Hospital Emergency Plan (a)
I. Purpose
1, in order to safeguard the legitimate rights and interests of patients and medical personnel, to ensure medical safety, minimize medical errors and accidents, according to the State Council promulgated the "Regulations on the Treatment of Medical Accidents", "Regulations on the Management of Medical Institutions" and other laws and regulations, this plan is formulated.
Second, the precautionary measures
1, strengthen the legal education, strengthen the legal knowledge of medical staff learning and training, enhance the work of medical staff responsibility, so that the practice of law.
2, strengthen the professional ethics education, improve quality service, do warm reception of patients, take the initiative to communicate with patients and their families, patiently explain, adhere to the principles of medical care, adhere to the clean practice of medicine, shall not be used for personal gain.
3, strengthen the medical staff of business learning and continuing education, and constantly improve the business quality of medical staff, can be sent out to study, further training, training and please well-known experts to the hospital teaching and other ways to improve the hospital's overall level of business and technical skills and the ability to work in practice, and to better improve the quality of hospital health care, improve the medical staff and the hospital as a whole to prevent medical disputes, the ability to prevent accidents.
4, sound prevention of various management systems, strengthen the implementation of the system management. The hospital's rules and regulations are to ensure that the normal medical order, improve the quality of medical care, to prevent medical accidents important measures. Medical personnel should seriously implement the rules and regulations and operating procedures, strictly according to the system, according to the procedures. The hospital's management should often check the implementation of the system in each department.
Third, the precautionary provisions
1, the clinical, medical technology and related departments must focus on "patients first, medical quality first, medical safety first" purpose, improve the quality of medical care to ensure that the implementation of the rules and regulations.
2, a variety of rescue equipment should be maintained in good condition, to ensure that at any time into use. According to the resources *** enjoy, special emergency equipment *** with the principle, the medical department has the right to deploy according to the clinical emergency needs.
3, from the maintenance of the overall situation, between departments, between medical and nursing, clinical and medical technology, outpatient and emergency, outpatient, emergency and wards should cooperate with each other, is strictly prohibited in front of the patient to slander other people and other sections of the behavior is not in line with medical ethics.
4, in any case, the physician who has not obtained the license to practice medicine, training and internship are not allowed to practice independently.
5, to strengthen the following key patients and communication:
(1) low-income class of patients;
(2) widowed elderly or children are not around;
(3) in contact with the medical staff have been dissatisfied;
(4) expected surgery and other treatments are not good;
(5) I have too high expectations of the treatment;
(5) I have a high expectation of
(6) Those who have difficulty in understanding the explanation of their condition;
(7) Those who have signs of or have had nosocomial infections;
(8) Those whose condition is complicated and whose information suggests that there may be a dispute;
(9) Those who have insufficient pre-payment for hospitalization;
(10) Those who have incurred unpaid medical bills;
(11) need to use expensive drugs or materials;
(12) due to traffic accidents may shift the blame;
(13) featured identity of the patient;
6, for the emergence of doctor-patient disputes have arisen, the director of the department must be personally inquired about and to decide on the next step in the diagnosis and treatment of measures. Arrangements for specialists to receive patients and their families, other personnel shall not be arbitrary interpretation of the condition.
7, the examination must have strict relevance, rational arrangement of the examination and procedures and order. Attach importance to the regression of the disease and prognosis of the important significance of the examination and laboratory tests, the results should be carefully analyzed and properly stored.
8, the rational use of drugs, pay attention to drug contraindications and adverse drug reactions, special attention to the elderly and children's drug safety, prohibit the use of quinolone drugs in people under 18 years of age. Strictly grasp the indications of the drug, strictly prohibit the abuse of antibacterial drugs, the third generation of cephalosporin antibiotics generally not preventive use.
9, pay attention to the prevention and control of nosocomial infections, give full play to the role of hospitals, departments and infection control personnel, for nosocomial infections have occurred in a timely manner to register the report, shall not be concealed, and obey the technical guidance of the professionals.
