鑒定，對醫(yī)療護理質(zhì)量中存在的問題，提出整改要求。、定期向全院通報重大醫(yī)療、護理質(zhì)量情況和處理決定。、對院內(nèi)有關醫(yī)療管理的體制變動，質(zhì)量標準的修定進行討論，提出建議，提交院長辦公會義審議。2、醫(yī)療護理部職責、醫(yī)療護理部接受主管院長和醫(yī)療質(zhì)量管理委員會的領導，對醫(yī)院全程醫(yī)療質(zhì)量進行監(jiān)控。、定期組織會議收集科室主任和質(zhì)控小組反映的醫(yī)療質(zhì)量問題，協(xié)調(diào)各科室質(zhì)量控制過程中存在的問題和矛盾。、抽查各科室住院環(huán)節(jié)質(zhì)量，提出干預措施并向主管院長或醫(yī)院醫(yī)療質(zhì)量管理委員會匯報。收集門診和病案質(zhì)控組反饋的各科室終未醫(yī)療質(zhì)量統(tǒng)計結果，分析、確認后，通報相應科室人員并提出整改意見。、每月向醫(yī)院提出全程醫(yī)療質(zhì)量量化考核結果，以便與績效工資掛鉤。、定期編輯醫(yī)療質(zhì)量簡報和不良醫(yī)療文件公示欄。(二)、科室醫(yī)療質(zhì)量控制小組職責科室是醫(yī)療質(zhì)量管理體系的重要組成部分，科主任是科室醫(yī)療質(zhì)量的第一責任者?？剖屹|(zhì)控小組職責如下:(1)、各科室醫(yī)療質(zhì)量控制小組由科主任、護士長和科室質(zhì)控人員組成。(2)、結合本專業(yè)特點及發(fā)展趨勢，制定及修訂本科室疾病診療常規(guī)、藥物使用規(guī)范并組織實施，責任落實到個人，與績效工資掛鉤。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(3)、定期組織各級人員學習醫(yī)療、護理常規(guī)，強化質(zhì)量意識。參加醫(yī)療質(zhì)控辦公室的會議，反映問題。收集與本科室有關的問題，提出整改措施。(三)、醫(yī)務人員自我管理在醫(yī)療活動過程中，醫(yī)務人員的個人行為具有較大的獨立性，其個人素質(zhì)、醫(yī)療技術水平對醫(yī)療質(zhì)量影響較大，是質(zhì)量不穩(wěn)定的主要因素，是質(zhì)量控制的基本點。在質(zhì)控過程中，特別要強調(diào)三級醫(yī)師負責制度、會診制度和病例討論等把關制度，確保醫(yī)療質(zhì)量控制的正確實施。對各級醫(yī)務人員的要求分述如下:1(門診醫(yī)師(1)嚴格執(zhí)行首診醫(yī)師負責制。(2)詢問病史詳細、物理檢查認真，要有初步診斷。門診病歷書寫完整、規(guī)范、準確。合理檢查，申請單書寫規(guī)范。具體用藥在病歷中記載。藥物用法、用量、療程和配伍合理。處方書寫合格。第二次就診診斷未明確者，接診醫(yī)師應:a.建議?？凭驮\;b.請上級醫(yī)師診視;c?收住院。第三次就診診斷仍未明確者，接診醫(yī)師應:a?請科主任會診b.收住院;c.患者拒絕住院需履行簽字手續(xù)。按?？剖罩尾∪恕?(病房住院醫(yī)師病人入院30分鐘內(nèi)進行檢查并作出初步處理。急、危、重病人應即刻處理并向上級醫(yī)師報告。按規(guī)定時間完成病歷書寫(普通病人24小時、危重病人6小時內(nèi)完成;首次病程記錄應當在患者入院后8小時內(nèi)完成，急診病人術前完成)。病歷書寫完整、規(guī)范，不得缺項。24小時內(nèi)完成血、尿、便化驗，并根據(jù)病情盡快完成肝、腎功能、胸透和其它所需的?？茩z查。未完成的病程錄中注明原因。按專科診療常規(guī)制定初步診療方案。對所管病人，每天至少上、下午各巡診一次。按規(guī)定時間及要求完成病程記錄(會診、術前討論、術前小結、轉出和轉入、特殊治療、病人家屬談話和簽字、出院記錄和死亡討論等一切醫(yī)療活動均應有詳細的記錄)。(9)對所管病人的病情變化應及時向上級醫(yī)師匯報。(10)診療過程應遵守消毒隔離規(guī)定，嚴格無菌操作，防止醫(yī)院感染病例發(fā)生。若有醫(yī)院感染病例，及時填表報告。病人出院時須經(jīng)上級醫(yī)師批準，全愈者主治醫(yī)師審簽，好轉、未愈者需科主任批準，應注明出院醫(yī)囑并交代注意事項。3(病房主治醫(yī)師(1)及時對下級醫(yī)師開出的醫(yī)囑進行審核，對下級醫(yī)師的操作進行必要的指導。