醫事人員對病人安全事件通報認知、態度及行為之探討

研究目的病人安全，人人有責，以往管理的焦點都放在如何去治療病患的疾病，今應省思醫療作業的缺失，給病人帶來的傷害可能遠大於醫療的正面功能，本研究目的是探討醫療人員對病人安全事件通報的認知、態度和行為之差異及建立病人安全事件安全通報認知、安全通報態度、安全通報行為之預測。研究方法本研究採橫斷式相關性研究，選取高雄市二家、屏東縣一家區域（含一家公立醫院）醫院醫事人員為研究對象，包括病人安全事件通報認知量表、態度量表及通報行為量表，各量表之內在一致性Cronbach’s α 分別為.897、.875及.916。收案時間自2010年02月01日至2010年2月14日，共發放722份問卷，有效回收643份，有效回收率93.45%。問卷調查資料以SPSS14.0版for Windows套裝軟體進行統計分析。研究結果本研究收集三家區域醫院醫事人員之資料，分析結果如下：一、以Pearson相關分析「通報行為」與「通報認知」呈現正相關(r=-0.303, p＜0.01)，顯示病人安全通報認知與通報行為有較高相關；「通報行為」與「通報態度」呈現負相關(r=-0.102, p=0.015)，顯示在通報態度中通報阻礙愈高，則通報行為不落實。二、醫事人員的個人基本屬性、個人通報經驗對病人安全事件通報認知、態度和行為之差異析結果顯示：（一）個人基本屬性、個人通報經驗對病人安全事件通報認知 1. 個人基本屬性在年齡(F=3.796, p=0.010)、工作職位(t=4.455, p=0.0005)有顯著性差異。 2. 個人通報經驗在耳聞同事通報(F=4.220, p=0.015)、通報責任（F=5.024, p=0.02）及通報依據(F=3.240, p=0.012)有顯著性差異。（二）個人基本屬性、個人通報經驗在病人安全事件通報態度 1. 個人基本屬性在聘僱別(t=-2.553, p=0.011)、工作職位(t=-2.196, p=0.028)、醫院權屬別(t=3.497, p=0.001)有顯著性差異 2. 個人通報經驗在耳聞同事通報(F=4.345, p=0.013）、通報件數(F=3.118, p=0.026）、填寫通報單的時間(F=2.793, P=0.040)有顯著性差異。（三）個人基本屬性、個人通報經驗在病人安全事件通報行為 1. 個人基本屬性在聘僱別(t=0.825, p=.004)、工作職稱(F=5.590, p=0.0005)及工作職位(t=4.454, p=.00005)有顯著性差異。 2. 個人通報經驗在病安教育訓練(F=3.650, p=0.027)、耳聞同事通報(F=7.893, p=0.0005)、通報件數(F=3.930, p=0.009)、填寫通報單的時間(F=9.302, p=0.0005)及通報依據(F=5.858, p=0.005)有顯著性差異。三、個人基本屬性、個人通報經驗預測病人安全事件通報認知、通報態度、通報行為解釋力分別為6.4%、4.7%、12.7%，個人基本屬性、個人通報經驗預測病人安全通報行為最佳。結論與建議在過去經驗中有通報經驗及接受相關教育的人員對通報認知、態度及行為得分較高，建議醫院管理方面：工作人員認為通報病人安全事件無誘因，增加額外工作，通報時間花費太長，建議應訂定獎勵措施、縮短通報單填寫時間、良好的回饋機制進而提升通報病人安全事件認知、態度及行為，建立正向病人安全通報氣氛之文化，進而可以杜絕病人安全事件之發生。

關鍵字

認知；態度；行為；病人安全事件

並列摘要

Objectives Patient safety is everyone's responsibility. In the past, management is focus on how to treat patients with the disease. But now we realize that the deficits in medical delivery which bring harm to the patient may be much greater than the positive effect. The purpose of this study was to explore the medical staff about the knowledge on incident report of patient safety, their attitude and behaviors towards it. And establish a prediction model on the awareness, attitude, and behaviors on patient safety. Methods This study was a cross-sectional studies. Medical staffs from two regional hospitals in Kaohsiung City and one in Pingtung County were surveyed. We used structured questionnaires which includes patient safety, incident report cognitive scale, attitude scale and volume of communications behavior table for the study. The scale’s internal consistency Cronbach's α was .897, .875 and .916 respectiely. The period for the collection of data was from February 1, 2010 to February 14, 2010. 722 questionnaires were distributed. The effective responses were 643 and the response rate was 93.45%. Questionnaire survey data was analyzed with SPSS 14.0 edition for Windows. Results The study results are as follows: I) While using Pearson correlation analysis for "reporting behavior" and "reporting cognition", there shows positive correlation (r =- 0.303, p <0.01). It means that they are highly correlated; On the other hand, "reporting behavior" and "reporting attitude" are negatively correlated (r =- 0.102, p = 0.015). It reflects that the higher the obstruction in reporting attitude, the lower the implementation of reporting behavior. II) The analysis results of the individual basic properties, personal reporting experience for patient safety incident reporting knowledge, attitudes, and behaviors different are: 1. In terms of personal characteristics, and personal reporting experience in reporting cognition: (1) The age group (F = 3.796, p = 0.010) and job position (t = 4.455, p = 0.0005) are having significant difference in cognition towards reporting. (2) Personal reporting experience in the heard of colleagues informed (F = 4.220, p = 0.015), reporting numbness (F = 5.024, p = 0.02) and time of reporting (F = 3.240, p = 0.012) are significantly different in cognition towards reporting. 2. In terms of personal characteristics, and personal reporting experience in reporting attitude: (1) The personal characteristics in different types of employment (t =- 2.553, p = 0.011), job position (t =- 2.196, p = 0.028) and hospital ownership (t = 3.497, p = 0.001) are significantly different (2) Personal reporting experience in the heard of colleagues informed (F = 4.345, p = 0.013), reporting number (F = 3.118, p = 0.026), and time of reporting (F = 2.793, P = 0.04) are significantly different. 3. In terms of personal characteristics, and personal reporting experience in reporting behavior: (1) The personal characteristics in different types of employment (t = 0.825, p =0. 004), job title (F = 5.590, p = 0.0005) and job position (t = 4.454, p =0.00005) are significantly different. (2) Personal reporting experience in patiens’t safety education and training (F = 3.650, p = 0.027), heard of colleagues informed (F = 7.893, p = 0.0005), reporting number (F = 3.930, p = 0.009), time of reporting (F = 9.302, p = 0.0005) and reporting basis (F = 5.858, p = 0.005) are significantly different. III) The explanatory power of personal characteristics and personal reporting experience in reporting cognitive, attitudes and behavior are 6.4%, 4.7%, 12.7%. It mean the personal characteristics and personal reporting experiences have the best prediction in reporting behavior. Conclusion and suggestion From our previous experience, person who have reporting experience and have received relevant education will get higher score in reporting cognition, attitude and behavior. The hospital staffs may have no incentives for reporting patient safety due to additional work and spent too much time for it. In order to improve this phenomenon, hospitals should made incentives for reporting, reducing time for reports and a good feedback mechanism. To establish a positive reporting climate of patient safety culture, in turn, can prevent the occurrence of patients’ safety incidents.