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对于终末期肾病患者致命性饮食处方错误,营养师法律责任的跨学科认知。

Interdisciplinary perceptions of the dietitian's legal responsibility for lethal dietary prescription errors for patients with end-stage renal disease.

作者信息

King D G

机构信息

New York University, NY 10003.

出版信息

J Am Diet Assoc. 1993 Nov;93(11):1269-73. doi: 10.1016/0002-8223(93)91953-n.

DOI:10.1016/0002-8223(93)91953-n
PMID:8227876
Abstract

OBJECTIVE

To determine intergroup and intragroup consensus for interdisciplinary perceptions of dietitians' legal responsibility for lethal dietary prescription errors.

DESIGN

Survey research was conducted by a mail questionnaire containing four hypothetical cases in which the dietitian provides a lethal amount of dietary potassium for an anephric patient.

SETTING

Of the 90 New York State end-stage renal disease facilities contacted, 64 returned one or more questionnaires.

SUBJECTS/SAMPLES: Usable questionnaires were tabulated from 51 registered dietitians, 39 registered head nurses, and 43 physician-medical directors.

MEASURES

Consensus was recognized when 60% or more of the responses occurred in one extreme collapsed and dichotomized category of "yes" or "no" regarding the dietitian's legal responsibility.

STATISTICAL ANALYSES PERFORMED

Intergroup and intragroup consensus levels were compared by frequency, mean, standard deviation, and Scheffe test of differences.

RESULTS

The triad groups met varying levels of consensus on all four scenarios, with dissenting opinions by nurses on two scenarios. The dietitians and the physician-medical directors had mirror-image perceptions that the dietitian was not legally accountable for two cases of following foreseeably lethal dietary prescriptions "as written." Eight dietitians viewed the dietitian as legally nonculpable for causing a patient's death because of the dietitian's sole incompetence or carelessness in making a serious calculation error. Nurses met the highest levels of agreement and perceived the dietitian to be legally accountable for all four cases. The nurses, in contrast to the dietitians and physician-medical directors, held opinions of dietitian legal responsibility as consistent with the standard of care expectations of prudent health care professionals defined by professional malpractice jurisprudence.

APPLICATIONS/CONCLUSIONS: The data indicate that to protect both the patient and the professional, there is a notable need for greater understanding dietetics jurisprudence.

摘要

目的

确定跨学科团队对营养师开出致命性饮食处方错误的法律责任认知的组间和组内共识。

设计

通过邮寄包含四个假设案例的问卷进行调查研究,案例中营养师为一名无肾患者提供了致命剂量的饮食钾。

背景

在联系的90家纽约州终末期肾病机构中,64家返回了一份或多份问卷。

研究对象/样本:从51名注册营养师、39名注册护士长和43名内科医生兼医疗主任处整理出可用问卷。

测量方法

当60%或更多的回答出现在关于营养师法律责任的“是”或“否”这一极端合并且二分的类别中时,即认定达成共识。

进行的统计分析

通过频率、均值、标准差以及差异的谢费检验比较组间和组内的共识水平。

结果

三组在所有四个案例中达成的共识水平各不相同,护士在两个案例中有不同意见。营养师和内科医生兼医疗主任的看法呈镜像,即对于两例“照写”的可预见致命饮食处方,营养师在法律上无需负责。八名营养师认为,由于营养师在进行严重计算错误时仅存在能力不足或粗心大意的情况,因此在法律上不应为导致患者死亡负责。护士达成的共识程度最高,认为营养师对所有四个案例在法律上都应负责。与营养师和内科医生兼医疗主任不同,护士对营养师法律责任的看法与专业医疗事故判例法所定义的谨慎医疗专业人员的护理标准期望一致。

应用/结论:数据表明,为保护患者和专业人员双方,非常有必要更好地理解饮食学判例法。

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