(2)新入院的普通病人要在48小時內(nèi)進行首次查房。除對病史和查體的補充外，查房內(nèi)容要求有:?診斷及診斷依據(jù);?必要的鑒別診斷;?治療原則;?診治中的注意事項。(3)新入院的急、危、重病人隨時檢查、處理，并向上級醫(yī)師匯報病情。(4)及時檢查、修改下級醫(yī)師書寫的病歷，把好出院病歷質(zhì)量關，并在病歷首頁簽名。(5)入院3天未能確診或有跨專業(yè)病種的病例時應及時舉行科內(nèi)或科間會診。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(6)待診病人在入院1周內(nèi)仍診斷不明時，向主任請示病例討論或院內(nèi)會診。根據(jù)抗菌素的合理使用原則正確分級使用抗生素和?？朴盟?。手術和介入治療前親自檢查病人，做好術前準備，按手術分級管理標準擬訂嚴密的手術方案并實施。術后即刻完成術后記錄，24小時完成手術記錄。術后嚴密觀察患者病情變化，并做好術后工作。負責治愈患者出院的審批手續(xù)，并向上級醫(yī)師匯報。4(病房主任(副主任)醫(yī)師組織或參與制定本科質(zhì)量管理方案、各項規(guī)章制度、診療和操作常規(guī)。(2)指導下級醫(yī)師做好醫(yī)療工作，督促檢查下級醫(yī)師執(zhí)行各項制度和診療常規(guī)。(3)對新入院的普通病人要求72小時內(nèi)進行首次查房;危重病人至少每日查房1次;病人病情變化應隨時查房;每周組織全科查房1次。(4)查房內(nèi)容除對病史和查體的補充外，普通病人應有:?診斷及其診斷依據(jù);?鑒別診斷;?治療原則;?有關方面的新進展。未確診病人應有:?鑒別診斷;?明確的診斷思路和方法;?擬定相應的治療措施。危重病人應有:?當前的主要問題;?解決主要問題的方法。疑難病例及入院1周未確診病例，組織科內(nèi)討論或院內(nèi)會診，必要時向醫(yī)務處申請院外會診。指導和監(jiān)督下級醫(yī)師正確分級使用抗生素和專科用藥。組織術前和重要治療前病例討論，指導下級醫(yī)師做好術中、術后醫(yī)療工作。重大手術和重要治療要親自參加。審批未愈患者出院，并指導病人出院后的繼續(xù)治療。審簽主治醫(yī)師審查的轉科、出院病歷。5(醫(yī)患溝通各級醫(yī)師在診療過程中要增強自律和維權意識，重視患者知情同意權、知情選擇權，在醫(yī)療服務過程中落實談話、簽字、記錄、報告、實物保存等有關工作制度。三、考核內(nèi)容全程醫(yī)療質(zhì)量控制包括門診醫(yī)療、病房醫(yī)療、院外部分醫(yī)療活動等多個組成部分。其考核內(nèi)容按過程分為:(一)門診醫(yī)療1、掛號、分診咨詢處、掛號室:按照專業(yè)病種及病情輕重緩急指導患者掛號。分診護士:?對一般病人應測量血壓，發(fā)熱患者應測量體溫。?加強巡視，視病情輕重，決定病人是否需要提前就診。?根據(jù)病人主訴指導分診，發(fā)現(xiàn)傳染病患者要及時隔離，并指導就診。?復查再分診，保證患者?？茖Ｖ?。2、首診醫(yī)師:、首診醫(yī)師負責制:a、詢問病史詳細，物理檢查認真，擬定初步診斷，做出恰當處理，同時按病歷要求書寫門診、急診病歷。b(建議專科門診就診。c(收住院。(2)、第二次就診仍未明確診斷或治療無效者:?原接診醫(yī)師應:a?應提請上級醫(yī)師會診，b.建議?？凭驮\;c.收住院。？新接診醫(yī)師應:a收住院;b門診治療。(3)、第三次就診:仍未能確診，接診醫(yī)師應:a.請科主任會診b.收住院，患者拒絕住院應履行簽字手續(xù)。inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds(二)、病房醫(yī)療:l、24小時內(nèi)、病人入院30分鐘內(nèi)應給予初步處理。、由經(jīng)治醫(yī)師做出初步診療意見并完成病歷書寫。、必要時由主治醫(yī)師提出并請示上級醫(yī)師組織科內(nèi)討論、科間或院內(nèi)會診。(4)、急、危、重病人隨時請上級醫(yī)師查看并于6小時內(nèi)完成病歷書寫。2、入院三天內(nèi)(1)、確診者按診療常規(guī)進行。、未確診者，做進一步檢查，必要時組織科內(nèi)討論、科間會診。