醫師對醫療異常事件通報之認知、態度及行為相關因素之研究-以中部地區某區域醫院為例

The Physician，s Knowledge,Attitude and Behaviors Related to Medical Adverse Event Report- A Case Study of A Regional Hospital in Central-Taiwan

楊鳳凰(YANG FENG-HUANG)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

提升病人安全、降低醫療錯誤是當前各國醫療體系改革的重要方向之一，而異常事件通報則是病人安全架構中不可或缺的一環。
本研究的目的有三：一、探討中部某區域醫院內醫師對醫療異常事件通報之認知、態度及行為。二、探討醫師對醫療異常事件通報意願之重要影響因素。三、探討影響醫師對於異常事件通報制度之認知、態度及行為之相關因素。
本研究採用問卷調查法，針對中部某區域醫院內所有醫師共計104人為研究對象，研究工具係參考國內外相關文獻研擬而成之半結構式問卷。總計完成80份有效問卷，回收率76.9%。
研究結果發現：
（一）醫師對於醫療異常事件通報的認知會因年齡、工作年資及過去通報經驗不同而有所差異，工作年資越長者，對異常通報有較高的認知。然而對於醫院內部異常事件通報方式，仍有62.8﹪的醫師表示從未曾通報，及12.5﹪的醫師表示『從未有人告知』此系統。
（二）當自己發生醫療錯誤或異常事件時，僅有六成七的醫師願意通報，低於五成的醫師願意通報同事的錯誤；當別人通報自己的錯誤時，二成四的醫師表示會感到生氣與難堪。
（三）68.8%的醫師認為醫院內部異常事件通報系統保密性不夠，醫療糾紛及法律問題是其所擔心的。
（四）醫師對異常事件通報制度的認知程度越高，會伴隨越正向的態度及主動之行為，異常事件通報態度越正向，通報意願之行為亦愈佳，彼此間呈現統計上顯著相關。
因此本研究建議：衛生署應加強針對全國醫師對於病人安全相關議題之認知教育與宣導；而針對研究醫院在規劃異常事件通報制度及系統，應廣納醫師之意見，作為規劃及設計之考量，以提升醫師通報之意願及行為。此外，未來可採用深度質性研究方式，俾使更深入了解醫師之通報認知及態度行為間之關係。

關鍵字

醫療異常事件 ； 通報系統 ； 認知、態度、行為

並列摘要

The purpose of this study is to examine the physicians’ knowledge,attitudes,and behaviors toward Medical Adverse Event Report.
During the period of time on April 2006,the total number of respondents were 80 responding rate is 76.9%.
The results show：
(1) doctor the perception which notified regarding the medical adverse event can the age, the work period of service and the past notifies the experience to have difference , the work period of service elder, to exceptionally notified has the high perception. However notifies the way regarding the hospital interior adverse event, still some 62.8 ﹪ doctors expressed from not notifies, and 12.5 ﹪ doctors expressed 'never some people inform' this system.
(2) when own have the medical error or the adverse event, only some 67.1% doctors want the report, is lower than 50% doctor to want the report colleague's mistake; When others notify own mistake, 24.4% doctors indicated will feel is angry embarrassed with.
(3) 68.8% doctors thought the hospital interior adverse event notifies the system secrecy not enough, the medical dispute and the legal matter are its worried.
(4) Positive relationships among physicians’ perception, attitudes, and behaviors toward adverse reports, respectively, and positive relationships between adverse reports attitudes and behaviors. Incident reporting culture also revealed positive relationships with incident report perception, attitudes, and behaviors, respectively.
This study provides following suggestions: First, health authority can strengthen the knowledge of medical professionals toward reporting system. The National reporting system should be executed by the third party and the government should set up an efficient monitoring system. Besides, legislative yuan can enact bills to protect the confidentiality of person who file reports. Second, hospital management department should provide appropriate reporting environment to medical professionals, and encourage them to give opinions to incidents.. In addition, future researcher may modify the sequence of conditional questions; combine in-depth interview to understand the relation between safety culture and the knowledge and attitude of medical professionals.

並列關鍵字

medical adverse event, ； reporting system, ； knowledge, attitude, behavior

參考文獻

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