摘要
通过对药物相关医疗鉴定系统的归纳,来分析导致医疗损害发生的原因,探讨临床用药行为与损害后果之间的内在联系,对规避和防范医疗风险的途径和策略进行总结。对2015年至2019年天津市医学会医疗鉴定办公室已进行的有效鉴定中所有患方诉求涉及药物的127个相关案例,按照基本情况、病种、医院等级、治疗药物、损害后果等方面进行系统归纳、分析。得出以下结果:在所有涉药案例中,老年人占比最高,为47.2%,其次是中年人,为33.9%,≥40岁人数所占比例达81.1%;三级医院发生率(82.5%)远高于其他各级医院;各专业学科中,外科发生率(58.3%)最高;发生损害的主要诊断病种列前三位的是心血管、感染性疾病和肿瘤;涉及药物品种最多的是抗菌类、心血管类、抗凝类及激素类药物;所有案例中,经鉴定与病人损害后果有因果关系的案例为54件(42.5%),与药物相关的案例为32例(25.2%),与损害后果构成因果关系的案例占59.2%。药学专家5年的平均参与度为30.7%。建议药物治疗应明确诊断,并依据适应症用药,疾病进程中应行必要的药物辅助监测和前置药学专业监护,临床应充分进行重点人群和高风险药物治疗适宜性评估,履行告知义务,以达到降低损害程度,减少损害发生的目的。
Objective:To identify the causes and trends of medical injuries by summarizing drug-related medical identification systems,and to analyze the internal connection between clinical drug using behavior and injury consequences,summarize the strategies to avoid and prevent medical risks.Method:According to the basic information,disease classification,hospital grade,drug classification and damage consequences,we conducted an analysis of 127 cases.All these cases were related to patients'appeals involving drugs and have been effectively identified by the Tianjin Medical Association Medical Identification Office from 2015 to 2019.Results:Among all drug-related cases,the elderly accounted for the highest proportion at 47.2%,followed by middle-aged people at 33.9%,and≥40 years old accounted for 81.1%;the incidence rate in tertiary hospitals(82.5%)was much higher than other hospitals at all levels;among all professional disciplines,the incidence rate of surgery(58.3%)is the highest;the top three major diseases diagnosed with damage are cardiovascular,infectious diseases and tumors;the most involved drugs are antibacterial,cardiovascular.In all cases,67 cases(52.8%)were identified as having a causal relationship with the patient's injury consequences,34 cases(26.8%)were drug-related,of which the injury consequences 50.7%of the cases constituted a causal relationship.The 5-year average participation of pharmacists was 30.7%.Conclusion:It is recommended that medical treatment should be clearly diagnosed,and the medication should be based on the indications.The necessary drug-assisted monitoring should be carried out during the course of the disease progression.Pre-pharmaceutical professional monitoring is necessary.In order to reduce the degree of damage and the occurrence of damage,clinical should fulfill the obligation of evaluating and informing the key populations and high-risk drug treatments.
作者
赵琳
慕媛
褚建欣
张麟
宋晓坤
Zhao Lin;Mu Yuan;Chu Jianxin;Zhang Lin;Song Xiaokun(Management Of fice of Tianjin Medical and Pharmaceutical Association,Tianjin 300050,China;Armed police characteristic medical center,Tianjin 300171,China;Tianjin CancerHospital,Tianjin 300060,China)
出处
《中国卫生法制》
2023年第3期104-110,共7页
China Health Law
关键词
医疗损害鉴定
高风险药物治疗
药物不良反应
Medical injury identification
High-risk drug treatment
Adverse drug reactions
