Pediatri Pratiğinde Bilgilendirilmiş Ret: Üçüncü Basamak Bir Çocuk Hastanesinin Tek Merkez Deneyimi

Öz

Amaç: Aydınlatılmış onam ve beraberinde gelen tıbbi işlem ve tedaviyi reddetme hakkı, çocukluk çağında ebeveynler veya yasal temsilciler tarafından kullanılmaktadır. Bu çalışma, çocukluk çağında reddedilen tıbbi işlem ve tedavilerin neler olduğu ve kliniklere göre dağılımı ile ret sonrası çocuk istismarı ve ihmali açısından bildirim sıklığının saptanması amacıyla yürütüldü. Gereç ve Yöntem: Bu kesitsel araştırma, üçüncü basamak olarak hizmet veren ve aynı zamanda eğitim araştırma hastanesi olan bir çocuk hastanesinde yapıldı. Hastanemiz acil servis, yoğun bakım üniteleri, tüm genel pediatri, yan dal ve cerrahi kliniklerinde 1 Ocak- 30 Haziran 2019 tarihleri arasında izlenmiş tüm hastaların, hastane veri tabanındaki dosyaları geriye dönük olarak incelendi. Belirtilen çalışma süresi boyunca tıbbi işlem ve tedavi reddi yapılan tüm hastalar çalışmamıza dahil edildi. Bulgular: Çalışma grubu, çalışma süresince tıbbi işlem ve tedavisi, bilgilendirilmiş ret formu imzalanarak reddedilen 348 hastadan oluştu (ortanca yaş: 1 yaş 9 ay; Erkek/Kız: 197/151). Genel ret oranı %2,7 (348/12844) olarak belirlendi. Tıbbi işlem ve reddin en çok oluştuğu birimin acil servis olduğu görüldü. En sık reddedilen durum, hastaneye yatırılarak izlem (303/348; %87), en sık reddedilen girişimsel işlem lomber ponksiyon (18/39; %46) idi. Yoğun bakımlar ve palyatif bakım ünitesi dahil olmak üzere, çalışma grubunda yaşam sonu desteği reddedilen olgu saptanmadı. Hastaların sadece %7,5’i çocuk ihmali olarak değerlendirilerek adli ve idari makamlara bildirilmişti. Sonuç: Son yıllarda giderek arttığı bildirilen, tıbbi öneriye rağmen hastaneden ayrılma, çalışma grubumuzda en sık rastlanan ret şeklidir. Tıbbi işlem ve tedavisi reddedilen çocuklar, çocuk istismarı ve ihmali açısından dikkatli değerlendirilmelidir.

Anahtar Kelimeler

• Tedavi reddi
• tıbbi işlem reddi
• çocuk istismarı ve ihmali
• tıbbi ihmal
• bilgilendirimiş ret

Informed Refusal in Pediatric Practice: a Single Center Experience of a Tertiary Care Children’s Hospital

Öz

Objective: Informed consent and refusal of medical procedure and treatment are patient rights that are used by parents or legal representatives of children. This study was conducted to determine the most common treatments and medical procedures refused by parents, their distribution according to clinics, and the frequency of reporting the refusal as child medical neglect to governmental and/or judicial authorities. Materials and Methods: In this cross-sectional study, the files in the hospital database of all patients who were admitted to the emergency department, intensive care units, all general pediatrics, pediatric subspecialities and surgery clinics of our hospital between 1 January and 30 June 2019 were retrospectively reviewed. All patients whose medical procedures and treatment were refused during the study period were included in our study. Results: The study group consisted of 348 patients whose medical procedure and treatment were refused by signing an informed refusal form during the study (median age: 1 year 9 months; Male/Female: 197/151). The overall refusal rate was 2.7%. Most of the refusals had occurred in the emergency department. The most common refused recommendation was hospitalization (303/348; 87%), while the most common refused invasive procedure was lumbar puncture (18/39; 46%). There were no cases who refused end-of-life support in the study group, including intensive care units and palliative care units. Only 7.5% of the patients were evaluated as child abuse and neglect, and reported to the governmental/judicial authorities. Conclusion: Discharge against medical advice, which has been reported to increase in recent years, is the most common form of refusal in our study group. Children whose medical procedures and treatment were refused should be carefully evaluated for child abuse and neglect.

Anahtar Kelimeler

• Refusal of treatment
• refusal of medical procedures
• child abuse and neglect
• medical neglect
• informed refusal

Kaynakça

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