医院的安全文化与医疗安全

医疗安全是医院管理中最重要的课题之一。医院安全文化是国际上新近引入医院安全管理的新概念。作者介绍了医院安全文化的概念和内涵,提出了医院安全文化的6个基本要素,阐述了医院安全文化与医疗安全的关系。指出要处理好领导及员工与医疗安全、安全与效率、系统及个人与惩罚、报告与隐瞒、协作与交流等的关系,并积极创建学习型组织,在创造、获取和传递知识的同时,及时调整自身行为,保障医疗安全,降低医疗风险,提升医院的安全文化。     

医疗注射器使用的安全性分析

1995年1月，世界卫生组织(WHO)和联合国儿童基金会(UNICEF)关于安全注射的《亚穆苏克罗宣言》指出，在发展中国家，儿童每年要接受55亿次注射，其中占10．0％的预防接种注射中约有30．0％是不安全的。而占90．0％的非免疫注射中则高达50．0％是不安全的。许多人知道使用未消毒的针管注射后会传染HIV病毒，从而引起艾滋病，但更多的     

浅析县级医院医疗质量与医疗安全管理

在新时期医改政策下,基层县级公立医院在医疗卫生服务中承担的比重越来越大,医院管理中医疗质量与医疗安全管理的重要性日益增大,在县级医院管理的实践中,如何进一步加强医疗质量与医疗安全管理,提高县级医院医疗风险防范意识成了新时期医院管理工作的重点。对县级医院中医疗质量与医疗安全管理实践的分析,探讨适用于县级医院的管理经验,对县级医院管理水平的提高有着重要意义。     

基于医疗投诉的医疗安全监测指标探索

目的 构建以投诉信息为切入点的医疗安全监控信息收集指标.方法 运用文献评阅、专家咨询论证方法,建立医疗投诉基本信息收集和监测指标体系,并通过试点运行,对监测指标进行修正和完善.结果 从5个维度建立医疗投监测指标总体框架,构建"患方投诉事由"和"医方原因分析"等8个一级指标和20个二级指标所形成的指标体系.结论 基于医疗投诉的医疗安全监测指标具有科学性和可行性,能有效监测医疗安全不良事件.     

浅谈医疗设备使用安全

目的:随着医疗科技的快速发展,医疗设备在临床应用中的安全问题日益突出,医疗仪器操作人员必须了解各种医疗设备可能产生的危险及其应对措施.方法:对医疗设备产生的各种能量进行分析,掌握医疗设备的有效管理方法.结果:针对医疗设备产生的各种安全隐患提高安全意识、采取预防措施.结论:通过对医疗设备各类能量产生的安全隐患进行分析,要求操作人员必须严格执行操作规程,正确使用各种医疗设备,确保各类医疗设备的使用安全.     

论医学媒介实验室的生物安全防护

医学媒介生物检测监测重点实验室的目的在于加强各国境口岸的医学媒介生物监控力度,防止医学媒介相关传染病的传人与传出,保障国境口岸的卫生安全。其生物安全防护工作是一项系统化的工作,从实验室的规划设计、生物危害评估、生物安全水平分级对设施和设备的要求、生物安全管理要求和生物安全培训工作都有明确的标准和要求。     

系统安全理论在医疗安全管理中的应用

阐述了系统安全理论的概念、起源与发展、主要内涵,分析了我国医疗安全管理的现状和未来,认为系统安全理论在医疗安全管理中的应用前景广阔.在医疗安全管理中可以系统安全的理念为指导,遵循系统管理的原则,设定系统安全的目标,确定安全体系的范畴,通过建立全方位的反馈机制、明确责任界限及倡行安全文化,全面提升医疗安全管理水平.     

加强医疗设备质量控制确保医疗工作安全

针对医院质控工作刚刚起步的实际情况,分析质控管理工作中常见的问题,提出了医疗设备质量控制和医护质量考核相结合的管理方法,解决了实际问题,为质控工作顺利开展、提高卫生装备的质量、确保医疗工作安全打下坚实的基础。     

Health and safety in medical laboratories

There has been a large increase in the number of persons employed in medical laboratories in the last 25 years. These workers are exposed to a variety of infective agents in the course of their work, the most important being Mycobacterium tuberculosis, Salmonella typhi, Brucella spp., and serum hepatitis virus. Chemical and physical hazards include toxic chemicals, lacerations, skin disease, and possibly cancer. Current knowledge of safe working practice in laboratories leaves much to be desired and there is an urgent need for both internationally agreed codes of safe practice and the development of guidelines for the medical surveillance of laboratory workers. The World Health Organization is developing such guidelines in an attempt to protect the health of workers employed in the investigation of ill health in others.     

Update on patient radiation doses at a large tertiary care medical center.

