医疗风险预警管理在内科临床的应用

目的:探讨风险预警管理在内科临床的应用效果.方法:分析内科医疗工作中常见的医疗风险因素并按危险操作、危险医嘱、危险药物、危险医患沟通等进行分类,制定风险警示录并应用于临床.结果:实施风险预警管理后,内科医疗不良事件发生例次明显减少.结论:运用风险预警管理能提高医务人员风险识别能力,规范诊疗操作行为,减少医疗纠纷、医疗投诉和医疗差错的发生.     

综合应用Delphi法、FMEA与Borda序值法评估接种门诊预防接种风险

目的评估嘉兴市接种门诊的预防接种风险,为制定相应风险应对策略提供依据。方法采用Delphi法、失效模式和效应分析(FMEA)、Borda序值法分析嘉兴市接种门诊各项预防接种风险发生的可能性、严重性及可探测性,确定风险水平和排序。结果本研究根据Delphi法构建了包含7项一级风险、26项二级风险的接种门诊预防接种评估指标体系。7项一级风险的Borda排序由高到低依次为疫苗接种实施、预检告知和健康宣教、管理和人力、疑似预防接种异常反应管理、疫苗和冷链管理、资料和数据管理、服务环境;FMEA风险优先指数(RPN)分别为280、180、120、96、90、60、36。26项二级风险的Borda排序最高、最低分别为接种前三查七对、门诊标识,其RPN分别为280、24。结论接种门诊预防接种仍存在许多潜在风险;可综合应用Delphi法、FMEA与Borda序值法构建多维度、全过程的预防接种风险管理机制。     

医疗风险预警及控制机制探讨

目前我国医疗纠纷及其伤医事件频发,医疗风险预警及控制机制的不健全、医患沟通不畅及信任危机是造成这种冲突的主要原因.通过对医疗风险预警及控制机制的研究,为政府和医疗机构在减少医疗风险的发生上提供干预措施和参考依据.     

第七届世界军人运动会期间汉口江滩公共卫生风险评估

目的评估第七届世界军人运动会期间汉口江滩公共卫生事件发生风险,为风险预警和风险应急准备工作提供参考。方法召开专家咨询会,确定评估指标与风险分值。基于Kaiser模型,建立适用于汉口江滩的公共卫生风险评估体系,借助风险值计算方法计算各风险事件的风险值。运用风险矩阵法,对汉口江滩不同区域不同风险事件的风险等级进行评估。结合Kaiser模型风险分值,运用Borda序值法计算出不同区域风险事件的Borda值及Borda序值,对江滩各区域不同风险进行排序。结果借助风险值的计算,血吸虫病在江滩一、二、三、四期的风险值分别为8.43%、14.68%、25.26%和27.56%;媒介生物传染病在江滩各期的风险值分别为13.42%、16.40%、18.67%和19.22%;意外伤害及其他事件在江滩各期的风险值分别为20.34%、22.94%、19.00%和16.53%。风险矩阵图显示,江滩一期、二期的血吸虫病和媒介生物性传染病以及江滩四期的意外伤害位于低度风险带,其他各风险事件均位于中度风险带。Borda序值排序结果显示,江滩一期、二期风险最高的公共卫生事件为意外伤害及其他,江滩三期为血吸虫病和意外伤害,江滩四期为血吸虫病。结论综合考虑各评估方法评估结果,江滩一期、二期风险最高的公共卫生事件为意外伤害,江滩三期四期风险最高的公共卫生事件为血吸虫病。建议各相关部门根据评估结果,对江滩各期分别制定策略,采取有针对性的措施,以保证军运会期间汉口江滩各期的公共卫生安全。     

基于结构方程模型的居家失智老人照护风险预警体系实证研究

目的：构建居家失智老人照护风险预警体系,有利于预测关键风险因素,强化针对性风险管理,预防控制风险事件发生,进而降低医疗照护费用支出等直接和间接经济损失。方法：对浙江省宁波市1045位居家照护失智老人开展调查,运用SPSS25.0统计软件和AMOS17.0软件进行数据分析和结构方程模型构建。结果：居家失智老人照护风险预警体系包含失智老人因素、家庭支持和居住环境3个维度的15个预警指标。结构方程模型的拟合优度指标GFI=0.934,调整后拟合优度指标GFI=0.903,比较适配度指标GFI=0.967,渐进残差均方和平方根GFI=0.065。结论：基于实证调查构建的居家失智老人照护风险评估预警体系可为照护风险管理提供重要科学依据。     

