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Clubs · Nov 21, 2024 · 8 min read
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This article provides detailed information on the concept of medical incidents and classification guidance under Vietnamese law, aiming to raise awareness and protect patient rights.
According to Clause 1, Article 2 Circular 43/2018/TT-BYT, medical incidents (Adverse Events) are unwanted situations that occur during the process of diagnosis, care and treatment due to objective and subjective factors that are not due to pathological developments or human constitution. disease, impact on the patient's health and life.
The classification of medical incidents is specified in Article 7 Circular 43/2018/TT-BYT, specifically as follows:
(1) After receiving the medical incident report, the medical incident receiving and management department of the medical examination and treatment facility must classify according to all 3 criteria below:
- Classify incidents according to the level of injury to the patient in Appendix I issued herewith Circular 43/2018/TT-BYT.
STT | According to the development of the situation | According to the level of damage to the patient's health and life (Risk level-NC) | Report form | |
1 | Near miss situations | A | Not yet occurred (NC0) |
|
- Classify incidents according to incident groups in Section II, Appendix IV issued herewith Circular 43/2018/TT-BYT.
II. Classify incidents by incident group (Incident type) | ||
1. Implement technical procedures and professional tips | □ Without the consent of the patient/family (for prescribed techniques and procedures, a commitment must be signed) □ Not performed when indicated □ Performed on the wrong patient □ Performing the wrong procedure/process/treatment method □ Performing the wrong surgery/procedure location □ Missing tools and consumables during surgery □ Death during pregnancy □ Death at birth □ Neonatal mortality | |
2. Hospital-acquired infections | ||
- Classify incidents according to groups of causes of incidents in Section IV, Appendix IV issued herewith Circular 43/2018/TT-BYT.
IV. Classify incidents according to the group of causes causing the incident | |
1. Staff | □ Awareness (knowledge, understanding, concept) □ Practice (practice skills not following regulations, standard instructions or practicing according to regulations, incorrect instructions) □ Attitudes, behaviors, emotions □ Communication □ Psychological, physical, pathological □ Social factors |
2. Sick people | □ Awareness (knowledge, understanding, concept) □ Practice (practice skills not following regulations, standard instructions or practicing according to regulations, incorrect instructions) □ Attitudes, behaviors, emotions |
(2) For incidents determined to be serious injuries (NC3), it is necessary to continue to classify them in detail according to the List of serious medical incidents in Appendix II issued herewith. Circular 43/2018/TT-BYT.
SURGICAL INCIDENT | |
1. | Surgery on the wrong location (body part) Is surgery in a position of the patient's body that does not match the data recorded in the medical record, except in emergency situations such as: A. Changes in surgical site occur during surgery B. This change is approved. |
2. | Surgery on the wrong patient: Is surgery performed on a patient that does not match the patient's identification data recorded in the medical record. |
3. | Wrong surgery method (wrong procedure) causes serious damage: |
The incident has occurred and has not had a direct impact on the patient |
B |
Mild damage[1] (NC1) |
|
3 | The incident occurred and had a direct impact on the patient and did not cause harm. | C |
|
4 | The incident occurred and had a direct impact on the patient, requiring timely monitoring or treatment intervention so it did not cause harm. | D | Voluntary reporting |
5 | An incident has occurred that causes temporary harm and requires treatment intervention | AND | Moderate damage[2] (NC2) |
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6 | An incident has occurred, causing temporary harm, requiring treatment intervention and prolonging hospital stay | F |
|
7 | The incident that occurred caused lasting harm and left sequelae | G | Severe injury[3] (NC3) (attached to serious medical incident table) |
|
8 | An incident has occurred that is dangerous and requires active resuscitation | H | Mandatory reporting |
9 | The incident occurred that affected or directly caused death | I |
|
□ Pneumonia
□ Other types of infections
□ Surgical wound infection □ Urinary tract infections |
3. Medicines and infusions | □ Dispensing wrong drugs and infusion fluids □ Lack of medicine □ Wrong dose, wrong content □ Wrong time □ Wrong orders | □ Missed medication/dose □ Wrong medication □ Wrong patient □ Wrong route of use |
4. Blood and blood products | □ Side effects and complications from blood transfusion □ Transfusion of wrong blood or blood products □ Infuse wrong dose at wrong time | |
5. Medical equipment | □ Missing instructions for use □ Device error □ Missing or inappropriate equipment | |
6. Behavior | □ Tendency to self-harm and suicide □ Sexual harassment by employees □ Sexual harassment by patients/visitors □ Physical abuse by patients/visitors | □ There are suicidal actions □ Escape from hospital |
7. Accidents to patients | □ Falls | |
8. Infrastructure | □ Damaged or defective | □ Missing or inappropriate |
9. Resource and organizational management | □ The appropriateness and completeness of medical examination and treatment services □ Suitability and adequacy of resources □ The appropriateness and completeness of policies, regulations, procedures, and professional instructions | |
10. Records, documents, administrative procedures | □ Lost or missing documents □ Documents are unclear and incomplete □ Long waiting times | □ Providing documents slowly □ Wrong document file □ Complicated administrative procedures |
11. Other | □ Incidents not mentioned in items 1 to 10 | |
□ Communication
□ Psychological, physical, pathological
□ Social factors
3. Working environment | □ Facilities, infrastructure, equipment □ The distance to work is too far □ Assessment of safety and risks of the working environment □ Rules, regulations and technical specifications |
4. Organization/service | □ Policies, procedures, and professional instructions □ Follow standard practice procedures □ Organizational culture □ Teamwork |
5. External factors | □ Natural environment □ Products, technology and infrastructure □ Service processes and systems |
6. Other | □ Factors not mentioned in items 1 to 5 |
Is a surgical method performed not in accordance with the previously proposed surgical plan, except in emergency situations such as:
A. Changes in surgical methods that occur during surgery.
B. This change is approved.
4. | Forgetting medical equipment and consumables in the patient's body after surgery or other invasive procedures: Except: A. The device is implanted in the patient (as indicated). B. The instrument existed before surgery and was intentionally retained. c. Medical equipment that was not present before surgery was intentionally left behind because it could be dangerous to remove. For example: very small needles or screw fragments. |
5. | Death occurs during the entire surgical process (pre-anesthesia, skin incision, skin closure) or immediately after surgery in patients with ASA grade I classification. |
PROBLEMS DUE TO EQUIPMENT |
6. | Death or serious sequelae related to drugs, devices or biological products |
7. | Patient death or serious sequelae related to the use or function of medical equipment during patient care that is different from the initial plan. |
8. | Patient death or serious sequelae related to intravascular air embolism during patient care and treatment. Exception: Neurosurgical or cardiovascular procedures are known to have a high risk of intravascular air embolism. |
INCIDENT RELATED TO PATIENT MANAGEMENT |
9. | Wrong newborn delivered |
10. | Patients who escape from the hospital die or suffer serious sequelae |
11. | The patient dies or has serious sequelae due to suicide at a medical examination and treatment facility. |
INCIDENTS RELATED TO CARE AT MEDICAL EXAMINATION AND TREATMENT FACILITIES |
12. | Patient death or serious sequelae related to medication errors: Including: Giving a drug knowing that the patient has a history of drug allergies and drug interactions that can potentially lead to death or serious sequelae. Exception: Reasonable differences in drug selection and dosage in clinical management. |
13. | The patient dies or has serious sequelae related to hemolysis due to transfusion of the wrong blood type |
14. | Maternal death or serious complications related to labor and childbirth: Includes incidents that occur during the postpartum period (42 days after birth). Except: A. Pulmonary embolism or amniotic embolism B. Acute fatty liver during pregnancy C. Cardiomyopathy. |
15. | The patient died or had serious complications due to hypoglycemia during treatment. |
16. | The patient dies or has serious sequelae (keratinous jaundice) due to hyperbilirubinemia in newborns. |
17. | Grade 3 or 4 pressure ulcers occur during a hospital stay. |
18. | Patients die or have serious sequelae due to physical therapy causing spinal trauma |
19. | Confusion in organ tissue transplantation. Includes sperm or egg confusion in artificial insemination |
INCIDENTS DUE TO THE ENVIRONMENT |
20. | The patient dies or has serious sequelae due to electric shock. Exceptions: Incidents caused by electrical therapy (electrogenic shock or selective electrical cardioversion). |
21. | Accidents due to the design of oxygen lines or other gases supplied to patients such as: A. Gas confusion. Or B. Gas and toxic substances |
22. | Patients die or have serious sequelae from burns arising from any cause while receiving care at the facility. |
23. | The patient dies or has serious complications due to a fall while receiving medical care at the facility. |
THE INCIDENT WAS CONSIDERED A CRIMINAL OFFENSE |
24. | Impersonating medical staff to treat patients |
25. | Kidnapping (or seducing) sick people of all ages |
26. | Sexually assaulting patients on hospital grounds |
27. | Causing death or serious injury to patients or medical staff within the medical examination and treatment facility premises |
28. | Other serious medical incidents (NC3 types G, H, I) not mentioned in items 1 to 27 |
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