Radiation procedures in diagnostic radiology and nuclear medicine examinations, especially at referral centers, contribute a significant proportion to population dose; hence, there is a presumed detriment. Knowledge of the magnitude of dose from each type of exam is helpful in determining where to implement dose reduction efforts. Additionally, new records of dose data facilitate comparisons with past measurements. In this paper, updated patient exam dose data (frequency and effective dose equivalent) are provided for a large, comprehensive, tertiary care medical center that served more than 340,000 patients in 1997. Patient billing code data were used to study 31 different types of diagnostic exams encompassed in five major categories (angiography, fluoroscopy, radiography, nuclear medicine, and computerized tomography). Organ doses for each radiographic and nuclear medicine exam were estimated using published Monte Carlo conversion factors and appropriate exposure values. Estimates of organ doses were utilized to compute effective dose equivalent (EDE) per ICRP 26 and collective effective dose equivalent. Mean effective dose equivalent was also calculated for each exam category. Total collective effective dose equivalent had decreased from 1988 (2,030 person-Sv) to 1997 (1,817 person-Sv). The largest contributors to collective effective dose equivalent were angiography (768 person-Sv), computerized tomography (447 person-Sv), and nuclear medicine (355 person-Sv). Radiography (150 person-Sv) and fluoroscopy (97 person-Sv) contributed the least to collective effective dose equivalent. Mean effective dose equivalent contributions remained the same, with angiography accounting for the highest component, followed by nuclear medicine, computerized tomography, fluoroscopy, and radiography, respectively. Effective dose equivalent, collective effective dose equivalent, and mean effective dose equivalent values were calculated and tabulated in five major categories. These data provide updated information as to trends in exam and; collective dose from 31 common types of radiologic exams performed at a large medical center, which can be used as an up to date baseline for analyses of trends in U.S. radiation doses due to medical imaging procedures. Although minor changes were observed in comparing the mean effective dose equivalent data to those of a previous study, substantial differences were evident in the collective effective dose equivalent data. This was due primarily to variations in the number of patients examined and changes in technology and practice.     

医学装备使用质量与安全指标的探讨

目的：医院医学装备使用质量与安全已成为医疗安全管理重要内容,目前我国还没有明确的医学装备使用质量与安全指标,如何确定通用、规范、标准的医学装备质量与安全指标,成为各级卫生行政部门及医疗机构必须研究的课题。方法：根据长期医学装备管理实践的经验,依据国家针对医学装备的相关法规、标准和规范,对医学装备使用质量与安全指标的确定进行探讨。结果：从技术和管理两方面建立医学装备使用质量与安全指标。结论：通过探讨为医院制定规范、可行的医学装备使用质量与安全指标提供参考。     

建立医疗安全监控系统的可行性分析

在分析各国病人安全报告系统的基础上，探索在上海建立医疗安全监控系统的可行性，同时通过对试运行模式及情况的评价，为后期系统的完善提供改进建议。     

医疗设备通用电气安全质量控制的研究

目的:论述医疗设备通用电气安全质量控制工作的方法,并从检测数据中得出规律性因素。方法:运用独立样本t检验统计手段,以手术室和病房CF型设备的通用电气安全检测数据为例进行分析。结果:手术室和病房两组数据虽都符合国家标准,但受供电系统影响在统计学上存在显著差异。结论:供电系统和医疗设备是通用电气安全的两个方面,二者通过相互配合才能更好的开展通用电气安全的性能检测和质量控制。     

建立医疗安全监控系统的必要性分析

从我国医疗安全所面临的严峻挑战、强制性医疗安全报告系统的特点、国外的经验和现代医疗安全理论观探讨在上海建立医疗安全监控体系的必要。     

如何进行医疗设备的安全管理

为了有效提高医疗服务的安全性和有效性，医院必须加强对医疗设备的安全管理。本文首先阐述了医疗设备安全管理应遵循的几个原则，然后在医疗设备安全风险分析的基础上，从技能管理、过程管理和重点管理几方面探讨了如何建立医疗设备的安全使用与管理机制。     

防范医疗纠纷 维护医疗安全

根据医院近年医疗纠纷发生率有上升趋势，正确认识医疗纠纷的概念，探讨了发生医疗纠 各种因素。在防范医疗纠纷上；（１）领导要高度重视；（２）加强技术训练；（３）建立健全各项规章制度和操作规程；（４）结合形势加强医德医风建设。正确处理医疗纠纷的态度；一是高度重视医疗工作方面的投 做好纠纷的接待处理工作；二是学习有关法律，提高法律，提高依法办事能力；三是聘请义务监督员，发挥社会对医院工作的监督和促进作用     

Patient safety problems in adolescent medical care

PurposeThis study estimates the annual incidence and describes the nature, types, and contributing factors involved in patient safety problems in adolescent medical care.MethodsThis study uses data from the population-based Colorado and Utah Medical Practice Study to describe the incidence of hospital-based adverse events and preventable adverse events in adolescents and “critical incidence analysis” data reported by pediatric clinicians to elucidate the nature, types, and contributing factors in adolescent patient safety problems.ResultsThe incidence of adverse events in adolescents in the Colorado and Utah Medical Practice Study was 2.74 (CI 95% = 2.62–2.86), significantly higher than all other age groups of children. The incidence of preventable adverse events in adolescents was 0.95 (CI 95% = 0.65–1.25), significantly higher than that of children 1–12 years old, but not significantly different than infants. Diagnostic events were most common, followed by medication events. Services associated with the highest frequency of events were pharmacy and Family Practice. In the critical incident analysis, adolescent-specific factors contributed to 54.8% of the described patient safety problems. Discomfort with adolescents, a factor not described for other age groups of children, contributed to 17% of the adolescent patient safety problems.ConclusionsAdolescents experience relatively high rates of patient safety problems compared with other age groups of children. Adolescents represent a defined population with a patient safety risk profile that differs from adults and younger children. The substantial contribution of adolescent-specific factors suggests that patient safety improvements, to be effective, should address adolescent-specific risks.