牙体牙髓病学本科实习教学中医疗不良事件的原因分析与对策

目的分析口腔医学本科生在牙体牙髓病科实习期间出现医疗不良事件的原因，探讨减少和防止不良事件发生的对策。 方法收集2014年1月至2018年12月期间，通过中山大学附属口腔医院管理系统呈报的牙体牙髓病科实习生不良事件共计144例。采用回顾性分析方法对不良事件进行归纳总结，分析其发生原因，并针对性地制定改进和预防措施。使用SPSS 25.0软件对不良事件的类型及引起各类不良事件原因的数据进行分析，因各组数据不满足正态分布及方差齐性，故采用Mann-Whitney U检验。 结果口腔医学本科生在牙体牙髓病科临床实习教学过程中出现的不良事件，主要有职业暴露、医疗沟通事件与医疗处置事件三类，多属于Ⅲ级未造成后果事件和Ⅳ级隐患事件。其中，以职业暴露最为多见，五年共计63例，与医疗沟通事件（Z = 5.765，P<0.001）、医疗处置事件（Z = 4.163，P<0.001）相比，差异均有统计学意义。职业暴露主要由操作疏忽或不合规范引起，与防范意识不足（Z = 4.063，P<0.001）、患者因素（Z = 3.421，P<0.001），以及科室教育不足（Z = 4.263，P<0.001）相比，差异具有统计学意义。导致医疗沟通事件发生的主要原因是医护态度，与收费标准（Z = 4.139，P<0.001）、患者不实期望（Z = 3.990，P<0.001）和不信任实习生（Z = 3.314，P<0.001）相比，差异具有统计学意义。导致医疗处置事件的原因有知识缺乏、操作不规范和带教指导不足，三者之间差异无统计学意义（P>0.05）。 结论通过制定各种预防及改进措施有助于减少口腔医学本科生在牙体牙髓实习教学中不良事件的发生，促进医患关系的和谐发展。

Analysis of causes and countermeasures of adverse events in undergraduate endodontics practice teaching

ObjectiveTo analyze the causes of adverse events in undergraduate endodontics practice teaching, and to discuss the countermeasures of reducing and preventing adverse events. MethodsA total of 144 adverse events of interns were reported by the Volunteer Reporting System of the Affiliated Stomatological Hospital of Sun Yat-sen University, from January 2014 to December 2018. The retrospective analyzes were used to summarize these adverse events, analyze their causes, and formulate improvement and preventive measures. Mann-Whitney U test was used to analyze the types and the causes of adverse events by SPSS 25.0 software. ResultsThe adverse events in undergraduate endodontics practice teaching included occupational exposure, medical communication events and medical treatment events, among which the Ⅲ level events and Ⅳ level events were multiple types. The occupational exposure was the most common, adding up to 63 in the past five years. There were significant statistical differences between the occupational exposure group and the other two groups, including medical communication events (Z = 5.765, P<0.001) and medical treatment events (Z = 4.163, P<0.001) . The negligence or non-standard operation may act as the major risk factor to occupational exposure. There were significant statistical differences between the negligence or non-standard operation and the other three groups, including insufficient awareness of prevention (Z = 4.063, P<0.001) , patient related factors (Z = 3.421, P<0.001) , and insufficient education (Z = 4.263, P<0.001) . The major cause of medical communication events was the health care attitude. There were significant statistical differences between the health care attitude and the other three groups, including fees (Z = 4.139, P<0.001) , unrealistic expectations of patients (Z = 3.990, P<0.001) , and distrust of undergraduates (Z = 3.314, P<0.001) . Causes of medical treatment events were lack of knowledge, non-standard operation and insufficient guidance from teachers, and there was no significant difference among the three groups (P>0.05) . ConclusionIt′s essential to reduce the occurrence of adverse events and promote the harmonious development of doctor-patient relationship by establishing various preventing and improvement measures.