3、入院后1周未確診者，必須進行科內(nèi)病例討論或院內(nèi)會診，可請市一院專家會診，確診者按診療計劃實施，2周內(nèi)仍未能確診者須進行院外會診。(特殊專業(yè)按診療常規(guī)執(zhí)行)。4、治療措施(1)藥物治療?藥物選擇:a制定?？朴盟幰?guī)范并嚴格執(zhí)行;b.加強抗生素的合理使用;?用藥后注意觀察療效;?根據(jù)病情、療效及時更改、調(diào)整用藥方案。?注意觀察藥物的不良作用，注意藥物間的相互作用，注意藥物對其它臟器及其它疾病的影響。(2)、手術治療?.術前按診療常規(guī)做好術前準備，按手術分級審批;?.按手術常規(guī)操作;?按診療常規(guī)做好術后處理。、特殊診療按各專業(yè)診療常規(guī)執(zhí)行。5、轉歸:、治愈——出院，?？崎T診隨訪。、好轉——?？崎T診隨訪。、未愈——患者要求出院或轉院需履行簽字手續(xù)。、死亡——24小時內(nèi)完成死亡記錄，l周內(nèi)完成死亡病例討論并及時上交病案。(三)出院1、治愈者由主治醫(yī)師審批出院。2、好轉者由主任或副主任醫(yī)師向患者交待?？崎T診繼續(xù)治療或返院治療的注意事項，并批準方可出院。3、未愈者由科主任（或正、副主任醫(yī)師）向病人做繼續(xù)治療指導并批準方可出院。4、管床醫(yī)師必須在患者出院時出具“出院小結”。（四）病案歸檔凡出院病歷應于患者出院后5個工作日完成，未完成者有病案室統(tǒng)計，上報醫(yī)務科。注:1、根據(jù)病情，不受時間限制及時組織各種形式的會診，如院外會診等。2、重危病人應床邊交接班，每天有交接班記錄。3、報告方式:對病危病人須將病危通知單送交醫(yī)務處;對特殊、緊急搶救病人須電話報告院部;對死亡及入院兩周未確診病例應書面上報醫(yī)務處。四、考核方法和獎懲制度1、門診醫(yī)療質(zhì)量由各門診部負責考核、統(tǒng)計;基礎質(zhì)量由醫(yī)務處、護理部職能處室負責考評。住院醫(yī)療環(huán)節(jié)質(zhì)量由質(zhì)控小組對正在診療過程中的“活病歷”隨機抽查，按考核表內(nèi)容逐點考核，一般每個月對每個醫(yī)療組考核1-2次;終未質(zhì)量主要由科室質(zhì)控人員、病案室負責考評。2（分析各項診療活動對整體醫(yī)療質(zhì)量的影響程度，對各質(zhì)控點控制措施的落實情況，按合格（?）、輕度缺陷（1）、中度缺陷（2）、重度缺陷（X）分為四個級別進行定性標化，并在質(zhì)控考核表扣除相應分值。具體評分要求如下:inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweeds病房醫(yī)療質(zhì)量監(jiān)控量化考核的滿分為80分，如檢查的各項所得總分大于64分為合格。各質(zhì)控點（考核中每單項）檢查實得分數(shù)占應得分數(shù)的百分數(shù)?80,者為合格，70,,79,為輕度缺陷，60,,69,為中度缺陷，＜60,為重度缺陷。3、質(zhì)控小組每月對各質(zhì)控點缺陷發(fā)生情況統(tǒng)計分析一次，與科室考核分值與科室績效工資掛鉤。4、重大醫(yī)療質(zhì)量問題按醫(yī)院有關規(guī)定視情節(jié)給予罰款，取消先進科室評審資格和對責任人進行行政處罰等處理。無門診病歷、不合格處方（低于考核分值5分）和未在規(guī)定時間完成住院病歷的按醫(yī)院規(guī)定處罰到責任人?？剖覚z查日期經(jīng)管醫(yī)師扣分情況考核內(nèi)容及標準分值扣分標準住院號缺陷程度門診醫(yī)療部分20分門診病歷首診病歷書寫完整規(guī)范準確。主訴精煉,現(xiàn)病史與主訴相符,既往史、與診斷及鑒別診斷相關的重要陽性體征不得遺漏。5主訴、現(xiàn)病史、既往史、重要陽性體征每遺漏一項扣1分，書寫不規(guī)范每處扣0.2診斷2缺診斷扣0.5分有關常規(guī)檢查是否進行、申請單書寫是否規(guī)范。1一項不合要求扣0.5分具體藥物在病歷中記載1無記載扣1分醫(yī)師簽名1無醫(yī)師簽名或不規(guī)范扣1分首診醫(yī)師首診醫(yī)師負責制2不合要求扣2分第二次就診診斷未明確者應a.建議?？凭驮\b.請上級醫(yī)師會診c.收住院1不合要求扣1分第三次就診診斷仍未明確者，接診醫(yī)師應a.請科主任會診b.收住院c.