| 摘要: | 背景:「病人安全」（Patient Safety）是近年來世界各國重視的議題之一，在現今醫療機構，皆主張病人安全的目的就是使病人免於因為醫療照護過程中的意外而導致不必要的傷害。若能以實證為基礎，進行病人安全相關議題的研究，可避免或減少病人因接受醫療行為而遭受到傷害，藉由研究的推展，可營造一個重視病人安全的環境與文化。目的：調查並瞭解某地區醫院的醫療從業人員對病人安全文化態度的影響因素，以提供醫院領導者在促進病人安全目標、管理和領導的原則之參考。方法：以某地區醫院醫療從業人員為研究對象，以一年一次抽測方式由受試者以電腦線上填答。本問卷採用美國德州大學發展的安全態度量表(Safety Attitudes Questionnaire, SAQ)六個構面，及美國保健政策研究機構（Agency for Healthcare Research and Quality, AHRQ）病安文化問卷三個構面共九個構面41題項。執行前並通過醫院人體試驗倫理委員會審查，問卷調查期間2015年5月1日~5月25日有效問卷回收127份，回收率45.35%。對問卷回收的有效樣本採用獨立樣本t 檢驗的方法及ANOVA進行資料分析，並針對統計推論有顯著性意義構面再進行各族群間以Tukey HSD或Games-Howell進行事後檢定。結果：統計數據顯示，整體問卷以團隊合作構面為平均得分最高佔自變項共6項次，最低分則為對管理的感受構面共7項次。有統計顯著影響則以交接班構面為最多共3項次，是否擔任主管變項有4個構面達顯著性差異。 其中，在交接班變項男性較女性重視病人安全(p<0.05)。有擔任主管職人員認為在工作狀況、安全風氣、管理支持病安活動、交接班等變項會比非主管職重視病人安全(p<0.05)。年齡以41歲以上族群大於其他族群明顯認為在交接班變項較重視病人安全(p<0.05)。教育程度結果顯示研究所類族群於跨單位團隊合作構面認知明顯低於專科與大學類族群(p<0.05)。結論：安全態度量表和AHRQ問卷是有用的工具，可以揭露醫院病人安全文化的根本問題，並提升醫院員工的病人安全態度，提供院方對於病人安全作業執行推動之主要目標，了解缺乏項目作為未來監控之指標及未來推展全院改善之參考。根據本研究結果，建議建?常規安全文化調查的機制，定期瞭解組織成員對安全的態?以發掘院內不良現象。
Background: "Patient Safety" is one of the important issues of the world recent years. In today's medical institutions, it is advocated patient safety goal is to keep the patient from unnecessary harm because of an accident during medical care. If the research issues of patient safety are evidence-based, that can avoid or reduce patient, when receiving medical practices, suffered harm. We want to create an attention to patient secure of environment and culture through this research.Objectives: We try to investigate and understand the factors of medical personnel in a local community hospital of patient safety culture attitude in order to provide a consultation for the hospital leader in promoting of patient safety objectives, management, and the principles of leadership.Methods: For understanding the patient safety culture of employees in the study hospital, we participated in national Patient Safety Culture Survey held by Taiwan Joint Commission on Hospital Accreditation in 2015. The colleagues in the study hospital answered the cross-sectional questionnaires online to express the level of satisfaction for 41 items of patient safety questions in six constructs from SAQ (Safety Attitudes Questionnaire) developed by the University of Texas and three constructs from AHRQ (Agency for Healthcare Research and Quality, USA). Before executing this investigation, it was approved by the hospital ethics committee. During the May 1, 2015 - May 25, 2015 the 127 valid questionnaires were collected, recovery of 45.35%. The data analyzed by independent sample t test and ANOVA method. For statistical significant results of ANOVA, we use the Tukey HSD or Games-Howell post hoc test between the groups.Results: Overall questionnaire show the teamwork construct had highest average score at 6 variables, and the construct of management experience had 7 variables having lowest score. There are three variables having statistically significant difference in shift construct. The variable, whether as person in charge, showed statistical significance difference at four constructs.However, men showed more attention to patient safety than women at variable shift(p <0.05). Person in charge showed more attention to patient safety than not person in charge(p <0.05) at working conditions, safety culture, management support patient safety activities, and shift. In the group aged 41 years and older was significantly higher than other ethnic groups believe more emphasis on patient safety at the shift change variable (p <0.05). Institute group showed a significantly lower cognitive construct in cross-unit team cooperation than college-and-university group(p <0.05).Conclusion: Safety Attitude Questionnaire and AHRQ is a useful tool that can reveal fundamental problems of the hospital patient safety culture. The study results improve patient safety attitudes of hospital staff, provide the hospital for primary objective to promote the implementation of patient safety work, and understand the lack of items for future monitoring the indicators for improvement. According to the findings, we recommended the mechanisms for regular safety culture surveys to understand the attitude of the security of members of the organization to explore hospital undesirable phenomena. |
