摘要
目的本文对近5年来某区社区卫生服务中心发生猝死的32起案例进行回顾分析,为加强社区卫生服务中心医疗质量和安全提供依据,并提出合理建议。方法根据2007～2011年上海某区45家社区卫生服务中心上报的纠纷材料通过筛选得到32起案例资料,筛选条件:①患者发病至死亡时间小于24 h;②纠纷经医疗事故技术鉴定定性;③未经过鉴定的案例,均通过区医疗事故处理办公室邀请专家进行讨论定性。笔者对32起案例资料根据死亡原因、诊疗过程中存在的过失环节等方面进行统计和分析。结果 32例资料中死亡原因分析,因医疗技术缺陷造成患者死亡26例占81.25%;由于医护人员责任心不强错误用药导致过敏性休克死亡5例占15.63%;1例因患者酒精中毒急性呼吸循环衰竭死亡。32例突然死亡病例共涉及医疗过失环节55次,其中前5位的分别是:处置不当16次,占病例总数的50.00%;漏诊误诊10次,占病例总数的31.25%;告知不当9次,占病例总数的28.13%;病历书写不规范7次,占病例总数的21.88%;缺乏责任心导致药物过敏5次,占病例总数的15.63%。结论社区卫生服务中心医务人员需提高对致死性疾病的认识和处理,认真遵守诊疗常规,规范诊疗流程,强化三基训练,学会自我保护,才能不断提高医疗质量,真正履行社区居民健康的"守门人"职责。
Objective To explore the causes of 32 sudden death cases in a community health service center in almost five years, to strengthen medical quality at community health service center and to provide the basic safety regulation as well as rea- sonable suggestions. Methods The material reports of 32 cases according to 45 community health service centers in Shanghai district from 2007 to 2011 were analyzed retrospectively. All patients died in hospital less than 24 h and the medical accidents must be identified. The causes of death and treatment fault were analyzed. Results 26 （81.25 % ） cases of death were caused by medical technology faulty;5（ 15.63% ） eases were due to medical staff irresponsibility and using incorrect medicine leading to anaphylactic shock ; 1 case was alcohol poisoning death. All the cases were involved medical negligence 55 times, the top five were as follows ： improper disposal 16 times, accounting for 50.00% of the total number of cases ; misdiagnosis 10 times, accounting for 31.25% of the total number of cases;improper told 9 times, accounting for 28.13% of the total number of cases;irregadar case file writing 7 times,accounting for 21.88% of the total number of cases;lack of responsibility lead to drug allergy 5 times, ac- counting for 15.63% of the total number of eases. Conclusion In order to improve the quality of medical care at community health center, avoid medical disputes, in addition to the leadership to strengthen management, the key was to strengthen the legal knowledge of training, set up good ethics, strengthen the professional knowledge of the study and improve the basic skills, regulate the case file writing, abide by conventional diagnosis and treatment, and regulate the referral process.
出处
《中华全科医学》
2012年第11期1753-1754,共2页
Chinese Journal of General Practice
关键词
猝死
急救
医疗纠纷
Sudden death
Emergency management
Medical dispute
