刍议医疗风险的形成因素

医疗不良事件、医疗纠纷等医疗风险问题已成为社会的焦点,受到医疗管理者和大众的广泛关注。本文从医疗风险的性质与特点入手,深入分析医疗风险形成的社会因素、医院因素和医务人员自身的原因,力求探索出有效规避医疗风险、减少医疗纠纷、保障医疗安全的有效方法。     

患者安全文化及其不良事件报告研究进展

医疗不良事件已成为世界性问题<'[1]>,严重威胁着患者安全,护理不良事件占医疗不良事件的40%<'[2]>.根据美国医学会调查结果显示<'[3]>,向更加安全医疗体系转变的最大挑战是改变医院患者的安全文化.员工在发现系统的安全隐患及自己或别人出现了失误之后,采取主动报告还是隐瞒的态度,反映了一个医院安全文化水平.     

医院患者安全管理体系构建

随着医改的深入,提升医疗质量,保障患者安全提到了一个新的高度,建立患者安全文化体系,减少医疗过程中不良事件的发生是医院管理人员需要迫切解决的问题。分析我院在医院患者安全管理体系采取的方式,即优化医院制度体系,优化流程设计;加强药品相关管理;加强抗菌药物管理;药品安全(不良)反应事件报告;保护患者合法权益,鼓励患者参与医疗过程和医疗服务的拓展等。上述管理方式在我院初见成效,但也面临诸多问题,要求我们运用PDCA循环等质量管理方法,定期分析评价患者安全隐患,不断改进,提高服务水平。     

医疗不良事件相关因素分析

医疗不良事件,或称医疗不安全事件,是指患者在医院医疗过程中,凡是由于医疗系统的低能状态、医疗管理过失或医务人员医疗不当等原因,而给患者造成允许范围以外的心理、机体结构或功能上的障碍、缺陷或死亡。我国医院协会于2006年10月发布的《2007年度患者安全目标》中,将鼓励主动报告医疗不良事件作为患者安全的八大目标之一     

医疗护理实践中安全管理的认识与思考

<正>近年来,医疗风险、医患纠纷、医疗不良事件已成为医务人员和患者普遍关注的热点问题。虽然许多医院已建立了医疗护理风险管理机制,但很多因素仍影响医疗护理的安全性。如果医务人员对护理安全管理的薄弱环节认识和防范不足,就不能从根本上堵塞医疗差错和事故的发生渠道,健全管理机制,保证患者安全~([1])。本文对医疗实践中的安全风险进行综述,为防范医疗安全问题发生提高参考。     

医疗负性事件的成因与防范措施

医疗负性事件是指在医疗过程中发生的、与医疗管理有关的伤害,这些伤害不是源于患者的疾病本身,而是由医疗行为造成患者疾病未愈甚至死亡,或住院时间延长、出院时仍有某种程度的后遗症或残障［1］。美国1997年住院患者4.4~9.8万人死于可以预防的不良事件［2］。不良事件加拿大2004年为7.5%,英国2000年4.0%,美国科罗托州和犹他州2005年1.0%［3］,实际发生率可能远比报道的高。医院医疗负性事件是导致医疗纠纷的主要原因。如
　　何有效防范医疗负性事件的发生,是保障医疗安全,提升人民群众健康水平,促进医院发展的重要保证。     

整合型医院医疗安全(不良)事件管理体系的构建与应用

本文主要探讨公立医院改革背景下整合型医院医疗安全(不良)事件管理体系的构建及应用。医院采用"3+4"模式,通过建立管理组织架构、管理制度、内部报告系统,按照计划、实施、总结、提高4个阶段,构建整合型医院医疗安全(不良)事件管理体系并应用,从而解决院区分散,无统一管理的问题,为整合型医院医疗安全(不良)事件的科学管理探索一条标准化路径。     