10, blood transfusion must be carried out before HIV, HCV, HBSAG and syphilis serum antibodies and other checks. The blood bag after transfusion is handed over to the Blood Transfusion Department for unified custody and can be destroyed only after 7 days.
11, the medical and technical departments in the invasive examination, must be equipped with rescue equipment, and to ensure that at any time available with the same, in the emergency examination application must be arranged as soon as possible. Emergency laboratory test results are issued within 30 minutes after receiving the specimen (except for individual test items). Emergency X-ray and CT examination must be completed in time. Pharmacy Department to ensure that the normal purchase channels and quality of drugs, to ensure that the rescue drugs and into place.
12, medical record writing. Strictly in accordance with the "Regulations on the Treatment of Medical Accidents", "Chinese People's *** and State Practitioners Law" requirements for writing. Strictly prohibit alteration, paste, scraping, forgery, concealment and destruction of medical records.
Inpatient medical records:
(1) medical records must be written in accordance with national regulations and February 4, 2010, Wei Medical Development Medical Government issued (2010) No. 11, "the basic norms of cause of illness writing" requirements for writing. The attending physician in each ward must promptly check the quality of the medical records of subordinate physicians.
(2) the first page is filled out completely;
(3) the head of the department is responsible for the quality of the final book of the medical record, and the superior physician is responsible for the quality of the medical record writing and management of the operation of the various aspects of the medical record;
(4) each department must take seriously the unqualified medical records issued by the quality control section, and improve the medical record within 3 days;
(5) inpatient medical records must be completed within 24 hours.
(5) The hospitalized medical records must be completed within 24 hours.
(6) The attending physician must check on the newly admitted patients within 48 hours, and reflect the checking opinion in the medical record;
(7) The day of the admission of emergency critical patients, the second day of the admission of sick patients, outpatient general patients within three days of the admission of the doctor must have a deputy chief physician or above to check on the patient, and reflected in the medical record.
(8) The other contents of the inpatient medical record refer to the "Basic Standard for Medical Record Writing";
(9) The signature of the attending physician for the final medical record must be completed at the same time the patient is discharged.
(10) the director of the final medical record signature must be completed within five days of the patient's discharge;
(11) the death of the medical record discussion must be completed within one week of the patient's death.
(12) surgical records must be completed within 24 hours after surgery, the surgeon must personally write or review the surgical record and sign;
(13) resuscitation records, such as the failure to write in time to complete, must be in the end of the resuscitation within 6 hours of the actual record.
(14) a variety of test reports, images, pathology reports and a variety of signature sheets and other information must be properly preserved, not lost. Borrowing must be registered for the record, and returned in a timely manner;
(15) to stop patients and relatives without permission, randomly reviewing medical records;
(16) staff shall not be privately borrowing and copying medical records for patients and relatives;
(17) to keep hospitalized medical records, to prevent loss.