立体透视框架下的医疗风险管理理论、方法及进展

文章系统介绍了风险、风险管理、医疗风险管理的内涵及风险管理流程,并在以往研究的基础上提出了基于静态非标准化、动态标准化风险管理方法基础上的三维立体透视风险管理框架,目的是帮助研究者、管理者系统了解医疗风险的基本方法和识别、评价和控制与医院、医疗相关的潜在风险因素的基本流程,以减少损失,更好地完成诊疗任务和目标,提高医疗质量和病人安全。     

医疗机构消毒灭菌物品外包服务风险分析及评估

目的 对医疗机构消毒灭菌物品外包服务过程中的风险分析与评估,进一步规范消毒灭菌物品外包服务项目运行。方法 运用风险评估策略,对外包项目风险过程开展问卷调查,头脑风暴和实地考察,查找出消毒物品外包过程9个环节51项风险因素,采用矩阵法和Borda序值法对风险因素进行风险分级和风险排序。结果 风险主要来自于物流环节、消毒效果质量控制环节以及卫生计生行政部门政策和监管等环节。结论 将控制和减少风险作为项目管理的目标,提出相应对策和建议,为制定相关政策和标准提供依据。     

综合应用德尔菲法和风险矩阵法与Borda序值法评估接种门诊预防接种风险

目的探讨接种门诊预防接种风险评估方法,评估预防接种风险,为制定接种门诊预防接种风险应对策略提供科学依据。方法采用德尔菲法(Delphi法)对预防接种风险发生的可能性及后果的严重性进行风险分析;应用风险矩阵法评价预防接种风险水平;采用Borda序值法对各项风险的风险概率和风险影响进行量化评估及排序。结果专家共开展了2轮风险调研,2轮调研的专家积极系数均高于95%,权威系数为0.85±0.09;2轮专家Kendall协调系数为0.374~0.545,差异均有统计学意义(P0.01)。本研究构建了包含7项一级风险指标、26项二级风险指标的接种门诊预防接种评估指标体系,确定了各项预防接种风险发生的可能性和后果严重性,划分了风险水平并排序。结论目前接种门诊预防接种越来越规范,但仍存在许多风险等级较高的潜在风险。将Delphi法、Borda序值法与风险矩阵法综合应用到预防接种服务领域,是一种新思想、新模式、新手段,能够为预防接种风险评估工作提供参考,为接种门诊提供了应对预防接种风险做出正确决策的科学依据,具有推广价值。     

综合应用风险矩阵法与Borda序值法评价区域性大型活动公共卫生突发事件风险

[目的]探讨区域性大型活动公共卫生突发事件风险评价方法,为科学制订公共卫生保障策略提供依据。[方法]以2010年江苏省第17届运动会为研究对象,应用风险矩阵法评价餐饮食品安全事件、公共场所健康危害事件、生活饮用水安全事件、传染病疫情事件和病媒生物引起的公共卫生突发事件5类20种公共卫生突发事件的风险水平;进一步采用Borda序值法对5类20种公共卫生突发事件的风险水平进行排序。[结果]确定了5类20种可能对第17届省运会产生较大影响的公共卫生突发事件的风险水平及其排序,其中餐饮食品安全事件列5类公共卫生突发事件的第1位。细菌性食物中毒列7种餐饮食品安全事件的第1位;游泳池水质污染引起的流行性出血性结膜炎列3种公共场所健康危害事件的第1位;城市集中式供水污染事件、二次供水污染事件并列3种生活饮用水安全事件的第1位;呼吸道传染病列4种传染病疫情事件的第1位;病媒生物叮咬引起皮肤瘙痒、影响正常休息,使人产生烦躁、厌恶情绪列3种病媒生物引起的公共卫生突发事件的第1位。[结论]综合应用风险矩阵法与Borda序值法是评价区域性大型活动公共卫生突发事件风险水平的有效方法,具有推广应用价值。     

