台北市醫學中心藥師對病人安全文化態度及其影響因素探討

Pharmacists’Attitudes toward Patient Safety and Related Factors in Medical Centers in Taipei

范曉寧(Shiau-Ning Fan)

指導教授 ： 許怡欣

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(2007年)

摘要

自從IOM於七年前的研究調查中建議改善病人安全可從文化著手後，安全文化的調查即成為改善病人安全的起始點，目前台灣已有針對全院員工及醫師所做的安全文化調查，但沒有針對藥師的相關研究，而藥師在「病人用藥安全」中又扮演了相當重要的角色，故本研究即針對台北市醫學中心的藥師進行安全文化的調查。

本研究使用由Dr.Sexton所發展的安全態度量-藥局版（Safety Attitudes Questionnair-Pharmacy version）來做為本研究的測量工具，藉以瞭解藥局的安全文化及不同醫院間藥師的安全態度，本研究的研究對象為台北市醫學中心的藥師。

本研究問卷的回收率為32.8%，Cronbach’s alpha分別為0.76-0.88在團隊氣候、安全氣候、管理知覺、工作滿意、工作情況及自覺壓力這六個構面。主要的研究結果為（1）各家醫院的藥局在安全文化上的差異雖然較在作業單位不同的差距小，但扣除其它因素外，醫院間的不同卻仍為影響文化的重要因素。（2）藥師的年齡愈大，在安全文化上的態度愈正向。（3）擔任管理職的藥師較非管理職的藥師有較正向的安全文化。（4）當受訪者在面對與醫療錯誤相關較敏感或負面的問題時，傾向較保守的回答。（5）雖然受訪者都知道如何通報醫療錯誤，也知不會被懲罰，但願意使用通報系統的人仍為少數。（6）醫療人力的負荷相當大，可能是造成病人安全的一大隱憂。

根據本研究的研究結果，本研究建議：（1）醫療人力的負荷及改善（2）建立安全文化調查的機制：定期瞭解組織成員對安全的態度。（3）建立學習型組織：不良事件的經驗學習。（4）培養通報文化。（5）問卷適用的時機。（6）擴大研究的範圍。（7）提高問卷回收率。

關鍵字：病人安全文化；病人安全態度；病人安全

關鍵字

病人安全文化 ； 病人安全態度 ； 病人安全

並列摘要

Background: Seven years ago the Institute of medicine recommended improving patient safety by addressing organizational culture issues. Since then, surveys of safety culture have been considered as the beginning of the improvement of patient’s safety. Safety culture of hospital staff and physicians have been well investigated. However, it still lacks of safety culture investigations of pharmacists. So the objective of this study is to investigate the safety culture of pharmacies working in Medical centers in Taipei.

Methods: We used Safety Attitudes Questionnaire-Pharmacy version developed by Dr. Sexton to realize pharmacy’s safety culture and its effects and to understand attitudes of patient safety among different hospitals. The objects of the research were pharmacists working in Medical Centers in Taipei.

Results: two hundred thirty-five (32.8%) surveys were included in the analyses. Cronbach’s alpha ranged from 0.76 to 0.88 for the scales: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. Hospital is a important factor of patient safety culture. Older pharmacists have more positive attitudes about patient safety. Pharmacists who are in managerial positions have better attitude toward safety cultures. Pharmacists tend to answer conservatively when they face the questions regarding medical error events or related adverse issues. Although it is known that no punishment will be issued as well as how to report medical error events, still few pharmacists use the reporting system. Heavy working loading of medical personnel may lead to potential threats to patient’s safety.

Conclusions: According to the results of this study, some suggestions are drawn as follows: First of all, investigations and improvements of working loading of medical personnel should be carried out. Secondly, establish the investigation system of safety culture. Thirdly, establish learning organizations to obtain experiences from medical error events. Furthermore, build up aggressive reporting culture. Moreover, use questionnaires in the right time. Enlarge investigation range and enhance the questionnaire return rate.

Key word : patient safety culture；patient safety attitudes ; patient safety

並列關鍵字

patient safety culture ； patient safety attitudes ； patient safety

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