Outpatient medical records
(1) must use xxxx hospital outpatient medical records;
(2) outpatient (emergency) medical records include outpatient medical records home page, medical records, laboratory tests (examination reports), medical imaging data;
(3) outpatient (emergency) medical records cover includes name, gender, date of birth, occupation, marriage, nationality, Drug allergy history, address, telephone;
(4) outpatient (emergency) medical records are divided into initial medical records and follow-up medical records. Initial medical records include medical institutions, departments, consultation time (emergency medical records should be specific to the minute). The main complaint and current medical history, past history, personal history/family history, menstrual history, marriage and childbearing history, trauma/surgery history, signs, auxiliary examination, diagnostic and treatment opinions and physician's signature, date;
follow-up medical records, including the medical institution, department, time of consultation, the main complaint and current history, signs and auxiliary examination, diagnostic and treatment opinions and physician's signature, date, etc.;
(5) outpatient (emergency) medical records should be written by the medical institution, department, time of consultation (emergency records should be specific to the minute), the time of consultation should be specific to the minutes. (5) outpatient (emergency) medical records should be completed by the receiving physician in a timely manner during the patient's visit;
(6) rescue of critically ill patients, should be written rescue records. For patients admitted to the emergency observation room, the observation record should be written during the observation period;
(7) the prescription must be in line with the relevant provisions of the prescription management;
(8) outpatient medical records by the patient's own custody;
13, the admission of patients
(1) the implementation of the admission of patients in the emergency priority, specializing in specialized treatment principle. Prohibit the blind admission of patients between departments resulting in delayed diagnosis and treatment and medical disputes;
(2) for chronic diseases and critically ill patients, each department must be in the interests of the condition and the patient as the starting point, shall not be refused to accept patients with a variety of interfaces;
(3) where the specific beds of the specialty or ward, shall not be refused to accept patients with borrowed beds of other departments with any interfaces;
(4) the patients in the When hospitalized, sign the "Informed Consent for Hospitalization" and a power of attorney, and his or her principal is responsible for acting on behalf of the patient to fulfill the right to know and the right to choose during the hospital period;
14, three-level checkups and consultations
(1) three-level physician checkup system is an important measure to ensure medical safety and prevent medical risks, and physicians at all levels must be strictly enforced;
(2) for general patients. (2) For general patients, resident physicians check the room twice a day, attending physicians check the room once a day, and the director (deputy director physician) check the room 1-2 times a week;
(3) For key (critical) patients, the room must be checked in a timely manner and rounds;
(4) For the critically ill and complex cases, and for patients with potential medical disputes, it is necessary to report to the Department of Medical Services in a timely manner, and to organize in-hospital consultations, and if necessary, to invite experts from outside the hospital for consultations.
(5) Pediatric consultation is required before admitting patients under 14 years old;
(6) Emergency duty physician must be a resident for 3 years or more;
(7) Emergency consultation within the hospital, the consultation physician must be in place in 10 minutes, general consultation, the consultation physician is in place in 24 hours, and complete the consultation record in 48 hours;
(8) Emergency consultation is required to be in place in 10 minutes, the consultation physician must be in place in 48 hours;
(9) Emergency consultation is required to be in place in 10 minutes. /p>
15, preoperative discussion
(1) hospitalization during major surgery must be reported to the Medical Department, the Medical Department is responsible for organizing, convening the relevant departments preoperative discussion. Medium-sized surgical cases must undergo preoperative departmental discussion (except for emergency and rescue surgery cases), detailed records in the medical record, the operator must participate;
(2) prohibit preoperative discussion instead of the three-level checkup;
16, the content of the patient's informed consent is as follows:
(1) diagnosis of the disease, the proposed implementation of the examination, therapeutic measures, prognosis, unavoidable Treatment of contradictions, outpatient treatment of the toxic side effects of drugs, hospitalized patients in charge of the physician, attending physician and the corresponding director of the department (chief physician or deputy chief physician);
(2) examination, treatment measures are likely to produce adverse consequences and correct the adverse consequences of the further measures that may be taken, inpatient treatment of the toxic side effects of mandatory drugs.
(3) the need to retain internal materials during surgery;
(4) the situation of out-of-pocket expenses in medical costs;
(5) the implementation of surgery, anesthesia and other invasive operations;
(6) the discovery of foci of disease inconsistent with the preoperative diagnosis during surgery;
(7) the need to remove organs and tissues that have not been accounted for to the patient in the preoperative period during surgery
(8) Critically ill patients need to be moved due to special examinations that may cause danger;
(9) Blood transfusion, imaging, intervention, radiofrequency, tracheotomy, chemotherapy, etc.;
(10) Other content to be understood by the patient or his family;
The above 3-10 should be documented in writing and the signature of the patient or the delegate.
