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Analysis and countermeasures for incidents/accidents Haruko Kawamura 1 1Kyorin University School of Health Sciences Keyword: 医療事故 , インシデント , 事例分析 , 臨床検査 , 医療システム pp.643-648
Published Date 2011/7/15
DOI https://doi.org/10.11477/mf.1542102665
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There are two approaches to make use of incidents/accidents (I/A) for the prevention of further medical accidents;one is to utilize individual I/A, and the other is to utilize multiple I/A. To make use of individual I/A, we need to identify medical system problems for important I/A using analytical methods, such as RCA. There are two ways of utilizing multiple I/A. One is to create task-specific matrixes and present task processes on a vertical axis and error types on the horizontal axis, and the second is to create an error map on the matrix that provides a simple description of the details of the I/A. The other approach is to analyze only the I/A that has occurred in a specific population or under specific situations, such as those caused by new staff members or those occurring during holidays.


Copyright © 2011, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1367 印刷版ISSN 0485-1420 医学書院

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