947例儿童预防接种登记文件内容缺陷分析及修正措施

Defect analysis of registration documents for childhood immunization

目的:对儿童预防接种登记文件有效登记差错进行统计,并对差错发生的原因进行分析,提出有效的修正措施。方法:对儿童预防接种信息化管理系统存档的947份资料,利用电话查询方式,对儿童预防接种资料登记内容进行检查,使用自行设计的"有效内容差错登记表"进行统计。结果:研究发现儿童预防接种登记有以"接种信息数据库"代替接种登记簿及辅助资料,或者资料内容填写不全面,造成相关资料缺失的现象。统计资料显示,有效内容登记统计差错816条,占总计数5.40%。样本率与总体率比较,差异具有统计学意义(P<0.01)。结论:儿童预防接种登记文件存在内容缺陷现象,而预防接种登记资料有效内容的不完整性,直接影响工作质量,增加了医疗风险。应建立追踪制度,定期电话抽查,加强工作责任心,做好交接班工作,注重健康宣教及沟通技巧,履行告知职责,定期清点疫苗有效期,登记好疫苗种类、批号、生产厂家。

Objective：The registration documents of childhood immunization were checked to identify errors and mistakes. The authors also raised some corrective measures after cause analysis. Method：Totally 947 archived copies from the vaccination information management system were evaluated by telephone communication. The self-designed checklist was used to check errors or mistakes in the documentations. Results：In this study, the authors found that vaccination information database was used to take place of other vaccination register documents, such as vaccine register book and other supplement information. Some data content was not fully completed, resulting in the absence of relevant information. The number of items with error was 816 （5.4%）.It was much higher than the national regulation request for error rate of childhood immunization documents. Conclusion：Childhood vaccination registration documents have defect phenomenon. The incomplete vaccination registration information may increase medical risk. The tracking system and regular telephone checks should be established. In addition, some effective measures maybe also needed, such as enhancing the responsibility of employees, improving health education and communication skills, regularly checking the out-of-date vaccine, registering the vaccine type, batch lot, and its manufacturer.