What is medical ethics: It is a kind of professional ethics. It is the basic code of conduct and guidelines that are closely linked to the professional life of medical personnel, formed in medical practice, guided by social opinion and conscience, and used to adjust the relationship between medical personnel and patients, between medical personnel, and between medical personnel and society.
We must be worthy of: the training of the country, the trust of patients, our own hard work over the years, and the expectations of parents. In a word: to serve the people wholeheartedly.
We should strive to: strive to learn professional knowledge; strive to train ourselves to develop morally, intellectually and physically; strive to train ourselves to become medical, teaching and research-oriented talents.
Should do: self-respect, self-respect, self-love; pay attention to the instrument, grooming, etiquette.
About medical safety
Worldwide problem: Medical errors are the eighth leading cause of inpatient deaths in the United States, with 98,000 Americans dying each year from avoidable medical errors and $29 billion in costs associated with medical errors each year (source: Church Medical Center of Israel, Harvard University Defense Dynamics Research Corporation).
Professor Lucian Leape of Harvard University says: Everyone makes mistakes every day, no one makes mistakes intentionally, making mistakes is not the same as negligence, and we all make mistakes for a reason.
I. Definition of medical malpractice
Statutory definition: It refers to the medical care work, due to the negligence of medical personnel treatment and care, directly caused by the death of patients, disability, tissue and organ damage resulting in functional impairment.
Second, must have the following characteristics.
1, serious adverse consequences ;
2, the violation: pharmaceutical regulations, hospital rules and regulations;
3, the responsible subject is the medical staff
4, subjective negligence.
American scholars believe that the causes of medical errors accidents: work interference, too hasty, physical exhaustion, mood, emotional anxiety, lack of interest, fear.
Third, the causes of medical safety.
(a) human factors: low professional level, insufficient quality of personnel, inexperience
With the improvement of economic and cultural level, the patient’s family requirements and expectations are increasingly high, medical science development, knowledge update quickly.
Case: first child, examined in a secondary hospital before 36W, transferred to a tertiary hospital after 36W, admitted with contractions and water breakage at 40W pregnancy, repeatedly examined for unclear fetal position, hospitalized for 48 hours, family requested ultrasound examination five times and was refused. Morning care, the patient went down, the patient’s hand felt a lump in the vulva, found to be cord prolapse, immediately returned unsuccessfully, asked the director to come to the hospital from home, the fetal heart disappeared, stillbirth, designated as medical malpractice.
(II) Inadequate rules and regulations, unclear responsibilities
Case: The first child, hyperemesis, abdominal pain to the basic hospital, suspected placental abruption, because the night can not do ultrasound, transferred to the higher “tertiary” hospital. The tertiary hospital did not write the medical record, did not check the patient, and could not use the simple clinical means – artificial water breaking. The patient was also transferred to another hospital because of the inability to do ultrasound at night, at which time the fetus died in the uterus, a cesarean section was performed, the uterus had a stroke, and the uterus was removed.
Case: First baby, induced at 41W, unsuccessful. 5pm back to ward. The doctor on duty took over without checking the patient, 6:30pm, 9pm, 0Am called the nurse on duty due to abdominal pain, listened to the fetal heartbeat, anal examination were “normal”, 4Am patient shouted, looked at the patient again, the fetal heartbeat disappeared, the opening of the uterus 4cm, sent to the delivery room, stillbirth.
(C) new medical instruments, equipment, drugs do not know; the necessary equipment measures are not;
For the sake of economic benefits, “bold” work case: patient obstetrician and gynecologist, second child, full term. She was admitted to the hospital at the time of labor, and her water was broken artificially + oxytocin to induce labor, and she was delivered in an emergency, with little bleeding, followed by shock, massive postpartum bleeding, respiratory and cardiac arrest, and diagnosed as hemorrhage due to lack of contractions, and she died in resuscitation. The hospital did not have any necessary knowledge of amniotic fluid embolism, and the hospital did not have the necessary equipment and drugs.
Case: first child, 40W, decreased fetal movement, 4Am admitted to hospital, admission for fetal heart monitoring. The diagnosis was: basically normal. Ultrasound was ordered for exclusion, 8Am handover, director check, all levels of physicians did not listen to fetal heart. 11:30Am ultrasound was done, fetal heart had disappeared. In the appraisal meeting asked the physician on duty to look at the monitoring again, the answer: will not look, did not learn well.
(IV) not serious and irresponsible work
Case: first child, full term, elective cesarean delivery in the morning, did not see the patient before the afternoon shift, the doctor on duty checked the patient: abdominal distension, shock, anemia, massive bleeding in the uterine cavity, weak contractions, postpartum hemorrhage, DIC, hysterectomy, the patient repeatedly complained of chest tightness and uncomfortable after the operation.
(E) Time factor: double shifts, holidays, night shifts, and handover shifts are all high-risk factors
Foreign experts believe that: human biorhythms affect the emergence of accidents, and there are cycles of physical strength, emotional fluctuations and intellectual cycles in the human body. Investigation found that people are in the critical period related to about 50% of accidents related to this.
(F) emotional factors: the so-called know people, not according to the principles
Case: first child, a student who has interned in obstetrics and gynecology. Before delivery, delivery repeatedly said “no lateral incision”, but did not make a record, estimated that the fetus 3600 grams, the result out of the shoulder difficulties, a huge fetus, resulting in brachial plexus nerve injury, sued the hospital, claims.
Fourth, medical safety precautions.
(a) the establishment of sound rules and regulations
Job responsibility system; room inspection system; medical record writing system; resuscitation system; consultation system; medical record discussion system; error accident control system; handover system; first consultation responsible system; 1 technical operation diagnosis and treatment routine system.
(2) Strengthening responsibility and service consciousness
Personal factors: doing things by feeling, too much non-manual labor, no standard to follow, resisting the routine system, working over long hours, too much workload, available information is easy to change.
(C) strengthen the basic skills and not to rely too much on auxiliary diagnosis, especially ultrasound
Case: patient 28 years old, first outpatient menopause 37 days, urine HCG (-) not checked pelvic, diagnosis of menorrhagia, one week later not checked pelvic, ultrasound diagnosis: menorrhagia, clinical diagnosis: delayed menstruation, next day acute abdominal pain, shock, emergency diagnosis of ectopic pregnancy, ordered to do ultrasound, the patient was more critical, admitted to the operating room for surgery, the operation was over, respiratory and cardiac arrest at the entrance of the operating room, resuscitation failed to die.
(D) strengthen communication, can reduce doctor-patient disputes
1, in order to reduce the risk of medical errors to patients, it is necessary to communicate with patients and their families frequently and in a timely and accurate manner.
2.Whenever clinicians know that their responsibilities are high-risk, we should anticipate responsibilities and communicate in a timely manner.
3.Physicians should encourage nurses and inform them when they find unsafe situations; when nurses suggest that physicians see patients, physicians should respond quickly.
4.When dealing with emergency patients, we should communicate and coordinate with doctors of various departments in order to develop timely and effective treatment plans.
Obstetric medical safety: The goal of obstetricians and health care providers worldwide is the same for deliveries, namely the health of the mother and child.
Risk assessment: Identification of high-risk factors that can be improved or treated to reduce complications and improve birth outcomes.
Adverse risk factors: malnutrition; treatment of chronic diseases before pregnancy: diabetes, hypertension; careful calculation of gestational weeks; identification of obstetric complications of previous pregnancies that may recur; identification of genetic risk factors; screening for at least one infectious disease: hepatitis B.
The 5 C’s of risk management.
Compassion
Communication (the more time spent, the less likely it is to result in litigation)
Competence Competence
Charting
Confession