医疗事故是指在诊疗护理过成中.ppt

Whatcanbetrust Thecombinedsurveyofmedicalaccidentsandmedicalerrors LiBenfu CongYali SunFuchuan ChenXiaoyang ChenPei ZhuKangmei FanMingsheng ZhouHongzhu Outline ThecurrentsituationofmedicalaccidentsinChinaThesurveyofmedicalerrorsin2008Whatcanmedicalprofessionalismdoforpatientsafety Medicalaccidentsmedicalerrors Medicalaccidentsare医疗事故是指在诊疗护理过成中 因医务人员诊疗护理过失 直接造成人员死亡 残废 组织器官损伤导致功能障碍的 Beclassifiedinto4gradesSubjectiveandobjectivereasonsErrors disobeyrules causeharm Medicalerrorsisderelictionofdutyandtechnologicalnegligenceintheprocessof医疗差错是指在诊疗护理过成中 医务人员虽有失职行为或技术过失 但未给病员造成死亡 残废 组织器官损伤导致功能障碍的不良后果 Thereasonsofmedicalaccidents 26casesofahospitalin2003 Thecurrentstatesofmedicalaccidents 47 8 happensonholidayandintheeveningMoststatisticsshowsthataccidentshappenoftenintheorthopedics obstetricsandgynecology MainlyeldersandyouthSomestatisticsshowsthattherelessaccidentsinthefirstlevelhospitalthanthesecondlevel lessinthesecondthanthethirdlevel Butsomesurveyshowsthecontraryresults ThehistoryofmedicalaccidentsinChina Periodofexploration 1949 1956 overpunishment limitedcompensationforpatients administrativemediation Periodofimprovement 1956 1965 Treatthemedicalerrorsmorereasonably buttheradicalphenomenadoesexist Periodofanarchy 1966 1976 CultureRevolution Periodoflegalization 1978tonow 1987 Measures 2002 Statues Therealitythatpatientsface Medicalaccidentsareveryfew mostaremedicalerrors Theexperienceofforeigncourtierstodealwithmedicalerrors ManagementMagazineofChinesePLAHospital No 6 2002 InU S Amedicalerrorsrank8thinthedeathreasons InChina majorfactorsformedicalerrorare skills incompetence faultinessofthebasicregulationsandimperfectsupervision Theattitudeofphysicianstomedicalerrors thecombinedsurveyinHarbin Beijing Jinan andShanghai Sharingresults sample 396 beijing 140 眼科 产科等 shanghai 58 内科和外伤 jinan 100 妇儿 外科 内总 五官 门诊 各20 harbin 98 5 Accordingtoyourobservation therateofmedicalerroraroundyou A 0 5 B 5 10 C 10 15 D 其他 如 90 以上选择A Onespecialpoint beijingbabydelivery 38 8 selectB orC Harbinpediatrics 37 5 6 Aftermedicalerrorhappened youfoundhowyourcolleaguestodealwith A don tletleaderknowsBdon tletcolleagueknowsC don ttellpatientfirst butobserveandcheckcarefullyD Telldepartment butkeepsecrettooutsideE others 选择C 33 3 132 396 选择D 36 4 144 396 7 Doyouoncemakemedicalerror ifyes whoyouoncetell A colleague Bleader C lowercolleague D family E patient F others选择A和B居多 其中B要多于A B A 8 IFhappenedbyyourself howmuchpercentyoushouldtakeresponsibility otherfactors pleasefillatleastthreeitems Most 10 20 Oneeldest 73yrs heanswered50 60 Otherfactors patientnotcooperation workpressure tootired complicateddisease notdevelopedsystemofruleandregulation andtheworkexchangetime eg Somepatientsnotpolite andrude sophysiciansveryworried andusuallyesaytomakesomethingwrong 9 Ifdon twanttotellcolleageandleader whatisthemainreasons A afraidleaderthinkuncompetent B afraidcolleaguethinklowerlevel C