摘要
目的多中心调查中国重症加强治疗病房（ICU）医疗错误发生现状及原因。方法于2006年10月23日-12月23日，选择全国8家三级甲等教学医院进行ICU患者医疗安全性调查，各中心由一名主治医师和护士长负责此项研究。除客观记录ICU错误（包括：①分类：诊断、药物治疗、操作、观察、其他；②性质：并发症、紧急抢救、医护人员工作能力不足、工作疏忽、其他性质；③后果：无严重影响、引起生命体征波动、呼吸功能损害、循环波动、产生器官损害、死亡）外，ICU床位数、医师／护士人数，调查期间收治危重患者数及每例患者疾病严重程度、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、发生ICU错误患者数以及发生错误的医师／护士学历、职称、工作年限均予以记录。结果8个参研单位中有3个中心调查结果与实际ICU错误发生情况不符合而将调查资料剔除。5个中心在调查期间共收治危重患者232例，1319个患者住院日。ICU错误发生总次数为296次，平均4．46例患者日发生1起ICU错误。错误涉及患者数为157例，占总患者数的67．6％，其中护理错误占74．3％，显著超过医疗错误。212次错误（占71．6％）未对患者产生严重影响，但有82起ICU错误引起了生命体征的波动。在引起ICU错误的原因中，APACHEⅡ评分≥20分患者医疗错误发生率显著增高。护理人力资源的短缺、低学历以及工作时间不足3年与护理错误发生率呈正相关。结论本次多中心调查结果显示：在中国高等级教学医院ICU内，危重患者正面临相对较高的医疗错误风险；患者疾病严重程度高、医护人员人力资源和能力不足与ICU错误发生的关系密切。
Objective To perform a prospective, multi - center investigation of the incidence and causes of medical errors happened in intensive care unit （ICU）. Methods This investigation was performed in eight ICUs in level A, grade 3 teaching hospitals from October 23 to December 23, 2006. One attending physician and the head nurse in each center were entrusted with the responsibility for this project. Medical errors were identified as ① type of errors （happened in diagnosis, medication, caring procedures or monitoring etc. ）; ② characteristics of errors （related to complications, emergency intervention, low ability or carelessness of care givers and others）; ③ consequence of errors （resulted in non -serious influence, vital signs fluctuation, alternation of respiratory or circulatory function, organ injury or death）. Besides the medical errors, data included ICU beds, numbers of doctors or nurses, numbers of critical patients receiving intensive care during the investigation period and their acute physiology and chronic health evaluation n （APACHE n ） scores, the academic degree and title and years of ICU working experience of doctors or nurses who made medical errors. Results Data from three of eight centers were excluded due to lack of objectivity. A total number of 232 critical patients were surveyed in 1 319 ICU patient · days. Two hundred and ninety- six ICU errors were found. One error occurred in average of 4.46 patient · days. Medical errors happened in 157 patients （67.6%）. The percentage of error related to nursing （74.3%） was significantly higher than that made by doctorrs caring （25.7%）. Two hundred and twelve errors （71.6%） were devoid of serious effects to patients. However, Eighty- two errors were followed by vital signs instability. Medical errors occurred more frequently in patients with the higher （greater than 20） than the lower （less than 20） APACHE n score. The frequency of nursing oriented errors was closely positively correlated with the rates of shortage of working force, low educational level and working years less than 3 years respectively. Conclusion Our survey indicates that critical patients are facing high medical error risk in the higher level Chinese teaching hospitals. There is a close relationship between ICU errors and severity of patientrs disease, inadequate training and less working experience.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第10期614-618,共5页
Chinese Critical Care Medicine
基金
中国病理生理学会危重病专业委员会与欧洲危重病学会合作项目（Heahh-2007-3.1-3：patient safety research）
