Introduction
Rights and obligations.
Source: YimaitongAuthor:The Running Emergency Old LiuThis article is published with the authorization of the author, and please do not reprint without authorization.
What appears to be a small clinical event eventually turns into a serious event. Habitual behavior, but it may contain potential risks.
Case Review
In 1998, a patient in his 70s was admitted to a hospital for treatment. drug. The medicine comes in a small medicine bowl with a total of 9 capsules(three of which are in a hard pack). The patient did not pay attention and took the medicine together with the hard packaging. After taking the drug, the patient developed symptoms of vomiting, coughing, and shortness of breath. A few days later, the patient died of aspiration pneumonia and respiratory failure.
The patient’s family believes that when the nurse on duty dispenses medicine for the patient, the outer shell of the hard package of the medicine must be peeled off. And can only leave after seeing the patient eat it, but the nurse on duty failed to fulfill her due obligations, which led to the patient taking the hard-packed medicine by mistake. There is a causal relationship between the patient’s ingestion of the hard packaging of the drug and its death. As a result, the family sued the court, requesting the hospital to be at fault for this, and requesting the doctor to pay a total of 150,000 yuan for various material and mental losses.
Doctors believe: The duty nurse is not obliged to peel off the outer shell of the hard-packed medicine in the process of dispensing the medicine. The patient is an adult with full capacity, and should have the common sense of life that cannot take medicine in hard packaging. Therefore, the hospital is not at fault. The patient’s aspiration pneumonia was not caused by mistakenly ingesting the hard packaging of medicines. Aspiration pneumonia was caused by vomiting, and the patient’s vomiting was caused by his own disease. Therefore, there is no causal relationship between the death of the patient and the misuse of the hard packaging of the drug, and the lawsuit request of the patient’s family cannot be agreed.
The Court held that:The patient was over 18 years of age adults, and they are not mentally ill, so they are people with full capacity for civil conduct. They can identify the 3 medicines with packaging, and have the ability to peel off the outer packaging and take medicines. The patient accidentally swallows the hard shell. The request of the patient’s family for the hospital to assume civil liability for compensation was not supported by the court. In this case, the patient took the medicine with hard packaging by mistake because the patient was careless. The hospital has fulfilled the “three investigations and seven one-on-one attention” stipulated by the Ministry of Health. The nurses did not violate the rules and regulations, nursing routines, no technical fault, and no fault. responsibility.
The patient refused to accept the first-instance judgment and appealed to the second-instance court. During the trial, the court of second instance held that the facts determined by the court of first instance were not wrong, and the patient’s claim was not supported. However, during the trial, the doctor voluntarily compensated the patient 10,000 yuan, which was approved by the court.
Can the pharmacy carry medicines? Hard pack?
The medicines for inpatients in the ward are usually done in the pharmacy. The ward prints a list of oral medicines for each patient, and the pharmacy dispenses them into medicine cups one by one according to the list. After the medicine is placed, the nurse takes the medicine back to the department after checking. Before dispensing the medicine, the nurse will generally check the doctor’s order and the medicine again to ensure that there is no mistake.
“Three checks and seven pairs” are often mentioned in nursing work. Three checks: check before medicine preparation, check during medicine preparation, and check after medicine preparation; seven pairs: bed number, name, medicine name, concentration, dosage, usage, time. Nurses also need to conduct three checks and seven pairs during the process of placing and dispensing oral medicines.
In practice, there is no fixed standard or pattern for placing oral medicines in wards:
Some hospital pharmacies remove the packaging of oral medicines and put them in containers in advance. There are only pills in a box. The advantage of this mode is that it is directly distributed after checking, and the patient can take it directly, which is simple and convenient. However, the disadvantage is that the tablets are easily contaminated during the process of sub-packaging and multiple checking. Without the packaging, if it is not stored properly, it may affect the drug treatment. And because the pills are not packaged, the nurse sisters are slow to check and require everyone to have a discerning eye for medicines.