医疗失效模式与效应分析在预防老年患者发生不良事件中的应用效果

目的探讨医疗失效模式及效应分析在预防老年患者发生不良事件中的应用效果。方法根据医疗失效模式与效应分析方法,成立安全管理小组,进行老年患者不安全因素分析,制订并实施安全管理措施。结果老年患者不良事件发生率降低（P〈0．01或P〈0．05）。结论运用医疗失效模式及效应分析对老年患者实施安全管理,能充分发挥系统防御对缺陷的屏蔽作用,保障老年患者安全。     

消毒剂的监测在医院感染管理中的作用

医院感染管理是医疗质量的重要组成部分,是医疗安全的重要保障.近年来,医院感染管理工作进展迅速,相关制度及管理规范先后出台,学术活动也比较繁荣和活跃.但是,频发的医院感染暴发事件也显示出, 医院感染已成为影响患者安全、医疗质量和增加医疗费用的重要原因,也是医疗高新技术开展的主要障碍之一. "预防和控制医院感染是保障病人安全,提高医疗质量以及维护医务人员职业健康的一项重要工作".     

构建医院护理差错及不良事件报告系统的研究进展

医疗不良事件在各国频发,患者安全遭受挑战,各国为此付出了巨大代价。美国等国家实践证明,医疗差错和不良事件报告系统能促进医疗质量和患者安全[1]。我国患者安全同样面临诸多问题,医院里各类不安全事件时有发生,给患者造成新的痛苦和伤害,甚至危及生命。由于护士和患者接触的时间更长,护士对死亡和伤害承担责任的数量比任何其他专业都高[2]。因此,建立一个有效、畅通、无障碍的护理差错及不良事件报告系统,是保障患者安全的重要管理手段,也是提高医疗服务质量的必然趋势。     

Risk assessment and fall prevention: practice development in action

Amongst the health disciplines, nurses spend the most time with patients providing most of the supervision in care. Therefore, nurses have a primary role to play in contributing to knowledge surrounding the best methods of assessment of risk and prevention of adverse events. According to the Australian Incident Monitoring System (AIMS), the adverse event (38%) most frequently reported in acute hospital settings is patient falls (Evans et al 1998). The continuing rise in reported rates of falls in the acute medical wards of a tertiary hospital, on the Central Coast of New South Wales (NSW), Australia was the impetus for an action research project aimed at increasing nurses' sense of ownership of their fall prevention practice. This paper specifically reports the findings of a pilot project related to development of a fall risk assessment chart that was one of the cycles of the action research.     

国外医疗不良事件监测方法及其启示

对国外医疗不良事件的监测方法如人工监测、复合监测模式、不良事件报告系统进行综述,提出我国医院应借鉴和参考国外的方法,形成有力的干预策略,达到提高病人安全的目的。     

创建安全文化保证患者安全

探讨医疗安全与患者安全现状,分析医疗差错发生的原因,提出医疗风险无处不在,保障患者就医安全应从加强医疗安全做起,患者安全成功的关键在于文化建设,积极的安全文化接受差错出现的必然性,主动地寻找系统内潜在的危机,患者安全文化是医疗安全的思想基础、行动依据和内在动力;医疗机构应重视患者安全,增加人、财、物的投入,优化资源配置及诊疗流程,增进患者安全。     

外来医疗器械的规范化管理

目的：规范外来医疗器械在医院内的管理,保证清洗、消毒、灭菌质量。方法：依据现行标准,采用书面调查和实地调研的方式了解外来医疗器械在医院中的使用、负责处理部门或单位。结果：87.7%的医院在使用外来医疗器械。其中由本院消毒供应中心（CSSD）负责处理外来医疗器械的医院占78.1%。结论：医院应细化外来医疗器械的管理规定,规范处理流程和加强人员培训等,以保障手术质量和患者安全。     

Informal risk assessment strategies in health care staff: an unrecognized source of resilience?

