药品使用不当相关医疗纠纷41例分析

背景　药品在临床治疗过程中发挥着重要作用，而因药品使用不当引发医疗纠纷事件层出不穷，关注药品使用不当相关医疗纠纷是保障医疗质量、促进医患和谐的重要举措。目的　分析药品使用不当相关医疗纠纷，以指导临床上合理用药的安全管理。方法　于2018年7月从中国裁判文书网（http：//wenshu.court.gov.cn/）进行高级检索，共纳入41例以药品使用不当为诉因的判例，对其进行文本分析，提取立案年份、地区、医院级别、医疗事故、诉讼原因、医疗损害鉴定、责任程度（参与度）、判决结果、索赔金额、赔偿金额、药品使用不当原因等信息，计算审判时间、赔偿系数、参与度、赔偿比重。结果　41例以药品使用不当为诉因的判例中，一审22例，二审19例，申请医疗损害鉴定72次，平均每例鉴定1.76次，4例为医疗事故，34例存在不同程度参与度；41例平均索赔金额为704 220.60元，37例平均赔偿金额为211 865.10元，赔偿比重为30.1%；实际以药品使用不当为原因的医疗纠纷共29例，包括用药差错25例、药物不良反应2例、原因尚不明确2例，其中抗菌药物、激素、镇静镇痛药品、解毒药品在使用过程中存在剂量、时间、联合用药、方案调整等多方面差错。结论　药品使用不当相关医疗纠纷形势不容乐观，通过信息化、制度化、流程化的方法加强临床用药的安全性，同时进一步理清纠纷处置的鉴定、赔偿程序，保障医患双方的合法权益。

Analysis of 41 Medical Disputes Cases Related to Drug Misuse

Background　Drugs play an important role in the process of clinical treatment，and medical disputes are caused by improper use of drugs. Paying attention to medical disputes related to improper use of drugs is an vital measure to ensure medical quality and promote harmony between doctors and patients. Objective　To guide the safety management of clinical rational drug use by analyzing medical disputes cases related to drug misuse.Methods　We selected and analyzed documents of 41 legal precedents caused by drug misuse from China Judgments Online （http：//wenshu.court.gov.cn/） through advanced search in July 2018，extracted the year of filing，district，hospital level，medical accident，accident grade，lawsuit reason，appraisal method，degree of responsibility （participation），judgment result，amount of claim，amount of compensation，cause of improper drug use，and calculated trial time，compensation coefficient，participation and proportion of compensations.Results　Among 41 cases of drug misuse，22 cases were sentenced in the court of first instance and 19 cases in the court of second instance.Among them，the appraisements of medical damage were applied for 72 times and average 1.76 times per case.Four cases were judged to be medical accidents and 34 cases were identified as fault participation.The mean compensation of the total 41 cases was 704 220.60 yuan，the mean compensation of 37 cases was 211 865.10 yuan，and the proportion of compensations was 30.1%.Twenty-nine medical disputes were directly caused by drug misuse，including 25 cases of medication errors，2 cases of adverse drug reactions and 2 cases of unclear cause.There were frequent misuse of antibiotics，hormones，sedatives，analgesics and antidotes in dosage，time，combination of drugs and treatment adjustment.Conclusion　The situation of medical disputes related to drug misuse is not optimistic.The safety of clinical pharmacy should be strengthened through informatization，institutionalization and process management.At the same time，the procedures of identification and compensation for disputes should be further clarified to protect the legitimate rights and interests of both doctors and patients.