In some hospitals, when medicines are placed, bottled medicines are placed directly. Packing the medicine. Nurses check the dispensing directly, or strip the medicine from the hard packaging after checking before dispensing and then dispense the medicine.
Some hospitals do not put medicines in pharmacies in order to avoid drug contamination. Medicines are dispensed in the smallest package, with boxes of medicines placed at the head of the patient’s bed. The nurse will inform the patient or family about the medication and know that the patient is taking the medication by himself. When there is no family member or the patient has difficulty in taking the medicine, the nurse will take the medicine from the bedside and put it in the medicine box on time before instructing the patient to take the medicine. Although the quality of the medicine is relatively guaranteed in this method, without the process of “three checks”, it cannot guarantee that the wrong dose, missed dose, and repeated doses will not occur.
I searched through some hospital pharmacies’ regulations for the administration of medicines, and found that there are no very specific regulations on the form of medicines, nor is it clear that medicines cannot be dispensed in hard packaging. But, come to think of it, the hard-packed pills or capsules are actually quite dangerous. The edges of plastic or tinfoil cut with scissors can be sharp, and many patients on the Internet have scratched their lips, stabbed their throats, and entered their esophagus without noticing.
This case occurred more than 20 years ago, after the medical malpractice identification of the Medical Association, it was believed that the patient was careless and wrong. service, and the medical behavior does not violate the medical and health management laws, administrative regulations, departmental rules, medical and nursing norms and routines, and does not belong to medical malpractice. The court recognized the identification conclusion and pointed out that no autopsy was performed after the patient’s death, and the opinion of the patient’s family that the patient’s death was related to medical behavior lacked scientific basis and could not be trusted.
Hospital management can also pay attention to details
This case was shared as a hospital management case. As a hospital administrator, it is not the ultimate responsibility for compensation that is called a medical dispute. Regardless of whether medical treatment is at fault, whether medical damage is ultimately caused, and whether there is a causal relationship between fault and damage, disputes will also arise as long as the patient is unilaterally dissatisfied.
Most of the medical disputes are because the patients lack basic medical knowledge, correct medical treatment and the natural transformation of the disease. It can also be caused by the unreasonable censure of the patient due to the incomprehension of inevitable complications and medical accidents. No matter what, no matter the final verdict, as long as there is a dispute, the medical side needs to spend manpower, material resources, energy and time to deal with it. For hospital managers, it is a loss, so they always hope to avoid unnecessary incidents and cause unnecessary disputes.
In this case, is the question raised by the patient totally unreasonable? Think about it carefully, is there really nothing wrong with the doctor? If it is replaced by medical fault identification, will there be no responsibility?
The legal community emphasizes the need for medical practitioners to exercise due diligence, and whether the medical practitioners fully this obligation? Many tablets are together, and only a few carry the outer packaging, so it is easy to be ignored. And for elderly patients who may have poor vision, should nurses do their duty to remind them?
Many similar cases have been shared in this column. A nurse at the hospital caused the patient to cough while feeding, and died of aspiration pneumonia. The hospital compensated. The patient died of suffocation after the nurse gave oral sugar cubes due to hypoglycemia, and the hospital also compensated. This case is only because more than 20 years ago, the Tort Liability Law had not been promulgated and implemented, and it was still the era when medical malpractice identification ruled the world. That’s all.
Are the single-piece preparations with drug hard packaging still issued in clinical practice? The answer is of course yes. Has there been a similar case? The answer is still yes. Is there any way to prevent this from happening? The answer is still yes.
In pediatrics, such events are rare. It is more common in clinical practice for children to accidentally take medicines, foreign bodies in the airway or esophagus, and medical staff have a sense of protection. With an aging population, more elderly patients, and varying degrees of need for care, caregivers may need more attention, more precautions.
Counselor
Xiang Heyman, Beijing Quan A lawyer from Zhi Law Firm (formerly Beijing Renchuang Law Firm), he has long been engaged in the research and practice of medical law and has rich experience in medical law.
This case is from the Internet
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