【作者】 黄晓巍；

【导师】 刘继文；

【作者基本信息】 新疆医科大学 ， 公共卫生（专业学位）， 2015， 硕士

【摘要】 目的:分析新疆某三级甲等综合医院医疗不良事件发生现况及相关影响因素,为医疗机构进一步加强医疗不良事件的管理,构建可持续改进的医疗不良事件管理体系,降低医疗风险,确保患者安全,全面提升医疗安全服务质量提供科学依据。方法:采用描述性研究方法,对2014年3月至2014年12月新疆某三级甲等综合医院发生的1224例医疗不良事件进行现况分析。结果:通过研究医院发生的1224例医疗不良事件发现,(1)在医疗不良事件发生的患者中,男性患者发生医疗不良事件的例数略高于女性患者,在不同年龄段的患者中,60岁以上患者发生医疗不良事件最多。而在医疗不良事件发生的场所中,主要集中在病房、重症监护室等患者主要的诊疗及高风险场所。(2)在医疗不良事件发生的内容中,由于评估错误、诊断错误、技术错误、查体错误、病史采集错误、医嘱错误、治疗延误、治疗遗漏、不必要的治疗、消毒/灭菌错误、环境设备错误、记录错误等医疗处置错误引发的医疗处置治疗类医疗不良事件最多。(3)在医疗不良事件的不同等级中,医院Ⅲ级、Ⅳ级医疗不良事件的发生数量最多,合计达到总数的82.93%。(4)在医疗不良事件发生的可能原因中,与工作人员个人因素相关的医疗不良事件最多,占47.55%。(5)在医院发生医疗不良事件的医务人员中,医师岗位、初级及以下的医务人员都是医院医疗不良事件涉及发生数量最多的,而在医院发生医疗不良事件的科室中,非手术科室的涉及发生数量最多。(6)按照国家医疗不良事件的分类,在4个等级医疗不良事件的相关影响因素中,医务人员不同的科室、职称、岗位间存在差异(P<0.05),患者不同的性别、年龄也差异显著(P<0.05),并且不同的事件内容、发生场所也存在明显差异(P<0.05)。结论:通过研究发现,医院医疗不良事件的发生存在很多影响因素,对此,医院应当将医疗不良事件的处置工作前移,进一步加强医院安全文化建设,强化医务人员的患者安全意识,不断完善医疗不良事件上报系统和医疗不良事件管理制度的建设,建立便捷、及时、有效的医疗不良事件上报方式,确保医院医疗不良事件的上报率,健全医院医疗不良事件的监管机制和反馈管理,加大医务人员的培训教育工作,提高医务人员对医疗不良事件管理工作的认知和认可程度,充分发挥医务人员“主人翁”精神,确保“安全的人员”,在“安全的环境”中,执行“安全的医疗”,真正让所有老百姓感受到“安全”与“安心”,从而创造出高品质的医疗安全环境。更多还原

【Abstract】 Objective: To analyze the current situation and related factorsfor medical adverse events in A 3A Tertiary General Hospital in Xinjiang, to further strengthen the management of medical adverse events inmedical institutions, build a sustainable improvement of medical adverse events management system and to reduce medical risks,ensure that patients security, thus to enhance the safety and quality of medical services provided scientific basis. Methods: Based on descriptive study methods of 1224 cases medical adverse events from March 2014 to December 2014 in a three general hospitals in Xinjiang. Results: 1224 cases of medical research hospital adverse events occur throughout the year found that the number of cases(1) adverse events in patients, the male patients of medical adverse events was slightly higher than female patients, patients that occurredover 60 years at most of different ages in medical adverse events. In the place of medical adverse events, the main focus in the ward, intensive care unit and other major clinics and patients at high risk places.(2) the content of medical adverse eventscaused up to disposal, since the evaluation of the error, that the error of diagnostic,technical, examination, history taking the wrong, prescription, treatment delays, missed treatment, unnecessary treatment, disinfection or sterilization, and even medical treatment, environment equipment, recording and other medical errors.(3) in different levels of medical adverse events, grade Ⅲ, Ⅳ adverse events occurred in the largest number, the total reached 82.93% of the total.(4) the possible causes of adverse events in health care, medical adverse events and factorsoccurred most in the related to individual staff members, accounting for 47.55%.(5) In the occurred of hospital medical staffadverse events, the physician positions, and below the primary hospital medical staff are the greatest number of adverse events, and adverse events in the hospital departmentof medical occurrence, the non-surgical departments taken part in the largest number occurred.(6) The classification of national health adverse events related factors in medical 4 gradeadverse events, the medical staff of different departments, there are differences(P <0.05) between titles, positions, patients with different sex, and different ages. It was significantly(P <0.05), and the contents of different events, there are also significant differences in the occurrence of sites(P <0.05). Conclusion: The study found that the presence of hospital medical adverse events occurred many factors, this, the hospital shall forward the disposal of medical adverse events, to further strengthen the safety culture construction of hospital, including medical staff and safety awareness of patients, and constantly building management improvement of the medical adverse event reporting systems and medical adverse events system, to establish a convenient, timely,and effective medical adverse events reported to the way to ensure that the rate of hospital medical adverse event reporting, improve the regulatory mechanism of hospital medical adverse events and feedback management, increase medical training and education of staff, improve the medical staff awareness and recognition of the extent of medical adverse events management, give full play to "ownership" spirit to the medical staff,, to ensure that "security personnel" in the "safe environment", and building the implementation of "safe medical care ", so that all people feel truly " safe " and " peace of mind ", thereby creating a high-quality medical security environment.更多还原