[医药卫生]常用急症急救药物的应用.ppt

常用急症急救监测与药物应用 中国人民解放军急救医学中心 上 海 市 创 伤 急 救 中 心 第二军医大学长征医院 ICU 陈德昌 端正思想，热爱护理 三十六行，行行出状元 三分治疗，七分护理 护理工作的错误会带来不可弥补的损失 罗氏芬 克林霉素 罗氏芬 可乐必妥 千里之堤，溃于蚁穴！ 人－是会犯错误！ 上帝－不会犯错误，会宽恕！ “To Err Is Human” Errors caused Deaths In US: 44000-98000 /Year Drew E. Altman, N Engl J Med 2004;351;20 In China: 12900/year ??? Adopted from CAC 1999 Bond CA; (AHA database) 1116 hospitals Errors: 430585 Errors Affected Outcomes: 17338 Occurred in 5.07% of admitted patients 22.7 hr or 19.33 admissions/ Error Medical Errors Survey Pharmacotherapy 2005 Errors Happened in ICU Critical Care Safety Study 391 patients (1 year) 1490 patient-days 277 errors 11% Life-threatening Jeffrey M CCM 2005 Am J Respir Crit Care Med 2010; 181: 134–142 (意向性的医疗计划没有实施或实施失败,或采用错误医疗计划达到某一目的) (医疗处置而非原发病导致的人体伤害) (减轻或治愈或阻断了的不良事件) (不能预防或阻止的医疗错误导致的损害) (正确的医疗处置导致的不可避免的损害) (医疗错误导致的损害由于处置得当在伤害进一步加重前大大减轻了) (医疗错误可能导致损害但没有发生) (医疗错误可能导致损害但在医嘱实施前被阻止了) (医疗错误可能导致损害而且实施了医嘱但由于运气或患者代偿作用没有出 现可检测到的损害) (可能导致损害的错误医嘱已实施于患者,但在伤害发生前患者已恢复) ICU Characteristics 70 ICU in France 1369 Pts March 27, 2006, at 8 A.M., to April 3, 2006, at 8 A.M. Safety Indicator Medical errors: 1192/1369/W At least one medical error:367 (26.8%) patients, 2.1/1,000 patient-days Second occurrences of specific errors: 203/367 (55.3%). The most common medical error: insulin administration, 185.9/1,000 days of insulin treatment Severity of Medical Errors Adverse events: 183 (15.4%) /128 (9.3%)Pts/1192 One or more clinical consequences (n=163) Required one or more procedures or treatments (n= 58) Clinical monitoring: 74/1,192 (6.2%) events Laboratory or radiological investigations: 28/1,192 (2.3%) events Medical or surgical treatment: 30/1,192 (2.5%) events Treatment for organ dysfunction for 2/1,192events Death One after self-extubation Three after delayed surgical tr