醫(yī)療事故是指在診療護(hù)理過成中ppt課件

1、What can be trust?The combined survey of medical accidents and medical errorsLi Benfu, Cong Yali, Sun Fuchuan, Chen Xiaoyang, Chen Pei, Zhu Kangmei, Fan Mingsheng & Zhou Hongzhu1;.2OutlineThe current situation of medical accidents in China The survey of medical errors in 2008What can medical pro

2、fessionalism do for patient safety?3Medical accidents medical errorsMedical accidents are 醫(yī)療事故是指在診療護(hù)理過成中，因醫(yī)務(wù)人員診療護(hù)理過失，直接造成人員死亡、殘廢、組織器官損傷導(dǎo)致功能障礙的。Be classified into 4 gradesSubjective and objective reasonsErrors, disobey rules, cause harmMedical errors is dereliction of duty and technological negligenc

3、e in the process of 醫(yī)療差錯(cuò)是指在診療護(hù)理過成中，醫(yī)務(wù)人員雖有失職行為或技術(shù)過失，但未給病員造成死亡、殘廢、組織器官損傷導(dǎo)致功能障礙的不良后果。4The reasons of medical accidents26 cases of a hospital in 2003Itemcasespercentage（%）misdiagnosis、missed diagnosis & delayed treatment623.1Operative indication choice, operation method and mishandling the observati

4、on after operation1661.5Improper use of drugs and adverse reaction27.7Carelessness, disobey the concerned rules27.75The current states of medical accidents47.8% happens on holiday and in the eveningMost statistics shows that accidents happen often in the orthopedics, obstetrics and gynecology .Mainl

5、y elders and youth Some statistics shows that there less accidents in the first level hospital than the second level, less in the second than the third level. But some survey shows the contrary results. 6The history of medical accidents in ChinaPeriod of exploration1949-1956. over punishment, limite

6、d compensation for patients. administrative mediation. Period of improvement1956-1965. Treat the medical errors more reasonably, but the radical phenomena does exist. Period of anarchy1966-1976. Culture Revolution. Period of legalization1978 to now。1987, Measures ; 2002, Statues7The reality that pat

7、ients faceMedical accidents are very few; most are medical errors“The experience of foreign courtiers to deal with medical errors”，Management Magazine of Chinese PLA Hospital. No.6, 2002：In U.S.A medical errors rank 8th in the death reasons. In China, major factors for medical error are: skills, inc

8、ompetence, faultiness of the basic regulations and imperfect supervision The attitude of physicians to medical errorsthe combined survey in Harbin, Beijing, Jinan, and ShanghaiSharing results8;.9sample （396）beijing：140（眼科、產(chǎn)科等）shanghai：58（內(nèi)科和外傷）jinan：100（婦兒、外科、內(nèi)總、五官、，門診各20）harbin：98105.According to y

9、our observation, the rate of medical error around you?A. 05% B.510% C.1015% D.其他：如 %90%以上選擇以上選擇A. One special point, beijing baby delivery：38.8% select B，or C。Harbin pediatrics: 37.5%116.After medical error happened, you found how your colleagues to deal withA.dont let leader knowsB dont let colleag

10、ue knows C.dont tell patient first, but observe and check carefully D.Tell department, but keep secret to outside E.others： 選擇C：33.3% 【132（396）】選擇D： 36.4% 【144（396）】127.Do you once make medical error? if yes, who you once tell：A.colleague；B leader. C.lower colleague；D. family；E.patient；F.others選擇A和B

11、居多，其中B要多于A。 B A138.IF happened by yourself, how much percent you should take responsibility? %，other factors, please fill at least three itemsMost: 10-20%。One eldest，73 yrs, he answered 50-60%。Other factors：patient not cooperation, work pressure, too tired, complicated disease, not developed system

12、of rule and regulation, and the work exchange time. eg. Some patients not polite, and rude, so physicians very worried, and usually esay to make something wrong149.If dont want to tell colleage and leader, what is the main reasonsA. afraid leader think uncompetent；B. afraid colleague think lower lev

13、el; C. afraid affect the promote of position D. afraid punishment on bonus Eothers明顯地，選擇A C和D疑問：現(xiàn)實(shí)中的醫(yī)生差錯(cuò)發(fā)生，與相繼的醫(yī)院、科室對(duì)其的經(jīng)濟(jì)處罰，到底是否進(jìn)行了客觀的區(qū)分和考慮1510. If dont want to tell patient, the reasons：A.sue, court；B.tell the media C.not necessary to tell pt D.others：reason：pt will not understand physicians, dont

14、trust physician, quarrel, hit doctor, sue doctors.（nothing is impossible）16Special pointHard to answer, some not serious, or one take several questionnairesBut still there exist many true response. Something like communicate with themDifferent depts, and hospitals, sometimes can show the obvious dif

15、ferences. If sample large enough, can find some factors related to hospital education environment, and different hospital rules and its relationship with medical error17醫(yī)療差錯(cuò)對(duì)待，醫(yī)師職業(yè)精神的核心問題之一誰的利益至上？新型的利益沖突患者生命安全利益 Vs 醫(yī)生的經(jīng)濟(jì)利益和名譽(yù)等其他利益目前不利的表現(xiàn)：觀念上的扭曲都清楚這是客觀存在的事實(shí)，但又認(rèn)為不能“承認(rèn)”；行政管理措施：報(bào)告則意味著處罰經(jīng)濟(jì)和名譽(yù)（如美國(guó)的高額賠付的風(fēng)險(xiǎn)

16、賠償機(jī)制也在一定程度上制約著醫(yī)療事故的自愿報(bào)告；我國(guó)的“面子”方面、“被歧視”等心理；有空子可鉆：不報(bào)告有可能對(duì)自己沒有負(fù)面的影響?？陀^上，不信任的醫(yī)患關(guān)系，更加阻礙了醫(yī)療差錯(cuò)的報(bào)告，也因此喪失了醫(yī)生從差錯(cuò)中學(xué)習(xí)的機(jī)會(huì)。我國(guó)，仍然缺乏認(rèn)錯(cuò)、反省、互相理解等機(jī)制和傳統(tǒng)?；颊邔?duì)差錯(cuò)也缺乏客觀的認(rèn)識(shí)。18Share experienceShouldnt inform the patients. Otherwise it will lead such results: misunderstanding by patients, mistrust by patients, quarreling with

17、 doctors, prosecution, battery, etc. （nothing is impossible）Dont report to the hospital administrators. Otherwise you will be punished. 19Whose interests are first? New model of interests conflicts: patients safety vs. doctors interests Some adverse phenomena：Distortion of ideasit is objective, but

18、some do not accept it.Administrative measures: report means punishmentExploit an advantage. There are some bad effects with no report.Objectively, the mistrust between doctors and patients hinders the report of medical errors. So doctors lose the chance to learn from the errors. There is no traditio

19、n of misknow, reflection and mutual understanding. Patients have no objective knowledge of medical errors. 20What can be trust for patient safety？Foreseeable：dealing with accidents, compensation, report of medical errors, building the safety system, the team work, etc. Unforeseeable ：the attitude to

20、 medical errors, the psychological stats after errors, etc. 21The construction of Error report systemvisible任仲杰，the report system of medical error and medical accident in U.S ，中華醫(yī)院管理雜志，2006年06期In U.S, there are more and more evidences that the report system of medical error and medical accident would promote the medical quality and security. It is adopted in mostly hospitals. Peter Singer etc，The ethical dilemma medical error and medical culture，An ethical dilemma-Medical errors and medical culture- 2002年03期 Commentary: Learning to love mistakesDoctors