afraidaffectthepromoteofpositionD afraidpunishmentonbonusE others明显地 选择AC和D疑问 现实中的医生差错发生 与相继的医院 科室对其的经济处罚 到底是否进行了客观的区分和考虑 10 Ifdon twanttotellpatient thereasons A sue court B tellthemediaC notnecessarytotellptD others reason ptwillnotunderstandphysicians don ttrustphysician quarrel hitdoctor suedoctors nothingisimpossible Specialpoint Hardtoanswer somenotserious oronetakeseveralquestionnairesButstillthereexistmanytrueresponse SomethinglikecommunicatewiththemDifferentdepts andhospitals sometimescanshowtheobviousdifferences Ifsamplelargeenough canfindsomefactorsrelatedtohospitaleducationenvironment anddifferenthospitalrulesanditsrelationshipwithmedicalerror 医疗差错对待 医师职业精神的核心问题之一 谁的利益至上 新型的利益冲突 患者生命安全利益Vs医生的经济利益和名誉等其他利益目前不利的表现 观念上的扭曲 都清楚这是客观存在的事实 但又认为不能 承认 行政管理措施 报告则意味着处罚 经济和名誉 如美国的高额赔付的风险赔偿机制也在一定程度上制约着医疗事故的自愿报告 我国的 面子 方面 被歧视 等心理 有空子可钻 不报告有可能对自己没有负面的影响 客观上 不信任的医患关系 更加阻碍了医疗差错的报告 也因此丧失了医生从差错中学习的机会 我国 仍然缺乏认错 反省 互相理解等机制和传统 患者对差错也缺乏客观的认识 Shareexperience Shouldn tinformthepatients Otherwiseitwillleadsuchresults misunderstandingbypatients mistrustbypatients quarrelingwithdoctors prosecution battery etc nothingisimpossible Don treporttothehospitaladministrators Otherwiseyouwillbepunished Whoseinterestsarefirst Newmodelofinterestsconflicts patients safetyvs doctors interestsSomeadversephenomena Distortionofideas itisobjective butsomedonotacceptit Administrativemeasures reportmeanspunishmentExploitanadvantage Therearesomebadeffectswithnoreport Objectively themistrustbetweendoctorsandpatientshindersthereportofmedicalerrors Sodoctorslosethechancetolearnfromtheerrors Thereisnotraditionofmisknow reflectionandmutualunderstanding Patientshavenoobjectiveknowledgeofmedicalerrors Whatcanbetrustforpatientsafety Foreseeable dealingwithaccidents compensation reportofmedicalerrors buildingthesafetysystem theteamwork etc Unforeseeable theattitudetomedicalerrors thepsychologicalstatsaftererrors etc TheconstructionofErrorreportsystem visible 任仲杰 thereportsystemofmedicalerrorandmedicalaccidentinU S 中华医院管理杂志 2006年06期InU S therearemoreandmoreevidencesthatthereportsystemofmedicalerrorandmedicalaccidentwouldpromotethemedicalqualityandsecurity Itisadoptedinmostlyhospitals PeterSingeretc Theethicaldilemma medicalerrorandmedicalculture Anethicaldilemma Medicalerrorsandmedicalculture 2002年03期Commentary LearningtolovemistakesDoctorsareobligedtobehonestwiththeirpatients theatmosphereoftrust understanding invisible Whatcanbedoneformedicalprofessionalismonmedicalerror TakemoreobjectiveeducationonmedicalerrortomedicalstudentsEducateddifferently forphysicians forhospitals forpatients fordoctor patientunderstandingetc Constituteforthelongtermdoctor patientrelationshipwithunderstandingandtrust sowecancreatemedicalhumanityideaChangingthecultureofblame whetheraculture inwhichthereismoretrustandsecuritybetweendoctorandpatients canbeconstructed Changingthecultureofblamingdoctorsonly excludingthesubjectivefactorslikeresponsibility