I. Purpose

1. In order to safeguard the legitimate rights and interests of patients and medical personnel, ensure medical safety, and minimize medical errors and accidents, this plan is formulated according to the spirit of laws and regulations such as Regulations on Handling Medical Accidents and Regulations on Management of Medical Institutions promulgated by the State Council.

2, this plan is suitable for clinical medicine, medical technology and related departments.

Second, preventive measures.

1, strengthen legal education, strengthen the study and training of medical staff's legal knowledge, enhance their sense of responsibility and practice medicine according to law.

2, strengthen professional ethics education, do a good job of quality service, do a good job of patient's warm reception, take the initiative to communicate with patients and their families, patiently explain, adhere to the principle of medical treatment, adhere to clean medical practice, and do not seek personal gain from medical treatment.

3. Strengthen the professional study and continuing education of medical staff, and constantly improve their professional quality. By sending them out for study, further study and training, and inviting well-known experts to teach in our hospital, we can improve the overall professional and technical level and practical work ability of our hospital, better improve the quality of hospital medical services, and improve the ability of medical staff and the hospital as a whole to prevent medical disputes and accidents.

4, improve the management system of prevention, strengthen the implementation of system management. Hospital rules and regulations are important measures to ensure normal medical order, improve medical quality and prevent medical accidents. Medical personnel should conscientiously implement various rules and regulations and operating procedures, and act in strict accordance with the systems and procedures. Hospital administrators should often go to various departments to check the implementation of the system.

Three. Precautionary clause

1, all clinical, medical technology and related departments must focus on the purpose of "patients first, medical quality first, medical safety first", improve medical quality assurance and implement various rules and regulations.

2, all kinds of rescue equipment should be kept in good condition, to ensure that put into use at any time. According to the principle of * * * sharing resources and * * using special first-aid equipment, the Medical Department has the right to allocate according to the needs of clinical first aid.

3, starting from the maintenance of the overall situation, between departments, between medical care, between clinical and medical technology, between emergency, emergency and ward should cooperate with each other, it is strictly prohibited to denigrate others and other departments in front of patients do not conform to the medical ethics.

4. In any case, doctors, interns and interns who have not obtained the qualification certificate of medical practitioners shall not practice independently.

5, strengthen the attention and communication of the following key patients:

(1) low-income patients;

(2) those who are widowed or whose children are not around;

(3) Those who have had insufficient contact with medical personnel;

(4) those who are expected to have poor therapeutic effects such as surgery;

(5) I have high expectations for treatment;

(6) people who express difficulty in explaining their diseases;

(7) There are signs of nosocomial infection or nosocomial infection;

(8) The patient's condition is complex, and all kinds of information indicate that there may be disputes;

(9) Insufficient advance payment for hospitalization;

(10) medical arrears;

(1 1) Those who need to use expensive drugs or materials at their own expense;

(12) Those who may shirk their responsibilities due to traffic accidents;

(13) patients with distinct identities;

6, for the doctor-patient disputes, the director must personally ask and decide the next diagnosis and treatment measures. Arrange special personnel to receive patients and their families, and other personnel are not allowed to explain the condition at will.

7, assessment must be strictly targeted, reasonable arrangement of assessment content and procedures and order. Pay attention to all kinds of examinations and tests that have important guiding significance for the prognosis of diseases, and the results should be carefully analyzed and properly preserved.

8, rational drug use, pay attention to drug incompatibility and adverse drug reactions, pay special attention to the safety of the elderly and children, 18 people are prohibited from using quinones. Strictly grasp the indications of drugs, prohibit the abuse of antibacterial drugs, and generally do not use the third-generation cephalosporins prophylactically.

9, pay attention to the prevention and control of nosocomial infection, give full play to the role of hospital, department infection monitoring personnel, for the hospital infection has occurred in a timely manner to register the report, shall not conceal, obey the technical guidance of professionals.

10, serum antibodies against HIV, HCV, HBSAG and syphilis must be checked before blood transfusion. Blood bags after blood transfusion shall be kept by the blood transfusion department in a unified way, and can be destroyed after 7 days.

1 1, each medical department must be equipped with rescue equipment when doing invasive examination, and ensure that it is available at any time. It must be arranged as soon as possible after receiving the application for emergency examination. The emergency laboratory test shall issue the results within 30 minutes after receiving the specimen (except for individual test items). Emergency x-ray and CT examination must be completed in time. Pharmacy department ensures the normal purchase channels and quality of drugs, and ensures the rescue and arrival of drugs.

