基于司法判决的抗菌药物临床应用纠纷防范策略分析

Analysis of Dispute Prevention Strategies of Clinical Application of Antibiotics Based on Judicial Decisions

目的:探讨基于司法判决的抗菌药物临床应用纠纷防范策略,以促进抗菌药物合理使用,保障医患双方合法权益。方法:检索中国裁判文书网从建库到2021年8月31日与《抗菌药物临床应用管理办法》相关的医疗损害责任纠纷司法判决书。分析案例涉及的医院、患者、纠纷原由、判决理由、判决结果等信息,提出纠纷防范的具体措施。结果:共纳入40份判决书,涉及的纠纷主要为医师无相应的抗菌药物使用权限、医疗机构无抗菌药物使用资质、抗菌药物使用不合理、无抗菌药物使用指征、特殊使用级抗菌药物会诊不规范等。被法院判定医院有责任的27例(67.5%),赔偿金额平均45.1万元/例,二级及以下基层医疗机构案例被判定有责的比例明显高于三级医院。死亡案例34例,占85%,死亡原因与抗菌药物相关9例(26.5%),无关8例(23.5%),不能排除相关性1例(2.9%),未进行尸体解剖无法判定16例(47.1%)。结论:医疗机构应加强抗菌药物临床应用能力建设,通过专业化培训和信息化手段提升抗菌药物应用管理水平,同时,重视患者健康教育,提升公众合理用药意识,从根本上防范纠纷。还应建立简易、高效、公平、公正的纠纷处置机制,维护医患双方权益,降低社会综合成本。

Objective:To discusses the dispute prevention strategies of clinical application of antibiotics based on judicial decisions,so as to promote the rational use of antibiotics and protect the legitimate rights and interests of both doctors and patients.Methods:The judicial judgments of medical damage liability disputes related to the Measures for the Administration of Clinical Application of Antibiotics in China Judgments Online were searched from the establishment of the database to August 31,2021.The hospital,patient,cause of dispute,reason of judgment,result of judgment and other information involved in the case were analyzed,and specific measures to prevent disputes were proposed.Results:A total of 40 judgments were included.The disputes involved were mainly doctors'lack of corresponding permission to use antibiotics,medical institutions'lack of qualification to use antibiotics,irrational use of antibiotics,no indication for use of antibiotics,and non-standard consultation of special use grade antibiotics.In 27 cases(67.5%),the hospitals were judged to be responsible by the court,and the average amount of compensation was 451000 yuan/case.The proportion of cases involving primary medical institutions at level II and below was significantly higher than that at level III hospitals.There were 34 cases of death,accounting for 85%,and the cause of death was related to antibiotics in 9 cases(26.5%)and unrelated to antibiotics in 8 cases(23.5%),and the correlation cannot be excluded in 1 case(2.9%)and cannot be determined without autopsy in 16 cases(47.1%).Conclusion:Medical institutions should strengthen the construction of clinical application capacity of antibiotics,improve the application management level of antibiotics through professional training and information means,pay attention to patient health education,improve the public awareness of rational use of drugs,and fundamentally prevent disputes.In addition,it is necessary to establish a simple,efficient,fair and just dispute resolution mechanism to safeguard the rights and interests of both doctors and patients and reduce the comprehensive social cost.