<EDUCATIONAL REPORT>Risk management in anesthesiology at the Health Sciences University of Hokkaido Hospital for providing security and consent in dental treatment

P(論文)Press news of medical malpractice and related judicial proceedings have increased in recent years. A survey conducted by the Japanese Society of Dental Anesthesiology indicated several cases per year involving death induced by injection of local anesthesia. Additionally, preventive measures such as health care risk management (RM) and informed consent in various medical practices have been reported. The Dental Clinic Department of Anesthesiology of the School of Dentistry of the Health University of Hokkaido, evaluated the risk management procedures and role in risk management, and points of improvement were clarified. A double-check list for anesthesia preparation was examined for the period between September 1996 and September 2001. Emergency management in operating rooms as well as in hospital wards in 2001 and the "Emergency Management in Dental Treatment" chapter in the "Medical Practice Manual" were re-evaluated. Items included on the double-check list for anesthesia preparation increased from 49 to 75 in 5 years. The number of items to verify has increased with technical advances in anesthetic treatment ; preparation time is approximately 2 minutes per item. Manpower and time expenditure with respect to risk management have increased. However, in the current environment, proper maintenance inspections of artificial respirators and anesthesia apparatus (according to the Medicine Act, Chapter 10, miscellaneous rules, section 63) have not been performed. Further, emergency management in operating rooms and hospital wards requires the quick, direct authority of a doctor with respect to advice relating to anesthesia : requests are directed to other departments or other medical centers in accordance with the decision of the department head. Alternatively, in the case of "Emergency Management in Dental Treatment", attending doctors are summoned to our department ; however, no reports detailing vital signs requiring summoning a doctor were available. Furthermore, the procedures for cooperation among staff members are unclear. As an initial first aid procedure, it is necessary to implement training sessions for staff members regarding vital sign readings, securing of air passageways, and oxygen administration. To achieve a sufficient level of risk management as outlined above, the department budget would be exceeded. Crisis management training for operating room staff is also considered necessary. For risk management in the dental hospital, creation of risk management manuals, acquisition of clear informed consent regarding accidents with respect to local anesthetic injections and summarization and announcements of accident reports must be implemented immediately. Moreover, creation of and education pertaining to risk management systems as an educational medical institute, support from university board members, establishment of a staff advocate system, and open dispute arbitration as well as investigation in each departmental section is essential.departmental bulletin pape