MANAGEMENT IN OBSTETRICS SAP在产科风险管理课件.pptVIP

RISK MANAGEMENT IN OBSTETRICS S Arulkumaran Professor Head Division of Obstetrics Gynaecology St.George’s Hospital Medical School University of London Some Definitions Risk: The potential for unwanted outcome (Wilson) Chance or possibility of loss or bad consequence (Oxford dictionary) Clinical Risk Incident: Injury or harm to a patient as a result of care or treatment Near Miss: An incident where there is a potential for harm or injury to a patient Serious Clinical Incident a situation in which one or more patients are involved in an incident which is likely to have: 1. An adverse effect on patients 2. Cause a major disruption to service 3. Attract press/media attention 4. Lead to a legal claim Contingent Liability by Speciality(CNST, 1997) Speciality Accident Emergency Anaesthetics General Surgery Gynaecology General Medicine Paediatrics Obstetrics Orthopaedics Cardiac Surgery Others TOTAL Value ￡million 2.3 2.9 2.1 1.2 1.6 2.9 59.1 1.6 1.5 6.0 81.2 Medical Negligence in the UK Potential claims ￡2.8bn in 1998 Obstetrics - largest claims - ￡1.4bn Handicapped child - sadness for life 38% of claims handled by defence unions Potential Problem Areas : Obstetrics (1) Antenatal Pre-natal diagnosis Labour/Delivery Meconium stained liquor CTG interpretation/fetal blood sampling Decisions to “wait and see” Use of oxytocic drugs Management of previous LSCS Inappropriate use of forceps Shoulder dystocia Analgesia Potential Problem Area : Obstetrics (2) Postnatal Rubella immunisation Anti-D immunoglobulin Guthrie result Contraceptive advice Potential Problem Areas : Gynaecology Complications of surgery Failed sterilisation Delay in diagnosis “Lost” IUCD Retained foreign bodies Why Do Risks Occur? System failures Short cuts Communication breakdowns Ill-defined responsibilities Inadequately trained staff Inadequate policies/procedures/guidelines Poor interagency/interdepartmental working Dishonesty Harvard Study : Hospital Adverse Events Study of 30,000 hospital rec