Автор: Михаил Каракозов
создано: 23.10.2005 03:25
Гена, прикола ради я задал поиск по данной теме в медлайне. Образовалось что-то около двух сотен статей, пик которых пришелся на восьмидесятые-середину девяностых. Ну вот типа приведенных ниже рефератов
Anesthesiology. 1993 Jan;78(1):184-90.
A reliable accounting system for controlled substances in the operating room.
Department of Anesthesiology, Hackensack Medical Center, New Jersey 07601.
BACKGROUND: Drug abuse is a leading occupational hazard for operating room personnel. Easy access to controlled substances allows drug dependence to develop and flourish. A system that accurately audits the distribution of controlled substances used in the operating room may decrease the onset of drug abuse and make it easier to identify drug addicts. A simple, inexpensive, and reliable system that improves accountability of controlled substances is described in detail. METHODS: This system involves participation by anesthesiologists, operating room nurses, and pharmacists to accurately record amount and type of drugs dispensed, used, wasted, and returned. Periodic, random, qualitative, and quantitative analyses of drugs returned for wastage are performed. RESULTS: In the first 6 months in which the system was used, 6,336 patients were treated and 7,182 ampules of controlled substances were dispensed. Thirty-seven incident reports describing deviations from the protocol occurred. In each case an explanation for the discrepancy was determined and compliance with the protocol was subsequently improved. No cases of drug diversion were discovered or suspected. CONCLUSIONS: The system described is simple and inexpensive to implement and has improved accountability for controlled substance management.
Jt Comm J Qual Patient Saf. 2005 Mar;31(3):167-72.
A systems approach to identifying inappropriate use of controlled substances: the need for balance.
Health Economics and Outcomes Research, Purdue Pharma LP., Stamford, Connecticut, USA.
BACKGROUND: The diversion, abuse, and inappropriate use of controlled substances remain of concern among health care practitioners, insurers, and policy makers in the United States. The principle of "balance" represents a need to establish a system of control to prevent abuse, trafficking, and diversion of controlled substances, while ensuring their medical availability for legitimate patients. ADMINISTRATIVE DATABASES TO STUDY OUTCOMES AND QUALITY OF CARE: Some models employ pattern recognition within administrative health databases, for example, to examine outcomes and quality of medical care and monitor fraudulent behaviors and inappropriate medical care. Patients' use of resources or variations in practitioners' practice patterns can be examined. A SYSTEMS APPROACH TO ADDRESS INAPPROPRIATE USE OF CONTROLLED SUBSTANCES: A systems approach would require collaboration with medical and pharmacy directors, systems analysts, coding experts, legal experts, and clinicians to develop the claims-based model. Once a patient and/or practitioner with possible diversion or abuse are identified, a second step is required to distinguish inappropriate and appropriate behaviors and medical care. CONCLUSION: Programs to detect misuse of controlled substances must be validated through clinical research, and a consensus should be reached as to what constitutes a breach of accepted medical practice.
Видно, что методика подхода к проблеме сильно отличается от отечественной. Административные меры применялись в шестидесятых-начале семидесятых, как у нас сейчас. Ну а теперь богатый Запад нашел возможности контроля этих препаратов без ущерба для работы врачей и здоровья больных. Да и трудно себе представить американского доктора, ворующего морфин для продажи. Его зарплаты хватит для того, чтобы обеспечить морфином всю больницу. То есть если он не наркоман, ему этот морфин и даром не нужен. То же относится и к другим странам. То же, вероятно, относится и к большинству сестринского персонала. Не стоит также забывать, что кредит доверия в этих странах не то что у нас, где все друг друга подозревают.
Короче, до цивилизованных методов нам еще долгий путь предстоит. А наши пока двигаются, так сказать, назад в будущее.
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Re: Привет из Органов! 
Ребята! Пошто про свой праздник забыли? 
ДЕНЬ Анестезиолога 