摘要
目的通过分析死亡病案内涵质量的缺陷,寻求控制病案内涵质量的方法。方法对2009年全年死亡病案进行质量检查。结果病案填写存在诸多问题,医护人员重视不足,领导管理存在漏洞,死亡病案讨论流于形式。结论提出了克服死亡病案质量缺陷需要加强的几项措施。
Objective The quality defects of death medical records were analyzed to seek methods for control its quality. Methods The quality of death medical record in 2009 was checked. Results The problems existed in the filling of medical record were as follows： medical staff paid less attention to the writing of medical record,some administrative mistakes and medical record discussion turned out to be a mere formality also contributed to this phenomenon. Conclusion Several measures were proposed to improve quality defects of death medical record.
出处
《中国病案》
2010年第9期10-11,共2页
Chinese Medical Record
关键词
死亡病案
病案书写
质控
death medical record
writing of medical record
quality control
