426份知情同意书缺陷分析

Analysis of Defects of 426 Informed Consent Forms

目的查找知情同意书存在的缺陷和改进措施,提高病历质量。方法回顾性分析2009年1月-6月的出院病案38 901份中知情同意书的填写情况。结果 38 901份病案中,知情同意书填写缺陷的病案426份,缺陷率1.10%。结论增强法律意识,规范知情同意书的书写,控制病历缺陷的发生,有利于提高病案质量,防止医疗纠纷发生。

Objectives To find defects and Suggest improvements of informed consent form.Methods Through analysing the the fill-out situation of informed consent form of 38901 medical records from January to June 2009.Results 426 informed consent forms exist defects in 38901 medical records,accounting for 1.10% of the total records.Conclusion We should strengthen the law consciousness,standardize the writing of informed consent form and control the occurrence of defects in medical record,in order to improve medical record quality and reduce medical tangle.