医疗风险影响因素评价指标体系构建

目的：筛选医疗风险影响因素,构建一套科学有效的医疗风险影响因素评价指标体系。方法运用德尔菲法构建指标体系框架、层次分析法确定指标权重。结果建立一个由患者因素、疾病因素、医院管理因素、医务人员因素和社会因素5个一级指标以及患者期望值过高、并发症、诊疗服务流程存在缺陷、违反诊疗操作规范、媒体失实报道等28个二级指标组成的医疗风险影响因素评价指标体系,各层判断矩阵均符合逻辑一致性、随机一致性（CR ＜0.1）。结论该指标体系科学、可靠,可以为医院风险管理提供参考依据。     

Mentally disordered offenders' views of ‘their’ risk assessment and management plans

In Britain, there has been an increased emphasis on the use of risk assessments in mental health services over the past 20 years. Mentally disordered offenders subject to Section 41 of the Mental Health Act 1983 (England and Wales) are defined as posing a serious risk of harm to others. They are thus dealt with by forensic mental health services, which are often seen as specialists in risk assessments. This paper is based on original research in three mental health trusts in the South of England which was carried out between March 2009 and September 2011. The paper examines mentally disordered offenders’ awareness and attitude to formal risk assessments in relation to theories of governmentality. Service users subject to Section 41 of the Mental Health Act 1983 were aware that their level of risk was being assessed by professionals caring for them but were commonly unaware of the content of these assessments. These risk assessments were viewed by participants as a means through which professionals measured and monitored behaviour. Although participants often referred to levels of risk, they did not view risk screening schedules as objective, but rather emphasised the need to persuade staff that their risk had reduced. Despite showing a limited awareness of the content of these risk assessments, participants generally identified more risks, in relation to their vulnerability, than did the professional assessments. However, participants generally identified fewer risks in relation to the dangers they posed to others than did professional staff.     

Exploring attribution of responsibility for visitor safety in a US national park

Attracting millions of visitors each year, US national parks represent one context in which unintentional injuries are recurrent and fatal. Given unique environmental and infrastructural risks, as well as varied recreational opportunities and social contexts, who is perceived as responsible for preventing visitor injuries, and how might this relate to risk perception? Further, how does attribution of responsibility relate to support for preventative risk management? Limited research has considered these questions yet increasing promotion of parks to diverse audiences suggests a need to build public support for risk management. Using quantitative and qualitative survey data, this study found that most visitors perceived themselves as responsible for their own safety, and perceptions of the uncontrollability of risks were positively related to these attributions; however, attribution failed to predict support for preventative risk management. Significant predictors included perceptions of risk, participation in high-risk activities, and travelling companions. Future directions for this research, including the role of voluntary risk-taking in recreational settings, are discussed.     

Risk perception of women during high risk pregnancy: A systematic review

Risk perception in women with high risk pregnancies can affect their attitude to medical care and therefore influence the wellbeing of mother and baby. This article reviews quantitative measures of risk perception in women with high risk pregnancies. A systematic search of eight electronic databases was conducted. Additional articles were obtained through searching references of identified articles. Seven studies were identified that reported quantitative measures of risk perception in relation to high risk pregnancy. The main findings were that women with high risk pregnancies perceive themselves and the pregnancies to be at risk. However, mean risk scores consistently fall below the midpoint on risk perception measures suggesting women do not perceive this risk as extreme. Women with high risk pregnancies consistently rated their risk as being greater than that of women with low risk pregnancies. Results were inconsistent for the association between women's risk perception and that of healthcare professionals. Women with higher socio-economic status were more likely to be concerned about risk, although lower socio-economic status is associated with increased risk in pregnancy. There was a consistent association between high risk pregnancy and higher levels of anxiety. This review indicates that women at high risk during pregnancy do not perceive this risk to be extreme and that there is poor agreement between women's and healthcare professionals’ perceptions of risk. This is likely to have implications for medical care and pregnancy outcomes.     

Pharmaceutical risk communication: Sources of uncertainty and legal tools of uncertainty management

The purpose of this article is to differentiate between the different functions of pharmaceutical risk communication and make explicit their different legal natures and implications. Risk communication has been generally categorised as a warning act, which is performed in order to prevent or minimise risk. Risk analysis has also drawn attention to the role played by information in reducing uncertainty about risk. Both approaches focus on the safety aspects of communication and its role in harm reduction. However, there are cases where a risk cannot be avoided or uncertainty reduced, for example the side effects associated with pharmaceutical products or when a decision about drug approval or withdrawal has to be made on the basis of available evidence. In these instances, risk communication has other purposes than preventing risk or reducing uncertainty. This article analyses the legal instruments which have been developed to control and manage the risks related to drugs (such as the notion of ‘development risk’ or ‘residual risk’) and relates them to different kinds of uncertainty. These are conceptualised as epistemic, ecological, metric, ethical and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management.     