Fourth, the reporting system and emergency treatment
1, once the occurrence of medical errors and accidents, you need to immediately notify the supervising physician and department director, and at the same time report to the Medical Department (during the daytime), the hospital general duty (night, holidays), and shall not be concealed. And actively take remedial measures to avoid or mitigate further damage to the patient's health and save the patient's life as much as possible. Errors and accidents caused by nursing factors, in addition to reporting according to the above procedures, and at the same time in accordance with the nursing system level by level;
2, by the functional department to organize the department head to find the cause;
3, by the medical department to organize a multi-disciplinary consulting, to participate in the consulting staff is the highest level of physicians on duty;
4, the department head and the medical department to decide to receive the patient's family members, designate a special person to Explanation of the condition;
5, according to the family requirements, the medical department combined with the situation, whether to seal the "Regulations on the Treatment of Medical Accidents," the contents of the medical records;
6, suspected transfusion, blood transfusion, injections, medications caused by the adverse effects of the functional departments in the case of the presence of the patient or family members*** with the immediate sealing of the physical, the physical by the hospital for safekeeping.
7, such as the death of the patient, the family should be mobilized to carry out an autopsy, and recorded in the medical record;
8, such as the patient needs to be transferred to the Department of treatment, the departments must make every effort to collaborate;
9, the department concerned shall be written within 24 hours on the fact that after the report, and at the same time put forward a preliminary view of the treatment, reported to the Medical Department;
10, the smallest part of the medical dispute, the patient can not be satisfied due to the unreasonable demands of the patient, the patient can not be satisfied, the patient can not be satisfied. Due to the patient's unreasonable requirements can not be met and take radical behavior, such as cursing, siege, assault on medical personnel, blocking the door and other disruptions to the public **** order, resulting in the hospital's . The normal medical order of the hospital is destroyed, the hospital's medical work is seriously affected, the hospital will mobilize the hospital security, in order to maintain the normal work of the hospital, order, and contact with the Xiaofuqiao police station, 110, the Office of Comprehensive Governance and the police; reported to the competent authorities and the relevant departments of the local government (the Office of Letters and Visits, Emergency Response Office, the Street Office, the community, etc.), and request the relevant departments to assist in the handling of disputes.
Hospital emergency plan (2)
To prevent medical disputes, medical accidents, properly handle medical disputes, medical accidents, the development of this plan:
First, the hospital set up a medical disputes, medical accidents, leading group:
Leader: President Xu Xianglin
Vice Chairman: Vice President Wang Ju
Members: Lei Jiming, Liu Jigui, Huang Guanghua, Liu Xiunian, Yang Xiuqiong, Zhou Anning, Yin and step, Zhang Jian, Yu Shui, Huang Lingzhi, Liu Yanhui
The establishment of medical disputes, accidents in the medical office.
Second, the plan:
1, medical staff in medical activities or found medical errors, or may cause medical errors in medical behavior negligence, should be immediately reported to the head of the department, the head of the department should promptly report to the Medical Section. After receiving the report, the medical department shall investigate when to the department concerned, report the relevant situation to the dean, and together with the head of the department concerned, make a good explanation to the affected party;
2. Medical malpractice resulting in the death of a patient, medical malpractice which may be above the second degree and medical malpractice resulting in more than 3 persons' personal injury, the dean or the authorized person shall report the case to the medical administration section of the Mianyang Municipal Bureau of Health within 12 hours. . After the occurrence of medical malpractice or serious medical disputes, the media interviews, lawyers to obtain evidence or other organizations, personnel request to understand the situation, by the hospital to arrange for a person responsible for the reception of the explanation;
3, after the occurrence of medical malpractice or serious medical disputes, the relevant clinical and medical technology departments and the relevant functional departments should be in the unified arrangement of the Medical Department to cooperate with the patient's side of the both yes and persuade the work of mitigating the contradiction between the doctor and the patient. The medical department shall cooperate with the patient's side under the unified arrangement of the medical department to persuade the patient and alleviate the conflicts between doctors and patients. If the incident of hospital working order occurs, it should be reported to the Defense Section immediately. The major events that may lead to vicious cases, should immediately report to the Municipal Health Bureau and the public security organs;
4, clinical and medical departments occurred or found medical negligence, departments and medical staff in the report at the same time, should immediately take effective measures to avoid or mitigate the damage to the patient's physical health, to prevent the damage from expanding;
5, the hospital set up a rescue team of medical damage, the team consists of all clinical and medical staff, and the team is composed of a team of medical staff and medical staff. The group is composed of the heads of clinical and technical departments.
