機構照顧疏失類型分析－以法院判決案例

Types on the Negligence of the Care Facilities--Evidence from the Judgments Delivered from District Courts

10.6317/LTC.20.269

郭淑珍(Shu-Chen Kuo)；邱文宏(Wen-Hong Chiu)；胡月娟(Yueh-Juen Hwu)；賴慧貞(Huey-Jen Lai)

照護機構 ； 疏忽 ； 法院判決 ； 內容分析 ； 住民安全 ； dementia ； advanced directives ； medical autonomy ； terminal care

長期照護雜誌

20卷3期（2016 / 12 / 01）

269 - 290

繁體中文

照護機構訴訟乃為今日醫療領域訴訟增長最快速者，一旦發生照顧疏失，導致住民傷害、甚至死亡，受照顧者或其家屬極易尋求法律途徑解決。本研究旨在探討照顧疏失類型及其原因，以提供照護機構與實務工作者參考，進而研擬預防策略，降低照顧疏失，以提升住民安全與照護品質。本研究採次級資料回溯分析方式，由司法院法學資料檢索系統，彙集照護機構糾紛判決文，以受照顧者（原告）觀點，探討發生照 顧疏失類型，運用內容分析法做失誤分類及歸納。收集2005年至2015 年共27案例，照顧疏失發生在獨立型機構（81.48%）顯著高於醫院附屬型機構（18.52%）；啟動索賠主要發起人是住民子女（79.57%）；索賠對象以機構負責人為主要被告，其次是護理 人員和照顧服務員；住民傷害嚴重度高達七成者（70.37%）為死亡；原告者勝訴率 29.63%。從判決文分析得知，主要疏失事件依序為：跌倒、哽咽、病情變化、感染、 管路誤置、誤食鹽酸、脫水；疏失次分類前六項：延誤送醫、照顧疏失、評估與判斷 力不足、照護紀錄疏漏、照顧人力不足、環境或設備不良等。研究結果可供長照機構 管理階層與實務工作者警惕，自加強照護人員教育訓練，建立照護標準流程，落實全 面無障礙安全環境，以提高住民的安全和照護品質。

Litigation on the care facilities has become today’s litigation in the medical field that has the fastest growth. Once the negligence in the care-taking occurred that leads to the injury of the resident, or even to the point of death, it would be very easy for the one who is under care or for his or her family members to seek for legal way to solve the problem. Objective of this research is to discuss types of care-taking negligence and its reason in order to provide as reference for the care facilities and its worker, so as to further study on drafting the prevention strategy, reducing the negligence on care-taking to increase the quality of care and safety of the resident. This research has adopted Secondary data analysis method to use Judicial Yuan Legal Information Retrieval System, and collect the verdict of litigation of care facilities The research is based on the standpoint of one receiving care (in this case the plaintiff) to discuss the categories of the care facilities negligence occurrence and read on the verdict to utilize content analysis method in order to categorize and induce. The survey collected total of 27 cases during year 2005 to 2015, and revealed that the occurring location of the care facilities negligence, independent type of organization is significantly higher than hospital’s affiliated organization (81.48% vs 18.52%); one who initiate claim indemnity mainly are resident’s children (79.57%); object of the claim is the person in charge of the organization to be the main defendant, secondary is the nursing staff and nurse aides; 70.37% are those critical degree of resident’s injury and resulting in death; the rate of winning the lawsuit by the plaintiff is 29.63%. From the analysis of the verdict, it is known that the main negligent incident according to its order are falling down, choking, deterioration of illness, infection, misplacement of tubing, digestion of hydrochloric acid by accident, and dehydration; the six main reasons of negligence out front are delay in hospitalization, care negligence, insufficiency in evaluation and judgment, neglect in care record, insufficiency in care manpower, Adverse environment or equipment, etc. Research result can be provided for the management level of long term care facilities and its worker as warning, and to strengthen educational training of the care facilities in order to combine with establishing standard procedure of care, realize an overall barrier-free safe environment, and enhance residents safety and quality of care.

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