12, medical record writing. Written in strict accordance with the Regulations on Handling Medical Accidents and the Law of People's Republic of China (PRC) Municipality on Medical Practitioners. It is strictly forbidden to alter, paste, scratch, forge, conceal or destroy medical records.

Hospitalization medical records:

(1) Medical records must be written in accordance with national regulations and the Basic Specification for Etiology Writing (No.:(2010)1) promulgated by Wei on February 4, 2065438. The attending physician in each ward must check the quality of medical records of junior doctors in time.

(2) the home page is complete;

(3) The director is responsible for the quality of the final medical record, and the superior doctor is responsible for the medical record writing and management quality of each link of the operation;

(4) Each department must take seriously the unqualified medical records issued by the quality control department and improve the medical records within 3 days;

(5) The inpatient medical records must be completed within 24 hours.

(6) The attending physician must make patient rounds for newly admitted patients within 48 hours, and reflect the opinions of patient rounds in the medical records;

(7) On the day of admission of critically ill patients, the second day of admission of critically ill patients, and within 3 days of admission of general outpatient patients, there must be a doctor with a deputy chief physician or above to make rounds, which should be reflected in the medical records.

(8) Other contents of inpatient medical records shall be implemented with reference to the Basic Specification for Medical Record Writing;

(9) When the patient leaves the hospital, the attending physician's signature on the final medical record must be completed at the same time.

(10) The final medical record signature of the department director must be completed within 5 days after the patient leaves the hospital;

(1 1) The discussion of death records must be completed within 1 week after the death of the patient.

(12) The operation record must be completed within 24 hours after operation, and the surgeon must personally write or review the operation record and sign it;

(13) If the rescue record is not written in time, it shall be truthfully supplemented within 6 hours after the rescue.

(14) All kinds of inspection reports, images, pathological reports, signatures and other materials must be properly preserved and shall not be lost. When borrowing, you must register and return it in time;

(15) Prevent patients and relatives from reading medical records without permission;

(16) Staff members are not allowed to borrow or copy medical records for patients and their relatives without permission;

(17) Take good care of hospital medical records to prevent them from being lost.

Outpatient medical records

(1) must use the outpatient medical records of xxxx hospital;

(2) The contents of outpatient (emergency) medical records include the first page of outpatient medical records, medical records, laboratory sheets (inspection reports), medical imaging examination data, etc.

(3) The cover of outpatient (emergency) medical records includes name, gender, date of birth, occupation, marriage, nationality, drug allergy history, address and telephone number;

(4) Outpatient (emergency) medical records are divided into initial medical records and follow-up medical records. First-time medical records include medical institutions, departments, and visiting time (the writing time of emergency medical records should be specific to minutes). Chief complaint and current medical history, past history, personal history/family history, menstrual history, marriage and childbearing history, trauma/surgery history, signs, auxiliary examination, diagnosis and treatment opinions, doctor's signature and date;

The follow-up medical records include the medical institution, department, time, chief complaint and past history, signs and auxiliary examination, diagnosis and treatment opinions, doctor's signature, date, etc.

(5) outpatient (emergency) consultation medical records should be filled in by the attending physician in time when the patient is hospitalized;

(6) When rescuing critically ill patients, a rescue record shall be written. For patients admitted to the emergency observation room, the observation records of the observation period shall be written;

(7) Prescriptions must comply with the relevant provisions of prescription management;

(8) Outpatient medical records shall be kept by patients themselves;

13, hospitalized patients

(1) Implement the principle of giving priority to emergency treatment and treating specific diseases. It is forbidden to blindly rob patients between departments to delay diagnosis and treatment and medical disputes;

(2) For chronically ill and critically ill patients, all departments must take the condition and patients' interests as the starting point, and may not refuse patients through various interfaces;

(3) Any specialist or ward with empty beds shall not refuse to accept patients from other departments by any interface;

(4) When the patient is hospitalized, the informed consent and power of attorney should be signed, and the client is responsible for performing the right to know and choose on behalf of the patient during hospitalization;

14, level 3 rounds and consultation

(1) The three-level physician rounds system is an important measure to ensure medical safety and prevent medical risks, and doctors at all levels must strictly implement it;

