不同通報來源下醫療異常事件差異探討

研究目的：病人安全在國內衛生署及醫策會的規定與督促下，以及病人權益及自主意識的高漲，於2003年建置台灣病人安全通報系統，簡稱TPR(Taiwan Patient-Safety Reporting System)，期藉由通報的異常事件提供各醫療機構學習重點改善建議或行動方案，預防不良事件再發。通報系統除了來自醫護人員的訊息外，病人自行通報也是重要來源。本研究擬調查病人和其家屬在住院醫療照護的過程發現醫療異常事件，和院內異常通報系統及病歷記載等不同來源，進行差異探討。期使透過病人的主動參與醫療照護的過程降低異常事件的發生以提升病人安全。研究方法：本研究採橫斷式前瞻性調查法量性調查研究。研究工具有（Weissman et al, 2008及Forster et al, 2003）文獻設計結構式問卷，進行二回合專家效度並保留一題開放性問答，調查期間2011年4月25日至5月31日共計五週，於出院前蒐集166位住院病人，回收率為94.3%；其他資料包括院內異常通報和病歷記載，進行差異比較並探討影響異常事件的因子及對醫療資源使用的影響。利用SPSS 14.0 for windows中文版統計套裝軟體進行統計分析，推論性統計分析採用Pearson相關分析、邏輯式迴歸分析（Logistic regression analysis）及複迴歸分析等方法分析。研究結果：研究結果顯示病人自我通報的異常事件比率13.9%，病歷記載異常事件比率9.6%，異常通報比率為4.2%，三個不同通報來源都有呈現的事件為跌倒事件，該事件病人自我通報件數與病歷記載一致性達50%。影響異常事件發生的因素為年齡、共病症嚴重度及住院天數。異常事件的發生在醫療品質指標項目中會影響十四天再入院，影響的程度為較未發生者高出三倍；在醫療資源使用會影響住院天數，影響的程度為每多住一天會增加10%發生異常事件的機會。結論與建議：本研究結論為，病人自我通報是獲取異常事件重要的來源。未來可在本研究的基礎下，增加醫院家數或不同層級醫院的研究資料，可以更加正確呈現本國異常事件通報的全貌，醫療品質之現況及未來改善的方向。各醫療機構管理者亦可參考本研究結果，了解醫療異常事件的風險因子發展預防策略，提升病人安全。

關鍵字

病人安全；病人通報；異常通報；醫療錯誤

並列摘要

Objective- In 2003, Taiwan Patient-Safety Reporting System (TPR) was established under the ever-rising patient rights and ownership awareness and by the regulations and guidance by the Department of Health and Medicine and the Taiwan Joint Commission on Hospital Accreditation. The system provides case studies in order to form views and suggestions to prevent incidents from recurring or to improve action plans after the incidents. In addition to the reporting by medical personnel, patient self-recognition-and-reporting plays a very important source to the system as well. This study focuses on and investigates the differences between those reporting sources into TPR from patients and their family members when any medical malpractice or medical anomalies occur during the treatment, report from chain-of-command communication in the hospital, and medical record. This study is to reduce medical incidents and to increase patient safety through patient’s participation during their treatment in the hospital. Methods- This research is based on prospective cross-sectional study of quantitative research survey method. Research tools include documentation-based structured questionnaire (Weissman et al, 2008 and Forster et al, 2003), with an open-ended question. The questionnaire is used to retain an expert validity. The survey was conducted between April 25th, 2011 and May 31st, 2011; a total of 5 weeks. 166 copies were collected when the participating patients were discharged. The return rate is 94.3%. Other data contributed to the comparison and discussion of the differences between the factors affecting abnormal events and the impact on the use of medical resource includes hospital incident reporting and hospital medical records and patient charts. The statistical analysis is done by using SPSS 14.0 (Windows, Chinese version). The inferential statistical analysis is done by using Pearson correlation analysis, logistic regression analysis and multiple regression analysis. Results- The results shows the rate of patient’s self-notification of abnormal, or incidental, events is 13.9%. The patient record or chart anomaly rate is 9.6%. Recorded in unusual events, exception notification rate is 4.2%. Slip-and-fall is reported in all three reporting resources. In such incident, the report rate shows 50% from both the participating patients and the medical records. The causes of reported incidents are age, severity of illness and hospitalization days. Per medical care quality index, those incidents that occurred in the hospital would result in the return of the same patient three times higher than those who did not experience such event. In terms of medical resource usage such as hospitalization, the chances for an incident to occur increase by 10% per each additional day stay in the hospital. Conclusions - The results of the present study, showed that patients ' self-notification is an important source of gets the incidental event. Under the basis of this study, the future, increase the number of hospitals or hospitals of different levels of research data, can be more properly rendered picture of the Bulletin of the national incident, medical quality improvement of current status and future direction. The managers may also refer to the findings of medical institutions, understanding medical incidental event risk factor in the development of prevention strategies to enhance patient safety.