2015年,我科发生跌倒坠床6例,其中跌倒4例,坠床2例,发生不良事件后,科内及时分析原因并提出相应改进措施,现总结报告如下。1原因分析1.1护理人员因素护理人员缺乏责任心,违犯规章制度及技术操作规程,核心制度执行不到位,如对高危患者在交接班的过程中不认真,不详细。 In 2015, 6 cases of falling fall beds occurred in our department, including 4 cases of falls and 2 cases of falling beds. After the occurrence of adverse events, the Company timely analyzed the causes and put forward corresponding improvement measures. The summary report is as follows. 1 reasons 1.1 Nursing staff factors Nursing staff lack of responsibility, violation of rules and regulations and technical procedures, the implementation of the core system is not in place, such as high-risk patients in the process of handover is not serious, not detailed.