護理人員的病人安全與病安文化認知及其對醫療異常事件通報的影響 — 以兩家署立醫院為例

The impact of nursing staffs patient safety cognitive and patient safety cultural cognitive to the medical incident reporting - A Case Study of two of department of health hospitals

黃品耀(Pin-Yao Huang)

指導教授 ： 張肇松

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2011年)

摘要

研究目的
透過實證研究來瞭解護理人員對病人安全與病人安全文化的認知情形、探討影響護理人員病人安全與病人安全文化認知的因子，以及護理人員病人安全與病人安全文化的認知對醫療異常事件通報情形的影響。
研究方法
本研究設計採全面普查，以不記名的問卷方式來調查。所研究的母群體是針對兩家署立醫院(署立新營醫院與署立澎湖醫院)的全體護理人員為研究對象。調查前經研究者親自向兩家署立醫院院長及護理部主任說明研究目的與問卷內容並徵詢同意後，同時尊重填寫者之填寫意願及隱私，再將問卷交由護理部主任轉發給護理人員填寫及協助進行問卷回收。共發出150份問卷，回收148份，回收率98.6%，有效問卷128份，有效問卷回收率86.5%。研究架構中，個人屬性(包括：教育程度、年齡、婚姻狀態、服務年資、職務別、服務科別、病安教育以及護理進階層級)為控制變項，將「病人安全認知」與「病人安全文化認知」這兩個因素視為自變項，而依變項則是「醫療異常事件通報」；藉此來探討護理人員的病人安全與病安文化認知情形及其對醫療異常事件通報的影響。
研究結果
護理人員的整體病人安全認知平均分數為4.61±0.38，整體病人安全文化平均分數為3.42±0.34，顯示護理人員在病人安全與病安文化認知兩方面都有相當好的認知程度。異常事件通報次數方面，有六成七的護理人員則在過去一年內完全沒有醫療異常事件通報的經驗。差異性分析方面，個人屬性中的臨床年資在預防病人跌倒(p value = 0.004)、鼓勵異常事件通報(p value = 0.008)以及提升民眾參與病人安全(p value = 0.028)這三方面的病人安全認知有顯著差異；服務單位在提升用藥安全(p value = 0.030)、提升手術正確性(p value = 0.011)、提升病人辨識正確性(p value = 0.022)以及改善交接病人之溝通與安全(p value = 0.007)這四方面的病人安全認知有顯著差異；個人屬性中的年齡(p value = 0.019)、職務別(p value = 0.040)以及臨床年資(p value = 0.028)在單位層面病人安全文化上有顯著差異。相關分析顯示單位層面之病人安全文化與異常事件通報為負相關，病安認知及病安文化認知與異常事件通報用二項式對數迴歸法分析顯示單位層面之病人安全文化與異常事件通報負向預測因子，意即出現病人安全文化認知高而異常事件通報情形低的落差情況。
結論與建議。
雖然護理人員對病人安全與病人安全文化的認知分數高，卻有超過六成的護理人員在過去一年內從未通報過醫療異常事件。護理人員存在有「認知高、通報低」的落差情況，顯示護理人員在醫療異常事件通報上仍是多所阻礙。建議加強護理人員在病人安全與醫療異常事件通報方面的教育訓練，並改善醫療異常事件通報系統的流程，以利病人安全工作之推行。

關鍵字

病人安全 ； 病人安全文化 ； 醫療異常事件通報

並列摘要

Objectives:
Through the empirical research in understanding the safety cognition of nursing staff for patients, the factors that affect nursing staff’s safety culture cognition towards patient and the impact to the medical incident report.

Methods:
In the research framework, the demographic characteristics (educational level, age, marital status) and vocational characteristics (years of service, job title, department, continuing education for patients’ safety, advanced nursing care) are the control variables. Two other factors, patient safety cognition and patient safety culture cognition are the independent variable. The medical incident reporting situation will be considered as the dependent variable. This research allows me to investigate the impact of nursing staffs’ patient safety cognition and patient safety cultural cognition found in medical incident report.

Results:
The nursing staff’s cognitive score on patient safety in the overall average is 4.61 ± 0.38, the nursing staff’s cognitive score of the patient safety culture in the overall average is 3.42 ± 0.34. Demographic characteristics of the age (p value = 0.019), and vocational characteristics such as job title (p value = 0.040) and clinical service years (p value = 0.028) are significant differences at the unit level of patient safety culture. Vocational characteristics of the clinical service years in such of these three areas of patient safety, including “the prevention of patient falls” (p value = 0.004), “to encourage incident reporting “(p value = 0.008), “to enhance public participation in patient safety “(p value = 0.028), are significant differences in cognitive scores. Service units in the four areas of patient safety, “to enhance drug safety” (p value = 0.030), “to increase surgery correction “(p value = 0.011), ”to improve patient identification accuracy” (p value = 0.022), “the transfer of patients to improve communication and safety” (p value = 0.007) are significant differences in cognitive scores. Under the unit level of patient safety culture significantly correlates to incident reporting cases (P = 0.005) and it is a negative predictor to incident report. It appears that high patient safety culture perception but low incident report status is the case study. Only thirty percent of the nursing staff had the experience of medical incidents report in the previous year.

Implication:
Although the patient safety cognitive scores and patient safety culture scores of nursing staff are high, there are still over sixty percentages of nurses had never been informed of abnormal events. In the previous year, the abnormal events were not properly reported that indicates the status of high patient safety cognition is associated with low medical incident report. Thus, I proposed to strengthen the educational courses for nursing staff in patient safety and medical aspects of incident report in order to improve the process of medical incident report system. Thus, it will enhance the implementation of patients’ safety.

並列關鍵字

Patients’ safety cognition ； patient safety cultural cognition ； medical incident report

參考文獻

一、中文部分

1.石崇良(2004)．病人安全之國際趨勢．第二屆臺灣醫療品質促進年會會議手冊． 醫策會主辦．臺北：公務人員發展中心。

2.石崇良(2004)．94年病人安全政策規劃．建構優質醫院作業環境成果發表會講義．臺灣醫院協會主辦．臺北：榮民總醫院。

3.行政院衛生署(2006)．九十五年度醫院執行病人安全工作目標之建議參考手冊．臺北：行政院衛生署。

4.臺灣醫院協會(2004)．護理作業安全參考指引．醫院安全作業參考指引手冊．臺北：臺灣醫院協會．