Pochybenie pri podaní injekcie s vážnymi následkami v rakúskom Grazi. Kto je za neho zodpovedný a čo robiť pre to, aby sa takéto pochybenia neopakovali? | Medicínske právo
              

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Pochybenie pri podaní injekcie s vážnymi následkami v rakúskom Grazi. Kto je za neho zodpovedný a čo robiť pre to, aby sa takéto pochybenia neopakovali?


 | 15.12.2013 | komentárov: 292

Pacient trpiaci leukémiou leží stále v kóme po tom, ako mu jeho ošetrujúca lekárka podala injekciu so substrátom pre chemoterapiu do miechy namiesto do žily

Obrazok Čo sa mohlo stať s etiketou na injekcii pri jej ceste z centrálnej lekárne do nemocnice? Kde a kedy sa stratila? A prečo bola neoznačená injekcia vôbec použitá? Kto pochybil, systém alebo ľudský faktor? Čo možno spraviť pre to, aby sa takéto pochybenie s vážnymi následkami už neopakovalo? Tieto i iné otázky vyvstávajú z prípadu, kedy ošetrujúca lekárka ohrozila zdravie pacienta podaním injekcie na nesprávne miesto.

Pred niekoľkými dňami sa v rakúskych médiách objavila správa o tom, ako lekárka z Uniklinik v rakúskom Grazi podala pacientovi trpiacemu na leukémiu nesprávnu injekciu. V priebehu ambulantne vykonávanej chemoterapie mu bola podaná vysoko toxická látka do miechy namiesto do žily. Pacientom bol známy podnikateľ z Grazu, ktorý mal dostať v priebehu chemoterapie dve injekcie, jednu do miechy a druhú do žily. Lekárka pravdepodobne tieto dve injekcie zamenila v dôsledku čoho sa teraz pacient nachádza na oddelení intenzívnej starostlivosti a bojuje o život.

K zámene injekcií došlo zrejme kvôli chýbajúcemu označeniu na podávanej injekčnej striekačke. Ako k tomuto mohlo dôjsť, nie je zatiaľ úplne zrejmé. Steirmarkská spoločnosť pre riadenie nemocníc totiž v pondelok 9.12.2013 vyhlásila, že injekcia bola v čase, keď opustila lekáreň, plne označená. Preto je na mieste položiť si otázku, prečo lekárka injekciu i napriek chýbajúcej etikete použila. Medzičasom už nemocnica v Grazi nehodu potvrdila. „Áno, skutočne došlo k pochybeniu“, nechal sa počuť Gernot Brunner, riaditeľ nemocnice. Zodpovedná lekárka priznala zamenenie, nakoľko druhá injekcia pre intravenózne použitie nebola v tom časom na mieste. Následne bol pacient informovaný a ošetrený. Dokumenty s opisom skutkovej podstaty by mali byť už v rukách prokuratúry.

Pacient bol umiestnený na jednotke intenzívnej starostlivosti. Doktori sa snažia pomocou vyplachovania dostať škodlivý liek preč z jeho miechy. Ak je totiž účinná vysoko toxická látka nachádzajúca sa v injekcii podaná na nesprávne miesto, môže spôsobiť závažné vedľajšie účinky a napadnúť zdravé bunky, najmä tie, ktoré sa nachádzajú v mieche a mozgu. Možnosť ochromenia preto nie je ešte stále úplne vylúčená.

„V tomto čase sa už pracuje na podrobnom preskúmaní prípadu“, zdôraznil Brunner. Komisia bude sledovať cestu injekcie z nemocnice do lekárne a následne zhodnotí správnosť postupu a bude zisťovať, kde došlo k pochybeniu. V súčasnosti sa chemoterapeutiká spracuvávajú centrálne. Každý kus sa samostatne balí, injekcia je počas celého procesu jasne označená etiketou s potrebnými informáciami a rovnaká etiketa sa nalepí na jej obal. „Nemôžem uveriť, že práve táto injekcia, o ktorú sa v prípade jedná, toto označenie nemala“, čudoval sa Still.

K prípadu sa medzičasom vyjadril už aj Franz Fazekas, člen predstavenstva nemocnice, „Nie z čisto zjavných dôvodov sa stalo niečo nepochopiteľné. Vždy sme boli presvedčení, že naše bezpečnostné opatrenia sú dostačujúce.“ Lieky na chemoterapiu sa spracovávajú priamo v centrále LHK nemocnice v Grazi, aby sa zabezpečil najvyšší stupeň hygieny. Liek následne vyzdvihuje pracovník nemocnice, ktorý ho zanesie ošetrujúcim odborníkom na preskúšanie. V niektorých nemocniciach už teraz funguje systém, kedy liek musí prejsť rukami dvoch špecialistov, aby sa predišlo podobným zámenám. Tento systém by mal byť zavedený v budúcnosti aj v nemocnici v Grazi. Okrem zavedenia princípu štyroch očí, kedy najmenej dvaja doktori musia skontrolovať správnosť lieku, sa plánuje tiež sprísniť bezpečnostné opatrenia. K označovaniu injekcií by mali pribudnúť červené jasne viditeľné informačné prúžky. Navyše sa plánuje zaviesť nový systém spracovania injekcií, kedy každý liek, ktorý je určený na aplikáciu do žily, bude najprv upravený do formy malej infúzie, tak, aby sa nedal injekčne aplikovať do miechy.

Prokuratúra podala žalobu na nemocnicu z vlastnej iniciatívy a veci sa ujala veľmi promptne. „Začali sme konanie ex offo na základe informácií v tlači ohľadom nehody v nemocnici,“ vyjadril sa prokurátor. Žaloba znie na poškodenie zdravia z nedbanlivosti.  


Spracovala: Lenka Mišová
Foto: thefreedigitalphoto.net
Zdroje
http://kurier.at/chronik/oesterreich/krebspatient-erhielt-falsche-spritze-lebensgefahr/40.322.379
http://steiermark.orf.at/news/stories/2619787/
http://steiermark.orf.at/news/stories/2620133/


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