From chance to choice: The use of a verbal analogy in the communication of risk

In risk communication to patients, Medical Doctors frequently use analogies attempting to enhance the otherwise poor comprehension of small probabilities by laypeople. Two experiments examined the effects of the verbal analogy (asking patients to figure out the probability of an outcome by imagining the chance to draw a winning ball from a jar) on individuals' probability perception by means of seven-point Likert scales. Study 1 showed that the employment of the verbal analogy reduced the perceived likelihood of the hypothetical event under judgment both in the positive (winning a 1 million Euro lottery) and in the negative domain (contracting malaria travelling to Africa). In Study 2, two possible versions of the verbal analogy (forced vs. weak) were tested on the perceived risk of contracting hepatitis A travelling to Africa. Results indicated that individuals' risk perception was decreased by the analogy only in the forced condition. The authors discuss possible explanations for this effect.     

Individualised risk estimation and the nature of prevention

Statistical risk models hold substantial promise for the practice of cancer prevention by helping to identify high risk populations and subsequently guide decisions about surveillance, further testing and treatments. They have come under criticism for creating new categories of disease-free but ‘at risk’ individuals. We analysed the debate over the interpretation of risk estimates to assess the importance of these models for the practice of cancer prevention. In particular, we focused on the Gail model for breast cancer risk assessment as a case study, because it is widely used and has been promoted directly to consumers. We describe the critiques that have been offered of the Gail model for individualised risk assessment, such as that classification of a new ‘high risk’ category may increase the use of medical intervention in otherwise healthy individuals. We then analyse the primary methodological limitations of individualised risk models, which are often overlooked in the application of these models and interpretation of their results. In particular, the application of statistical risk models like the Gail model to individuals fails to acknowledge the uncertainty surrounding estimates of individual risk. Moreover, putting the focus of risk management at the individual level minimises the influence of important environmental factors on risk, such as social influences and policies that may impact behaviour or outcomes. Overall, the increasing use of individualised risk estimates for individual decision-making may obscure the fact that successful disease prevention requires intervention on all levels, including the political, social, economic and individual level.     

规避医疗设备引进投资风险的有效方法

医院在投资医疗设备时,要增强风险意识,财务管理人员要考虑来源于多方面的风险因素,客观分析、测算各项财务数据,并根据实际情况及时调整投资决策方法,为医院管理者的科学决策提供真实、有效的依据,以保证医院健康发展。     

Danger from above? A quantitative study of perceptions of hazards from falling rockets in the Altai region of Siberia

Russian rocket launch sites are inland, unlike their European and American equivalents. Those living near to fallout zones from the Baikonur cosmodrome have expressed concern about apparent high levels of psychological ill health, which they attribute to the launches, linking it to either fear of falling debris or contamination by fuel residues. The aim of the research study on which this article is based was to quantify and explain the reported ill health, relating it to exposure to, concern about, and information on the launches. Drawing on literature on social amplification of risk, a quantitative survey was conducted among 1111 adults living in three areas around the fallout area. Psychological symptoms were measured on the SCL-90 scale, with mental health assessed using the GHQ-20. Relationships were assessed using regression and path analysis. The main findings were that those people living closer to the fallout area were no more likely to have symptoms but were more concerned about launches. Prompted concern was associated with distress, assessed by SCL-90 scores (but not consistently with GHQ-20) and seemed to amplify the association between other adverse perceptions of life and symptoms. There is a high level of distress in this region but it is not obviously associated with exposure to launches. In contrast, the existing process of communicating information appears to increase concerns and thus distress.     

医院聘用护士流失风险管理策略

为降低因聘用护士流失给医院造成的损失。笔者通过对2001年至2003年医院聘用护士的流失原因分别从护士自身因素和医院因素二方面进行分析,提出采用流失风险识别、风险防范、风险控制等有效的风险管理策略,达到降低流失风险,确保护理工作连续有效。