(2) For ordinary patients, the resident makes rounds twice a day, the attending physician makes rounds every day 1 time, and the director (deputy chief physician) makes rounds every week 1-2 times;

(3) For key (critical) patients, patient rounds and inspections must be made in time;

(4) For critically ill patients and complicated cases, as well as patients with potential medical disputes, report to the Medical Department in time, organize in-hospital consultation, and invite experts outside the hospital for consultation when necessary;

(5) Pediatric consultation is required before accepting patients under 14 years old;

(6) The emergency doctor on duty must be a resident for more than 3 years;

(7) Hospital emergency consultation and consultation doctors must be in place within 10 minutes, general consultation and consultation doctors should be in place within 24 hours, and consultation records should be completed within 48 hours;

15, preoperative discussion

(1) major surgery during hospitalization must be reported to the medical department, which is responsible for organizing and convening relevant departments for preoperative discussion. Medium-sized surgical cases must be discussed by the department before operation (except emergency and rescue surgical cases), and recorded in detail in the medical record, and the operator must attend;

(2) It is forbidden to substitute preoperative discussion for three-level rounds;

16, the patient's informed consent is as follows:

(1) Diagnosis of diseases, examination to be implemented, treatment measures, prognosis, inevitable treatment contradictions in outpatient treatment, toxic and side effects of drugs, chief physician, attending physician and corresponding department directors (chief physician or deputy chief physician) of inpatients;

(2) the possible adverse consequences of examination and treatment measures, possible further measures to correct the adverse consequences, and the toxic and side effects of drugs that must be used in hospital.

(3) Intraoperative materials should be kept;

(4) Out-of-pocket expenses in medical expenses;

(5) performing invasive operations such as surgery and anesthesia;

(6) The pathological changes found during operation are inconsistent with the preoperative diagnosis;

(7) When it is necessary to remove organs and tissues that were not explained to the patient before resection;

(8) When critically ill patients need to move due to special examination, which may cause danger;

(9) Blood transfusion, radiography, intervention, radio frequency, tracheotomy, chemotherapy, etc. ;

(10) Other contents that patients or their families need to know;

The above 3- 10 shall be recorded in writing and signed by the patient or the client.

Fourth, the reporting system and emergency treatment

1, in the event of a medical error accident, it is necessary to immediately notify the superior physician and the director of the department, and report to the medical department (during the day). The hospital is on duty at any time (at night, on holidays) and shall not conceal it. And actively take remedial measures to avoid or reduce further damage to patients' health and save patients' lives as much as possible. Errors and accidents caused by nursing factors should be reported step by step according to the nursing system in addition to the above procedures;

2. The functional departments shall organize the department heads to find out the reasons;

3, organized by the medical department multidisciplinary consultation, to participate in the consultation for the highest level of doctors on duty;

4, director of the department and the medical department decided to accept the patient's family, appoint someone to explain the condition;

5, according to the requirements of family members, medical department combined with the situation, whether to seal medical records according to the regulations on the handling of medical accidents;

6. The suspected adverse consequences caused by blood transfusion, blood transfusion, injection and drugs shall be immediately sealed in the presence of functional department personnel, patients or their families, and the physical objects shall be kept by the hospital.

7, such as the patient's death, should mobilize family members for autopsy, and recorded in the medical record;

8, such as patients need to turn to professional treatment, each department must try our best to cooperate;

9, the relevant departments should write a written report within 24 hours, at the same time put forward preliminary treatment opinions, reported to the medical department;

10 A very small number of medical disputes, because the unreasonable demands of patients are not met, take excessive actions, such as insulting, besieging, beating medical staff, blocking doors and other acts that disturb public order, resulting in the normal medical order of hospitals being destroyed and the medical work of hospitals being seriously affected. The hospital will mobilize the security guards in the hospital to maintain the normal work and order of the hospital, and cooperate with Xiaoqiaoqiao Police Station and 650. Report to the competent department and relevant departments of the local government (petition office, emergency office, street office, community, etc.). ) and request the relevant departments to help solve the dispute.

Hospital Emergency Plan (2)

In order to prevent medical disputes and medical accidents and properly handle them, this plan is formulated:

First, the hospital set up a leading group for handling medical disputes and medical accidents:

Team leader: Dean Xu Xianglin.

Deputy Head: Naomi, Vice President.

