艾滋病病房发生医疗安全不良事件现状及应对策略

Current situation of adverse events of medical safety occurred in AIDS inpatients and countermeasures

目的了解艾滋病住院病房医疗安全不良事件发生率及事件特征,了解其危险因素,提出应对策略。方法回顾性统计本院2017-2018年艾滋病专科病房上报的不良事件,计算发生率;统计不良事件发生类别,分析各类不良事件发生影响因素。结果共发生医疗安全不良事件132例(除外医院感染事件),其中8例为医务人员职业暴露,124例为患者不良事件(124/3554,3.5%),以安全隐患事件、药物不良反应事件、跌倒坠床事件、自杀事件、意外拔管事件为主,发生例数及占比分别为:30例(22.7%),26例(19.7%),20例(15.2%),18例(13.6%),12例(9.1%)。41~50岁年龄段患者发生不良事件概率(4.5%)高于其他年龄段人群,但差异无统计学意义(P>0.05)。18例自杀不良事件占同期收治艾滋病住院患者(3554例)的5.1‰,其中男性4例,占同期收治艾滋病住院男性患者(2762例)的1.4‰,女性14例,占同期收治艾滋病住院女性患者(792例)的17.7‰;女性自杀事件发生率高于男性(P<0.05)。自杀事件发生主要集中在41~50岁年龄段人群。跌倒坠床、意外拔管事件主要发生在年龄>60岁人群,前者集中发生在白天时段;后者易出现在置管3天内,当班工作人员相对较少时。职业暴露8人中6名为护士,工作年限均<2年。结论艾滋病住院病房不良事件发生率较高,且种类繁多,但大多数均为可避免发生事件;医护人员需提高警惕,加强对特殊患者及薄弱环节的管理。

Objective To understand the incidence and characteristics of adverse events of medical safety in AIDS inpatients,and to identify the high-risk factors,so as to put forward countermeasures to reduce the incidence of adverse events.Methods Retrospective statistics of adverse events reported by our hospital’s special AIDS ward during 2017-2018 were performed and the incidence was calculated.The types of adverse event were analyzed including the influence factors of the adverse events.Results A total of 132 adverse events of medical safety occurred(excluding nosocomial infection),among which there were 8 cases of occupational exposure among medical staff,and other 124 cases were all patients’adverse events(124/3554,3.5%).The most common events were 30 cases(22.7%)of safety risk events,26 cases(19.7%)of adverse drug reactions,20 cases(15.2%)of falls or drop from bed,18 cases(13.6%)of suicide events,and 12 cases(9.1%)of accidental catheter removal.The incidence of adverse events in the patients aged 41-50(4.5%)was higher than that in other age groups,with no statistical difference(P>0.05).The majority of suicides occurred mainly in this age group,and the incidence of suicides among the women was 17.7‰,significantly higher than that among men(1.4‰)(P<0.05).Falls and accidental extubation mainly occurred in the people aged over 60 years,with the former mainly in daytime and the latter most likely in the 3 days of tube placement.Those of occupational exposure were nurses(75%)with less than 2 working years.Conclusion The AIDS inpatients have a high incidence of adverse events with various types,and most of them can be prevented.Medical staff need to be careful and the management should be strengthened to provide medical services.