臨牀透析 Vol.25 No.6(2)


特集名 透析医療における安全性をどう確保するか -- Safety Management
題名 透析医療事故が発生したら,まず何をするべきか
発刊年月 2009年 06月
著者 篠田 俊雄 河北総合病院透析センター
【 要旨 】 医療事故には過失のある場合とない場合がある.事故直後には,応急処置・治療を行いながら,上司や管理者への報告,現場スタッフへの連絡,対策に関する管理者との相談が重要である.被害者あるいはその家族との初回面談では,過失がない場合にも遺憾の意を伝え,明らかに過失があると思われる場合には謝罪するとともに,「何があったか」を報告する.事故調査委員会を設置して,事故原因を究明,再発防止策を検討し,患者・家族に報告する.診療行為中の予期せぬ死の場合,24時間以内に所轄警察署への届出が必要である.診療行為に関連した死亡の調査分析モデル事業の利用も可能である.B型・C型肝炎の院内感染事故の場合は,7日以内に所轄保健所への届出を要する.
Theme Dialysis Safety Management Issues
Title What should we do for safety management after the occurrence of a severe medical incident in the dialysis division ?
Author Toshio Shinoda Dialysis Center, Kawakita General Hospital
[ Summary ] There are many medical incidents which may not necessarily be attributable to management failures. Immediately after the occurrence of a medical incident, it is necessary to make a report to the hospital administration concerning that incident in addition to treat the injury. It is also necessary to consult with both the administration and the medical staff members concerning implementation of countermeasures. During the first consultation with patient's family members, regrets should be expressed in cases not involving failure of medical management. An apology should be made in cases where medical management failure has occurred. The probable cause of the incidentand the countermeasures to prevent similar incidents should be investigated by a hospital committee. A report concerning the detail of the incident and the countermeasures against it should subsequently be provided to family members. In cases involving unexpected patient death, a report must be made within twenty four hours to the appropriate law enforcement authorities. In case involvingin hospital infection with hepatitis B and/or C, a report must be made to the proper public health authorities within seven days of diagnosis.
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