Members: Lei,,, Liu Xiunian, Yang Xiuqiong, Zhou Anning, Yin, Zhang Jian, Yu Shui, Huang Lingzhi and.

Set up a medical dispute and accident handling office in the medical department.

Second, the plan:

1, medical personnel in medical activities found medical accidents or negligence that may cause medical accidents, should immediately report to the head of the department, the head of the department should promptly report to the medical department. After receiving the report, the Medical Department will conduct an investigation when it comes to relevant departments, report the relevant situation to the dean, and explain to the patients in conjunction with the directors of relevant departments;

2. The medical accident that leads to the death of the patient can be a medical accident above the second level or a medical accident that causes personal injury to more than three people. The dean or authorized person shall report to the Medical Administration Department of Mianyang Municipal Health Bureau within 12 hours. After a medical accident or serious medical dispute, the hospital will arrange a special person to be responsible for the reception and interpretation of media interviews, lawyers' evidence collection or other organizations and personnel's requests for information;

3. After a medical accident or serious medical dispute occurs, relevant clinical medical departments and relevant functional departments should cooperate with the patient's persuasion under the unified arrangement of the Medical Department to ease the contradiction between doctors and patients. If there is an incident of hospital work order, it should be reported to the security department immediately. Major events that may lead to malignant cases should be reported to the Municipal Health Bureau and the public security organs immediately;

4. When medical negligence occurs or is found in clinical and medical departments, departments and medical personnel should immediately take effective measures to avoid or reduce the damage to patients' health and prevent the damage from expanding;

5, the hospital set up a medical damage rescue team, the team is composed of the heads of clinical medical departments.

Team leader: Naomi

Deputy Head: Liu Jigui

Members: Zhou Anning, Yin, Zhang Jian, Huang Lingzhi, Yu Shui, Liu Xiujun, Pang Huahui, Mu Zequan and Wang.

The medical damage rescue team is responsible for the rescue cooperation within the business scope after the occurrence of medical accidents or other emergencies. All members of the rescue team are required to arrive at the scene immediately after receiving the notice for consultation and rescue.

6. The patient's request for copying or duplicating medical records should be put forward by the patient himself; Power of attorney or relationship certificate signed by the patient's family; If it is proposed by the patient's lawyer, there must be an official letter from the law firm where the agent is located and a lawyer's certificate. The copied contents include outpatient medical records, admission records, temperature sheets, doctor's orders, laboratory tests (inspection reports), medical imaging data, special inspection consent, operation consent, operation and anesthesia records, pathological data, nursing records, other medical records and other objective medical records specified by the Ministry of Health;

7, patients to copy medical records, by the medical record room staff in conjunction with the medical department. When copying, patients or their families should be present. After the copy is completed, it shall be stamped and signed by the patient himself or his entrusted family members or his lawyer;

8. After the occurrence of medical disputes and medical accidents, patients request to copy medical records, and death case discussion records, difficult case discussion records, superior doctors' rounds records, consultation opinions and course records shall not be copied. It should be sealed in the presence of both doctors and patients and supervised by the director of medical department. The medical records being used for treatment may not be sealed on the original, but may be sealed on the copy. Both doctors and patients should be present when unsealing.

9, the adverse consequences of patients may be caused by infusion, blood transfusion, injection, drugs, etc. The on-site physical objects shall be sealed, and the sealed on-site physical objects shall be kept by the hospital, and the patients or their families shall be present when sealed and unsealed. When inspection is needed, the medical department and the patient shall agree through consultation to designate an inspection institution with inspection qualification for inspection. If you can't reach an understanding with the patient, apply to the Municipal Health Bureau for designation. If it is suspected that blood transfusion will cause adverse consequences and it is necessary to seal the blood at the scene, immediately notify Mianyang Blood Center to send personnel to the scene;

10, if the patient dies, the department should send the death notice to the family members in time to sign the stub. When the cause of death cannot be determined or there is any objection to the death, the department should inform the patient's family to conduct an autopsy within 48 hours after the patient's death; At the same time, put conversation record on record. Those who refuse or delay the autopsy for more than the prescribed time and affect the judgment of death shall bear the responsibility. Autopsy shall be approved and signed by the close relatives of the deceased;

1 1. If the medical association accepts the technical appraisal of medical malpractice, the medical department shall submit the materials, written statements and defense related to the technical appraisal of medical malpractice within 10 days from the date of receiving the notice from the medical association, including the following contents:

(1) Original medical records, such as the course records of hospitalized patients, discussion records of death cases, discussion records of difficult cases, consultation opinions, patient rounds of superior doctors, etc.

