Quality improvement in the health care system: Prevention of and dealing with adverse events [Qualitätsmanagement im gesundheitswesen: Fehlerprävention und umgang mit fehlern in der medizin]

被引：0

作者：

Ollenschläger G. ^{[1
]}

Thomeczek C. ^{[1
]}

机构：

[1] Ärztliche Zentralstelle Qualitätssicherung, Köln

来源：

Medizinische Klinik | 2002年 / 97卷 / 9期

关键词：

Adverse events; Clinical guidelines; Error management; Quality improvement;

D O I：

10.1007/s00063-002-1197-x

中图分类号：

学科分类号：

摘要：

Background: About 3.7% of in-house-treated patients in Switzerland, the USA and Australia are victims of treatment-related health problems which probably are related to avoidable "adverse events" in more than 50% of the occurrences. Reasons are primarily systematic incidents, e.g., organizational deficiencies in the health system and only secondarly individual mistakes. As there are no systematic studies available, it is not proven if those figures can be transferred to the German Health Care System. Here, experts anticipate up to 12.000 proven treatment errors per year. Prevention of and Dealing with Adverse Events: Dedicated programs for identification and prevention of adverse events should be implemented - besides systematic quality improvement - to improve professional handling and prevention of adverse events. This consists of a) assessment of the existing problem using existing data bases and/or implementation of mandatory documentation and information routines as well as reporting systems, b) development of sanction-free reporting routines within the legal framework, c) dissemination ofbehavior-oriented training systems for recognition and prevention of adverse events as well as incentives for the participation in such training systems, d) implementation of automatic routines for prevention of adverse events (e.g., computer-based monitoring of ADE or computer-based reminder systems based on clinical guidelines).

引用

页码：564 / 570

页数：6

共 44 条

[1]

Kohn L.T., Corrigan J.M., Donaldson M.S., To err is human. Building a safer health system, (1999)

[2]

Leape L.L., Berwick D.M., Safe health care are we up to it?, BMJ, 320, pp. 725-726, (2000)

[3]

Schwerpunktheft, Br Med J, 7237, (2000)

[4]

Rall M., Manser T., Guggenberger H., Gaba D.M., Unertl K., Patientensicherheit und fehler in der medizin. Entstehung, prävention und analyse von zwischenfallen, Anästhesiol Intensivmed Noffallmed Schmerzther, 36, pp. 321-330, (2001)

[5]

Ollenschlager G., Medizinische risiken, fehler und patientensicherheit. Zur situation in Deutschland, Schweiz Ärzteztg, 82, pp. 1404-1410, (2001)

[6]

Schwerpunktheft "Behandlungsfehler, Z Ärztl Fortbild Qualitätssich (ZaeFQ), 95, 7, (2001)

[7]

Thomeczek C., Fehlerquelle "Mensch, Berhner Ärzte, 38, pp. 12-16, (2001)

[8]

Brennan T.A., Leape L.L., Laird N.M., Hebert L., Localio A.R., Lawthers A.G., Newhouse J.P., Weiler P.C., Hiatt H.H., Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study - I, N Engl J Med, 324, pp. 370-376, (1991)

[9]

Weingart S.N., Wilson R.M., Gibberd R.W., Harrison B., Epidemiology of medical errors, Br Med J, 320, pp. 774-777, (2000)

[10]

Gawande A.A., Thomas E.J., Zinner M.J., Brennan T.A., The incidence and nature of surgical adverse events in Colorado and Utah in 1992, Surgery, 126, pp. 66-75, (1999)

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