患者拒絕住院需履行簽字手續(xù)1不合要求扣1分按?？剖罩尾∪?不合要求扣1分門診醫(yī)療部分20分處方前記（一般項目填寫齊全）1項目缺項者扣除1分正文處方書寫正確，格式以每藥“兩行全量書寫法”為準1未符合要求者扣1分后記（醫(yī)師簽名、藥品金額以及審核、調(diào)配、核對、發(fā)藥的藥學人員簽名1醫(yī)師未簽全名或無調(diào)劑、復核雙人簽名的扣1分藥物用法、用量、療程及配伍應用合理1不合要求扣1分西藥、中成藥、中藥飲片分別開具1未按規(guī)定執(zhí)行扣1分病房醫(yī)療部分80分inbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast45timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenupto1.5timestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandmanagement.Thefundamentalmethodsofweedpreventionandremovalistherationalmanagementofwaterandfertilizer,grassgrowthpromotionpurposes,increasecompetitivenesswithweeds,andmultipletrim,suppressweedsinbuildinglawn,lawnbuiltingrowingseasonrequiredafterapplyingfertilizer.Coldseasongrassdressingtimeisbestinearlyspringandfall.Afterthefirstgreen,canplayaroleinfacilitatingthegrowthofsecondinspring,aftertheweatherturnedhot,youshouldstopdressing.Fertilizationinautumnon9,October.Appliesfertilizerthetimeislatespringofwarm-seasongrasses.Inamonthor2monthsofgrowingseasontobecaughtupwithfertilizer.Increasingthedensityoffoliage,improveresistancetosteppingon.Fertilizingshouldnotbelateforthelasttimeinmid-September.3,trimmingthelawnisthefocus,andisthemostintensivework.Trimcontrollawnheightofthetillers,increasingthedensityofleaves,weedsandlawnneatandbeauty.Generallawntrimmedatleast4-5timesayear,pruneandtrimthenumberofheightisrelatedtotwofactors.Lowerthecuttingheightrequirements,pruningmoretimes.Leavesofgrassdensityandcoveragealsoincreaseswiththenumberoftrimandmore.Itshouldbenotedthatinaccordancewithregularmowingthegrasscuttingheight,whenuptotimestheheightofthegrass,trimtwicetimesthemaximumshallnotexceedthespecifiedheight.4,weedweedinvasionwillseriouslyaffectthequalityofthelawn,turflostuniformandneatappearanceandpurposeweedandgrasscompetitionforwater,fertilizer,racetheSun,sothatobjectivegrassgrowthdecline,soweedisanessentialpartoflawnmaintenanceandma