某院两季度医疗安全不良事件分析评价与对策

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目的:分析某院医疗安全不良事件(以下简称事件)的特点、原因,并施以对策评价效果,以减轻或减少事件。方法:分析某院2014年末季和2015年初季报告的188例事件的科室分布、事件级别、类型、原因,并采取对策进行效果评价。结果:Ⅰ类和Ⅱ类科室两季度事件报告无显著性差异(P>0.05);两季度事件级别有显著性差异(P<0.05),后季度级别降低;两季度28.6%事件有显著性差异(P<0.05),后季度同类事件减少却有新发事件,71.4%事件无显著性差异(P>0.05),前三位事件是脱管(20.7%)、药物不良反应(20.2%)和诊疗事件(11.%);事件原因前三位是工作制度流程未严格落实(19.1%)、宣教不到位(16.5%)和评估不到位(15.4%)。结论:采取有效对策,能减轻或减少事件,只有持久防范才能全面见效。“,”ObjectiveThis study was conducted to analyze the medical safety of adverse events (referred to as events) in one hospital between two quarters including characteristics and reasons so that countermeasures were put to reduce the event.Methods we valued 188 cases of events from October 2014 to March 2015 in level,type and cause.ResultsⅠ classes and classⅡ department two quarters incident report there was no significant difference(P>0.05) betweenⅠ classes and classⅡ department events ; there are significant difference (P <0.05) about events level between two quarters events.The top three events were tube taking off(20.7%), adverse drug reactions (20.2%) and clinical events (11. %); top three reason leading to events were the implement the system process (19.1%), inadequate mission (16.5%), and inadequate evaluation (15.4%).Conclusion Only persistence guard could reduce the medical safety of adverse events comprehensively.
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