Rationale Recent reports indicate that approximately 10% of in-patients in UK hospitals are involved in an adverse event (these reports also state that 50% of these events are preventable). This is indeed a worrying finding, and indicates the need to look at how these incidents are handled or indeed, what is done to minimize their occurrence. The Department of Health, via the National Patient Safety Agency (NPSA) published a guide which is aimed at encouraging accurate reporting, learning from past events and changing the attitudes of key stakeholders (healthcare managers, frontline staf etc) towards risk taking and risk management. Aims and objectives Our aim was to compare informally-learned and used risk assessment strategies volunteered by staff with the 'how to do it' guide published by the NPSA. We have compared each step of the NPSA guide with our empirical data relating to that activity. Methods We interviewed forty-eight healthcare professionals (doctors from several specialties; nurses from a variety of settings; and an array of allied healthcare professionals). We used semi-structured interviews in order to discuss participants' views on their everyday working life, working relationships and patient safety. Results Our results indicate that healthcare professionals develop their own unique way to approach the issue of patient safety and risk, based on their professional raining, seniority and role within the hospital. They did share the conviction that frontline and support staff need to have immediate and easy access to information about past adverse events. They see this as a powerful tool in minimizing the reoccurrence of the same errors/problems, as well as a vehicle to improve staff morale by feeling valued and having their opinion heard. Conclusions We believe that patient safety and welfare can benefit from the adoption of a more flexible and person-centred approach to how risk assessments are carried out. Enriching formal guidelines such as the 'Risk Assessment made easy' document with successful techniques and strategies which healthcare staff have informally developed has the potential to not only improve patient safety (since it will be based on the accumulated experience and knowledge of such staff) but also foster higher levels of self esteem amongst healthcare professionals.     

Detecting and reducing adverse events in an Australian rural base hospital emergency department using medical record screening and review

Objective: To determine if retrospective medical record screening and clinical review followed by appropriate action can effectively and efficiently detect and reduce adverse events in an emergency department.

Method and participants: The medical records of 20 050 patients who attended the emergency department over a two year period were screened for adverse events using five general patient outcome criteria. Records that screened positive were reviewed by the hospital's clinical risk manager. If an adverse event was detected, the record was also reviewed by the director of emergency. For the first three months details of adverse events were recorded to determine a baseline adverse event rate, but no further action was taken. When an adverse event was found in the remaining 21 months, further analysis and recommendations for action to prevent a recurrence were made to relevant hospital staff.

Setting: A rural base hospital in the Wimmera region of Victoria, Australia between October 1997 and September 1999.

Results: Of all the patient attendances 573 (2.85%) were screened positive for one or more criteria. An adverse event was confirmed in 250 patient attendances (1.24% of all attendances). Of the adverse occurrences, 81 (32.4%) were determined to be of major severity and 169 (67.6%) of minor severity. Quality improvement activities, mostly changes to hospital policies and work processes, were implemented with the aim of preventing the recurrence of specific adverse patient events. Over two years the number of adverse events fell from 84 (3.26% of all patient attendances) in the pre-intervention quarter to 12 (0.48% of all patient attendances) in the final quarter (relative risk reduction 85.3% (95% CI, 62.7% to 100%)).

Conclusions: Adverse events in emergency departments can be efficiently detected and their rate reduced using retrospective medical record screening together with clinical review, analysis and action to prevent recurrences.

     

Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.     

The role of risk management in maternal-child health

In today's litigious medical environment, risk managers serve as a support to health care providers by managing potential or actual liability situations. They analyze the facts in an untoward event, help clinicians communicate the appropriate information to the patient and family, and document it in an objective manner. This article briefly describes the inception of the risk managers' role, details how risk managers can provide support to members of the medical and nursing staffs and what their role is in patient safety, and explains various basic legal concepts that are important to understand should litigation ensue following an adverse event.     

医疗不良事件与系统问题相关因素的分析

目的:通过对医疗不良事件中能够发现的显性失误和内在隐性因素进行分析和总结,对系统问题进行详细而深入的剖析,改进系统和流程,使医疗风险管理更具有科学性和有效性。方法:针对在2003-2006年期间发生的35起医疗不良事件进行分析和总结。结果:经分析发现,引发医疗不良事件的因素主要是系统错误。结论:绝大多数医疗不良事件的发生是因系统和流程隐患造成的,个人因素只是其中较少的一部分。因此,应通过加强医疗事故处理管理和病人安全管理,改进医疗系统和流程,减小和防范医疗风险的发生。