(2) The original medical records of hospitalized patients, such as admission records (hospitalization records), temperature sheets, doctor's orders, laboratory sheets (inspection reports), medical imaging examination data, special inspection consent, operation consent, operation and anesthesia records, pathological data, nursing records, etc.

(3) The original medical records of emergency patients should be supplemented within the specified time;

(4) The sealed infusion, articles for injection, blood, medicines and other physical objects, or the inspection report of an inspection agency with inspection qualification according to law on these articles and physical objects;

(five) other materials related to the technical appraisal of medical accidents.

12. If there is any objection to the technical appraisal of medical accidents, apply for appraisal again. Hospitals and patients can resolve medical disputes through consultation.

13. The level of medical malpractice, the degree of responsibility of medical negligence in the consequences of medical malpractice, and the relationship between the consequences of medical malpractice and the patient's original disease status should be considered when solving compensation through negotiation. Determine the scope and amount of compensation in accordance with the Regulations on Handling Medical Accidents, and may not expand the scope and amount of compensation;

14. If medical malpractice compensation is settled through consultation, an agreement shall be reached. The agreement shall specify the basic information of both doctors and patients, the causes of medical accidents, the level of medical accidents recognized by both doctors and patients, and the amount of compensation determined through consultation, and shall be signed by both parties. The patient's signature is generally signed by the patient himself. If the patient himself cannot sign, it shall be signed by the patient's close relatives or other authorized persons.

15. After consultation with patients, the medical department should make a written report to the Municipal Health Bureau within 7 days from the date of consultation, and attach an agreement.

16. If negotiation fails, consult with the affected party, apply to the Municipal Health Bureau for mediation, and submit relevant materials. After the successful mediation by the Municipal Health Bureau, it shall be performed in accordance with the requirements of the mediation book. If the one-time compensation amount exceeds 1 10,000 yuan, it must be ruled by a third party or a court;

17. If the patient brings a civil lawsuit to the people's court, our hospital will actively organize forces to prepare for responding. And make the following preparations:

(1) Determine the agent ad litem;

(2) Write and submit the defense;

(3) Apply for technical appraisal of medical malpractice;

(4) Collect relevant information and evidence;

(5) Collecting witness testimony;

(6) Collect relevant technologies and management specifications;

(7) Collecting relevant medical literature;

18. After the mediation or judgment of the people's court becomes effective, report to Mianyang Municipal Health Bureau in writing within 7 days from the date of receiving the effective mediation or judgment of the people's court, and attach the mediation or judgment;

19, after the medical accident treatment, the medical department will file all the data, in accordance with the "Regulations on Hospital Defect Management" and the relevant provisions of medical dispute treatment, and put forward treatment opinions for the departments and related personnel with medical accidents;

Third, the process:

1, after the occurrence of medical complaints, departments should immediately report to the medical department, and failure to report will bear all possible consequences;

2, disputes caused by medical problems, the director should first investigate, quickly and actively take effective measures to control the situation, prevent the intensification of contradictions, and strive to solve them within the department. Receive the disputing parties, listen carefully to their opinions, and explain relevant issues according to their opinions. If it is acceptable to the parties, the complaint shall be accepted so far;

3, functional departments, after receiving the report of the department or the patient's complaint, should immediately to the relevant departments to understand the situation, and negotiate with the department director * * * solution, if the patient can accept, until the complaint is processed. If the patient can't accept it, please ask the patient to provide written materials about the understanding and requirements of the problem, and then find the person in charge to investigate the details of the problem, put forward a solution to the problem, report to the vice president in charge, and negotiate with the patient to handle the opinions. If the patient accepts it, the treatment will stop here.

4, the functional departments have accepted, but still can't solve the medical disputes, it is recommended that patients conduct medical appraisal according to legal procedures. The relevant departments should recite the required medical records, original medical records, relevant materials and department opinions within 3 days.

5. After the patient brings a lawsuit to the court, the parties, lawyers and functional departments appear in court;

6, according to the nature of the dispute to the relevant departments and individuals according to the Ministry of rewards and punishments regulations;