Leader: Wang Ju
Deputy Leader: Liu Jigui
Members: Zhou Anning, Yin and step, Zhang Jian, Liu Yanhui, Huang Lingzhi, Yu Shui, Liu Xiujun, Zhang Zhenxiang, Pang Huahui, mother Zequan, Jiang Yihua, Wang Zhengfa
Medical damage rescue group is responsible for the medical accident or other emergencies within the scope of the rescue work. Requirements of the rescue group members should arrive at the scene immediately after the notice of consultation and rescue.
6, the patient asked to copy or copy the medical records, should be proposed by the patient himself; the patient's family, should be signed by the patient's own power of attorney, or proof of relationship; the patient's attorney, should be acting on behalf of the law firm's official letter, attorney's license and other proof. The content of the copy includes outpatient medical records, admission records, temperature, medical orders, laboratory tests (test reports), medical imaging data, special examination consent, surgical consent, surgery and anesthesia records, pathological information, nursing records and other medical records stipulated by the Ministry of Health and other objective medical records;
7, the patient wants to photocopy the patient's medical record information, the patient's office by the special person in conjunction with the Department of Medical Science Handling. When copying, there should be a patient or family member present. After copying, stamped, and signed by the patient himself or his family or his lawyer entrusted in the registration book;
8, medical disputes and medical errors, the patient asked to copy the medical records, the death of the case discussion records, difficult case discussion records, the superior physician's examination records, consulting opinions, the course of the record shall not be photocopied. Instead, they shall be sealed in the presence of both the patient and the doctor, and kept under the supervision of the chief of the medical section. Medical records that are being used for treatment shall not be sealed in their original form, but may be sealed in photocopies. When unsealed, the doctor and the patient should be present.
9, the patient's adverse effects may be transfusion, blood transfusion, injections, drugs, etc., the scene of the physical should be sealed, sealed by the hospital to send a person to keep the scene of the physical, sealed and unsealed in the presence of the patient or his family. Need to test, the medical department and the patient both **** with the agreement to designate the test qualification of the testing organization to carry out the test. If the patient and the patient can not reach **** understanding, apply for the designation of the Municipal Health Bureau. Suspected transfusion of blood caused by adverse consequences, the need for blood on-site sealing and retention, immediately notify the Mianyang Municipal Blood Center to send staff to the scene;
10, if the patient died, the department should be promptly sent to the family of the death notification, and asked to sign on the stub. When the cause of death cannot be determined or there are objections to the death trap, the department should tell the patient's family to perform an autopsy within 48 hours of the patient's death; at the same time, the conversation will be recorded. If the autopsy is refused or delayed, the department should be held responsible if the time limit is exceeded, which affects the determination of the cause of death. Autopsy should be agreed and signed by the next of kin of the deceased;
11, the medical association accepts the technical appraisal of medical malpractice, the medical department in the receipt of the medical association's notification of the date of the submission of technical appraisal of medical malpractice within 10 days of the information, a written statement and defense, including the following:
(1) inpatient medical records, records of discussion of the death of the case, the record of the discussion of the case of difficulty, consultation opinions, records of room visits by supervising physicians and other original medical records;
(2) admission records of hospitalized patients (hospitalization records), temperature slips, medical prescription slips, laboratory slips (test reports), medical imaging data, special examination consent, surgical consent, surgical and anesthesia record slips, pathological data, nursing records and other original medical records;
(3) rescue of patients with acute and critical illnesses. In the specified time to make up the original medical records;
(4) sealed and retained infusions, injections and blood, drugs and other objects, or the test qualification of the testing organization in accordance with the law on these items, the physical test report;
(5) and other materials related to the technical appraisal of medical accidents.
