应用PDCA循环法对医疗安全不良事件持续改进的效果  

Application of PDCA Cycle Method to the Continuous Improvement of Medical Safety Adverse Events

作　　者：罗金梅[1] 黄洁[1] 彭清艳 朱凌燕 李瑞八 宋洁 高华斌[1] LUO Jin-mei;HUANG Jie;PENG Qing-yan;ZHU Ling-yan;LI Rui-ba;SONG Jie;GAO Hua-bin(Medical Department,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院医务部,云南昆明650032

出　　处：《医学信息》2020年第14期137-139,共3页Journal of Medical Information

摘　　要：目的分析我院医疗安全不良事件的上报情况,为制定有针对性的持续改进措施提供可靠依据。方法收集我院2016~2018年在院内信息系统主动上报的1796例医疗安全不良事件,对上报等级、类别、科室分布进行回顾性分析。结果近三年我院医疗安全不良事件的上报例数呈逐年上升趋势;医疗安全不良事件上报等级的频数分布比较,差异有统计学意义(P<0.05);医疗安全不良事件上报类别的频数分布比较,差异有统计学意义(P<0.05);医疗安全不良事件上报科室的频数分布比较,差异有统计学意义(P<0.05)。结论通过建立非惩罚性、主动上报的医疗安全不良事件院内信息直报系统,运用PDCA循环定期对获取的医疗安全信息、不良事件进行分类汇总分析,有利于发现存在的不足,提出改进措施,建立绩效激励机制,有助于提高医疗安全不良事件上报率,降低漏报率,促进医疗质量持续改进,有效避免医疗差错与纠纷,保障病人安全。Objective To analyze the report of medical safety adverse events in our hospital,and provide a reliable basis for the develop continuous improvement measures in a targeted manner.Methods A total of 1796 medical safety adverse events voluntarily reported by the information system of our hospital from 2016 to 2018 were collected,and a retrospective analysis was conducted on the grades,classifications and departments.Results The number of reported cases of medical safety adverse events in our hospital has increased year by year in the past three years;the frequency distribution of medical safety adverse event reporting levels has been compared,and the difference is statistically significant(P<0.05);categories of medical safety adverse event reporting Compared with the frequency distribution,the difference was statistically significant(P<0.05);compared with the frequency distribution of medical safety adverse events reported to the department,the difference was statistically significant(P<0.05).Conclusion Through the establishment of a non-punitive,proactive reporting of medical safety adverse events in-hospital information direct reporting system,the PDCA cycle is used to periodically classify and summarize the obtained medical safety information and adverse events,which is helpful to find the existing deficiencies,propose improvement measures,and establish performance The incentive mechanism helps to increase the reporting rate of medical safety adverse events,reduce the rate of missed reports,promote continuous improvement of medical quality,effectively avoid medical errors and disputes,and ensure patient safety.

关 键 词：PDCA 医疗安全不良事件 持续改进 

分 类 号：R197.323[医药卫生—卫生事业管理]