我國醫療機構病人安全教育國家政策綱領之發展

Developing a National Patient Safety Education Policy Frameworkfor Taiwan

李苓令(Ling-Ling Lee)

指導教授 ： 郭乃文

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2008年)

摘要

論文摘要
論文名稱：我國醫療機構病人安全教育國家政策綱領之發展
研究所名稱：台北醫學大學醫務管理碩士班
研究生姓名：李苓令
畢業時間：九十六學年度第二學期
指導教授：郭乃文 台北醫學大學醫務管理研究所副教授

提昇病人安全、降低醫療錯誤是近年來各國醫療體系改革的重要方向之ㄧ，由2006年NPSF舉辦之國際研討會中，美國發表將參考航空界組員資源管理（Crew Resource Management，CRM），發展適用於醫療界不同專業間的團隊訓練課程以促進團隊合作，被視為病人安全工作國際發展趨勢之ㄧ，可以得知病人安全教育在病人安全架構中扮演著關鍵角色。
有關病人安全教育訓練的成效，國際上，加拿大之研究顯示：教育訓練介入對於改善護理主管對於病人安全文化認知有顯著之改善；美國在應用改良航空界之機組人員資源管理系統(CRM)於急診室之研究發現，受過前揭團隊訓練之急診室之臨床錯誤較少；國內推動骨科醫師實施『術前標示』(Mark Op Site)計畫，於各區域醫療網加強宣導及辦理病人安全教育訓練，結果顯示：骨科醫學會會員百分之百標示手術部位的比例大幅提升；醫策會執行病人安全國際交流與民眾參與計畫結果顯示：增加醫院內在職教育有關異常事件通報的課程百分比後，由通報件數的增加，證明了教育訓練的介入確實可以有效提升品質。本研究希望藉由國內外經驗，發展一套經學者專家討論、檢視完成，適合國內醫療機構使用之病人安全教育課程，提供主政機關參考制定「我國醫療機構病人安全教育國家政策綱領」予各級醫療機構實施適當且必要之病人安全教育。
本研究之病人安全教育課程主題係經由國內外發表之文獻、已辦理之病人安全教育在職訓練課程主題及相關活動以及在相關網站及資料庫收集世界各國已制定之病人安全教育內容架構，初步研擬「我國醫療機構病人安全教育架構發展」草案，經二次學者專家焦點團體座談討論後，完成第一輪問卷，並經德菲法學者專家二次的問卷填答後，整理歸納出學者專家依重要性與可行性構面下評估選定之「我國醫療機構病人安全教育架構」包含7大領域21個教育目標及60項課程主題，製作問卷，發至124家新制醫院評鑑合格之地區教學醫院病人安全相關業務負責人填答。
研究結果顯示：依各醫院填答結果，選出符合重要性及需要性二大構面之課程主題計55項，涵蓋有「病人安全基本概念與方針」、「病人安全文化之建構」、「風險管理」、「領導與團隊合作」、「有效地溝通」、「運用證據及資訊」及「持續教育與學習」等七大領域，相較於澳、美、英等國已發展之病人安全教育訓練架構，涵蓋面更為廣泛，而選定之課程主題足以提供我國醫療機構之病人安全教育更有系統及全面性之明確方向，若能依此課程主題統一發展出各式之病人安全教育課程與教材，不但符合成本效益，又可解決許多小型醫院因不具經濟規模，無法自行發展病人安全教育課程之窘境，在推廣全國病人安全教育實務上，藉由有限的課程，影響受教者的認知，進而行為改變，最後落實為執行力，提升醫療服務品質。

關鍵字：病人安全、教育訓練

關鍵字

病人安全、教育訓練

並列摘要

Abstract
Title of Thesis：Developing a National Patient Safety Education Framework for Taiwan
Author：Ling-Ling Lee
Thesis advised by：Nai-Wen Kuo, Ph.D.

In recent years, improving patient safety and decreasing the error in medical activities is one of the important directions for reforming medical systems in various countries. In a conference held by NPSF in 2006, the United States declared that they would refer to the Crew Resource Management (CRM) in the aerial business and develop a group training course between various professions to improve team work. It was regarded as a trend of international patient safety activities development, and it also meant that patient safety education plays a critical role in the structure of patient safety.
The following are the performances of the patient safety education in various countries: Canadian research shows that training could significantly improve the cognition of patient safety culture in nursing management. American research also shows that the emergency rooms which adopted the CRM system in the aerial business made less clinical mistakes than those who did not. In Taiwan, orthopedists are encouraged to follow the「Mark Op Site」procedure. In addition, medical networks in various areas are promoting the practice of patient safety education. The results showed that an increasing amount of the members in Taiwan’s Orthopaedic Association had started to practice the Mark Op site procedure. Also, the results of the 「patient safety international exchange and the populace participation plan」, which was conducted by Taiwan’s Joint Commission on Hospital Accreditation, shows that after increasing the percentages of courses for abnormal events, the number of reported events relating to on-the-job training had increased. The results proved the involvement of education can certainly and efficiently improve quality. This research hopes that by referring to the domestic and international experience, to develop a patient safety education program which is discussed, reviewed, and accomplished by the experts and is suitable for the nationwide medical institutions. This program could provide the authority with a reference in establishing the「National Policy Guidance of Patient Safety Education for Domestic Medical Institutions」, which could be applied to all levels of medical institutions as seen appropriate and necessary for patient safety education.

The program subjects of patient safety in this research referred to domestic and foreign publications, program subjects of on-job training and related activities which had been held, and the contents and frameworks of patient safety established in various countries collected from related web-sites and databases. We first drafted on the article “Developing Patient Safety Education Framework in Medical Institution in Taiwan” and then held the focus group symposium for experts and academics twice to accomplish the first round questionnaire set; After that, we invited the experts and academics to filled out the questionnaires by Delphi Methods for two times, and consolidated the selections according to the “Importance” and “Feasibility” dimensions evaluated by the experts and academics. This “Patient Safety Education Framework in Medical Institution in Taiwan” contains seven areas, twenty-one educational goals, and sixty program subjects. We then made the questionnaires and sent to one hundred and twenty four hospitals (including Medical Centers, Regional Teaching Hospitals, and District Teaching Hospitals) which were accredited by the new accreditation, and invited the personnel who were responsible to patient safety and related business to accomplish them.

The result of this research demonstrates: Based on various hospitals’ answers, fifty-five program subjects were selected according to the importance and demand for the curriculum. These courses covered seven main areas “basic concepts and policies for patient safety”, “constructing patient safety culture”, “risk management”, “leadership and teamwork”, “effective communication”, “using evidences and information”, and “continuing education and studies.” Comparing with the patient safety education frameworks developed in Australia, United States, and England, these programs covered a wider range, and the selected subjects could provide a clear direction that was both more systematic and comprehensive for domestic medical institutions. If we could develop various courses and materials for patient safety education depending on these programs, then it could not only conform to the cost benefit but also improve the difficult situations of tiny hospitals which cannot develop patient safety education courses on their own due to they were too small to have the economic scales. In practice of popularizing patient safety education domestically, we want to influence the attendees’ cognitions and thus change their behaviors by limited courses. In the end, they would transform to executions and promote the quality of medical services.

Keywords：patient safety，education

並列關鍵字

patient safety，education

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