12, such as medical malpractice technical appraisal of objections, will apply for re-identification. Hospitals and patients can resolve medical disputes through consultation.
13, the negotiated settlement of compensation should take into account the level of medical malpractice, medical negligence in the consequences of medical malpractice in the degree of responsibility, the consequences of medical malpractice and the patient's pre-existing disease conditions between the relationship and so on. The scope and amount of compensation shall be determined in accordance with the provisions of the "Regulations on the Treatment of Medical Accidents", shall not expand the scope and amount of compensation;
14, negotiated settlement of compensation for medical malpractice, to create a letter of agreement. The agreement should be noted that the basic situation of doctors and patients and the causes of medical malpractice, doctors and patients *** with the determination of the level of medical malpractice and the amount of compensation determined by negotiation, etc., and signed by both parties on the agreement. The patient side of the signature is generally signed by the patient himself, the patient himself can not sign, by the patient's next of kin or entrusted to authorize the signature of other relatives;
15, and the patient side of the negotiated settlement, from the date of negotiated settlement within 7 days of the Medical Section to the Municipal Bureau of Health to make a written report, with a letter of agreement.
16, if the negotiated settlement fails to negotiate with the affected party, apply for mediation of the Municipal Health Bureau, and submit the relevant materials, the Municipal Health Bureau mediation is successful, in accordance with the requirements of the mediation to fulfill. One-time compensation amount of more than 10,000 yuan, must be ruled by a third party or the court;
17, the affected party to the people's court to file a civil lawsuit, the hospital will actively organize the force, ready to respond to the lawsuit. And make the following preparations:
(1) Determine the litigation agent;
(2) Write and submit a defense;
(3) Apply for technical appraisal of medical malpractice;
(4) Collect the relevant information and evidence;
(5) Collect the witness testimonies;
(6) Collect the relevant technical and managerial norms;
(7) Collection of relevant medical literature;
18. After the mediation or judgment of the People's Court has come into effect, within 7 days from the date of receipt of the mediation or judgment of the People's Court that has come into effect, the Department of Health of Mianyang Municipality shall make a written report to the Department of Health of Mianyang Municipality, with the mediation or judgment attached;
19. After the handling of the medical malpractice has been completed, the Department of Medical Services shall file all the information and shall give an explanation on the occurrence of the medical malpractice. Medical malpractice section and the relevant personnel in accordance with the hospital defects management regulations and the handling of medical disputes related provisions of the proposed treatment;
Third, the process:
1, medical complaints occur, the section should be immediately reported to the Medical Section, concealment of non-reporting, will bear all the consequences that may arise;
2, disputes caused by medical problems, the director of the department should be the first investigation Reception of disputes with the patient, listen carefully to the views of the patient, for the patient's views to explain the problem, if the patient can accept, the complaint acceptance stops here;
3, the functional department received the report of the department or the patient's complaint, should be immediately to the department concerned to understand the situation, and the director of the department **** with the negotiation of the solution, if the patient can be accepted, the complaint processing stops here. If the patient can not be accepted, the patient's understanding of the problem and requirements to provide written materials, and then find the person responsible for investigating and understanding the details of the problem, to propose solutions to the problem, and to report to the Vice President in charge of the consultation with the patient to deal with the views of the patient, such as acceptance of the patient, the handling of the end of the process.
4, the functional departments have been received, but still can not be resolved medical disputes, it is recommended that the affected party in accordance with the statutory procedures for medical identification. The department concerned within three days to memorize the required case summary, the original case, relevant information and departmental opinions.
5, such as the affected party to the court after the lawsuit, the parties, lawyers, functional departments to appear in court;
6, according to the nature of the dispute on the departments and individuals involved in accordance with the ministry of rewards and punishments regulations;