法制内化于心风险防范于行

RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYHUBEIGENERALHOSPITALHUBEIGENERALHOSPITALHUBEIGENERALHOSPITAL湖湖北北省省人人民民医医院院武汉大学人民医院武汉大学人民医院法制内化于心法制内化于心法制内化于心法制内化于心风险防范于行风险防范于行风险防范于行风险防范于行武汉大学人民医院医疗部武汉大学人民医院医疗部吴吴凡凡20122012年年1212月月2RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��医疗风险：指医疗行为可能引起患者机体、生医疗风险：指医疗行为可能引起患者机体、生理、心理的客观变化而导致的不良后果理、心理的客观变化而导致的不良后果��产生原因产生原因－－－疾病复杂性－－－疾病复杂性－－－个体差异性－－－个体差异性－－－预后难测性－－－预后难测性－－－管理与治疗水平的差异性－－－管理与治疗水平的差异性3RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY医疗事故高发的趋势��16.6%ofhospitaladmissionswereassociated16.6%ofhospitaladmissionswereassociatedwithanadverseeventwithanadverseevent��51%ofAESwerejudgedtobepreventable51%ofAESwerejudgedtobepreventable��46.6%ofAESresultedinminimaldisability46.6%ofAESresultedinminimaldisability��4.9%ofAESresultedindeath4.9%ofAESresultedindeath4RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��很少的错误很少的错误��很小的疏失很小的疏失��很大的损害很大的损害��损害不可弥补损害不可弥补5RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY医疗安全与事故发生的模式SituationalfactorLatentfailureActivefailureSafetybarrierAccident工作性质工作环境个人因素病人因素医疗体系医院管理工作环境团队因素人为错误6RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY7RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY按医疗过程分��诊断缺陷诊断缺陷��治疗缺陷治疗缺陷��护理缺陷护理缺陷��感染缺陷感染缺陷��服务服务缺陷缺陷��后勤缺陷后勤缺陷8RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY依法执业9RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY卫生法律��《《执业医师法执业医师法》》��《《侵权责任法侵权责任法》》��《《药品管理法药品管理法》》��《《献血法献血法》》��《《民法通则民法通则》》��《《传染病防治法传染病防治法》》��《《母婴保健法母婴保健法》》10RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY执业医师法11RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��执业类别：中医执业类别：中医((中西结合中西结合))、临床医学、临床医学��取得相应的资质取得相应的资质��在注册的执业范围内，进行医学诊查、医学处置在注册的执业范围内，进行医学诊查、医学处置（（2121条）条）��医师手术权限医师手术权限（四级腔镜、器官移植）（四级腔镜、器官移植）��心电、超声诊断人员的资质心电、超声诊断人员的资质��超范围执业超范围执业12RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��医师必须亲自诊查、调查，并按照规定及时填写医学医师必须亲自诊查、调查，并按照规定及时填写医学文书（第二十三条）　文书（第二十三条）　��对急危患者，医师应当采取紧急措施进行诊治；不得对急危患者，医师应当采取紧急措施进行诊治；不得拒绝急救处置（第二十四条）拒绝急救处置（第二十四条）��医师应当使用批准使用的药品、消毒药剂和医疗器械医师应当使用批准使用的药品、消毒药剂和医疗器械（第二十五条）　（第二十五条）　��应如实介绍病情，但应注意避免对患者产生不利后果应如实介绍病情，但应注意避免对患者产生不利后果��实验性临床医疗应得到医院批准和患者或其家属同意实验性临床医疗应得到医院批准和患者或其家属同意（第二十六条）（第二十六条）13RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY处罚��违反卫生行政规章制度或者技术操作规范违反卫生行政规章制度或者技术操作规范��由于不负责任延误急危患者的抢救和诊治由于不负责任延误急危患者的抢救和诊治��造成医疗事故的造成医疗事故的��未经亲自诊查、调查，签署诊断、治疗、流行病学等未经亲自诊查、调查，签署诊断、治疗、流行病学等证明文件或者有关出生、死亡等证明文件的证明文件或者有关出生、死亡等证明文件的��隐匿、伪造或者擅自销毁医学文书隐匿、伪造或者擅自销毁医学文书14RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY15RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��隐私权隐私权��名名誉权誉权��生命权生命权��身体权身体权��知情权知情权��选择权选择权��获得与所在地医疗水平相适应医疗权利获得与所在地医疗水平相适应医疗权利16RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY17RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY18RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY19RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��临床路径临床路径��诊疗常规（侵权责任法第诊疗常规（侵权责任法第5858条第条第11款）款）��尽到与诊疗水平相关的义务（尽到与诊疗水平相关的义务（5757条）条）��严格掌握手术禁忌严格掌握手术禁忌��不得过度医疗不得过度医疗��不得过度检查（第不得过度检查（第6565条）条）20RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY《中华人民共和国传染病防治法》��预防为主的方针预防为主的方针��防治结合防治结合��分类管理分类管理��依靠科学依靠科学��依靠群众依靠群众21RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY传染病防治法��普通医院收治传染病病人普通医院收治传染病病人��传染病院收治没有救治能力的传染病人传染病院收治没有救治能力的传染病人��妊娠合并妊娠合并H1N1H1N1感染的管理感染的管理��艾滋病患者的管理艾滋病患者的管理22RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY医疗机构职责��实行传染病预检、分诊制度实行传染病预检、分诊制度��对传染病病人、疑似传染病病人，应当引对传染病病人、疑似传染病病人，应当引导至相对隔离的分诊点进行初诊导至相对隔离的分诊点进行初诊��不具备相应救治能力的医疗机构应患者转不具备相应救治能力的医疗机构应患者转诊诊��认真执行传染病的报告制度认真执行传染病的报告制度23RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY卫生管理的法规��《《医疗机构管理规定医疗机构管理规定》》��《《病历书写基本规范病历书写基本规范》》��《《医院感染管理办法医院感染管理办法》》��《《医学教育临床实践管理暂行规定医学教育临床实践管理暂行规定》》��《《医师外出会诊管理暂行规定医师外出会诊管理暂行规定》》��《《处方管理办法处方管理办法》》��《《医疗事故处理条例医疗事故处理条例》》24RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY25RENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITYRENMINHOSPITALOFWUHANUNIVERSITY��保护患者的知情同意权、隐私权（第七条）保护患者的知情同意权、隐私权（第七条）��告知患者以配合临床实践活动（第七条）告知患者以配合临床实践活动（第七条）��不得独自开展临床诊疗（第十四条）不得独自开展临床诊疗（第十四条）��文字材料经审核签名后作为正式医疗文件文字材料经审核签名后作为正式医疗文件26RENMINHOSPITA