運用巡迴輔導探討人員對病人安全認知、態度、行為及其安全關議題
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(2) S38. (N = 86) (%) 22 (25.6) 64 (74.4) ( 92. 4. 1. 12. 33. ). 20 25. 17 (19.77). 26 30. 51 (59.30). > 31. 18 (20.93) 45 (52.3) (. ) (. 41 (47.7). ). 1. 3. 38 (44.19). 4. 6. 29 (33.72). 7. 10. 15 (17.44). > 10. 4 (4.65) 67 (77.9) 19 (22.1). 3 / 0. 1. / 55 (64.0). 3. 26 (30.2) 2 (2.3) 3 (3.5) 3 /. 1 0. / (1. Vincen's. ). 3. Kuder-Richardson formula 20 (K-R 0.82. 20) 0.80 4 1 (1. /. / ). 0.82. 0 4 (Content Validity Index). 83.5%.
(3) S39. (N = 86) / 3 1. 0.60. 0.49. 0. 1. 1. 0.98. 0.15. 0. 1. 1. 0.72. 0.45. 0. 1. 3. 2.30. 0.93. 1. 3. 1. 0.59. 0.49. 0. 1. 1. 0.27. 0.45. 0. 1. 1. 0.15. 0.36. 0. 1. 3. 0.66. 0.93. 1. 3. 1. 0.70. 0.46. 0. 1. 1. 0.60. 0.49. 0. 1. 1. 0.87. 0.34. 0. 1. 1. 0.58. 0.50. 0. 1. 4. 2.30. 1.76. 2. 4. 3. (. ) 4. Near misses (. ). (. ). 4). 24. EXCEL. SPSS10.0 1). 30. 1. 2) 3) (Pearson correlation coefficient). 3. 3 Vincen's 1). 2). 3). Vincen's.
(4) S40. (N = 86) /. (%). /. (%). /*. (%). (76.6%) 60.1. 30.2. 97.7. 2.3. 0. 72.1. 25.6. 2.3. 37.2. 59.3. 3.5. 26.7. 73.3. 0. 84.9. 2.3. 3.5/9.3. 69.8. 20.9. 9.3. 60.5. 30.2. 9.4. 65.1. 34.9. 0. 22.1. 77.9. 0. 7.0. 93.0. 0. 9.7. (26.3%). (. ). (57.6%). Near misses (. ). (. ). 5.8. 94.2. 0. 12.8. 41.9. 45.3. 58.1. 12.8. 14/15.1. Vincen's (%) (n = 37) 13 (35.1). (64.0%). 7 (18.9). (2.3%). 7 (18.9). 64. (30.2%) (2.3%) (74.4%). 4 (10.8). 20. 3 (8.1). (77.9%). 30. (1.2%). 22. (25.6%). (79.1%). 2 (5.4). (44.2%). 4. 1 (2.7). (17.5%). 10. 1 6. 29. (33.7%) 4. (n = 20). 3. 38. 9. 15. 7. (4.6%). 52.3% 10 (50.0). 47.7% (. (. ). ). 4 (20.0) 3 (15.0) 2 (10.0). (. ). 1 (5.0) (n = 13) (SOP). 97.7% 5 (38.5). 72.1%. 4 (30.8). (. 60.1% ). 2 (15.4) 1 (7.7) 1 (7.7). (. ). 37.2% 26.7%. (n = 7). 84.9% 5 (71.4). (. ). 2 (28.6). (. ).
(5) S41. β (SE). β (SE). p. reference 0.999. 0.028. 3.444. 0.343. reference. reference. 3.00 (0.134) (. 0.125 (0.131). 1.403 (0.101) < 0.001. reference. p. reference. reference. 10-17 (0.089). 3.545. β (SE). p. -15. 10 (0.151). 0.800 (0.197) < 0.001. 0.999. ). 1 3. reference. 4 6. reference. reference. -15. 10 (0.123). 0.999. 0.687 (0.139) < 0.001. 0.875 (0.181) < 0.001. 7 10. 0.583 (0.163). 0.001. 0.687 (0.184) < 0.001. 1.292 (0.240) < 0.001. > 10. 0.583 (0.417). 0.166. 0.687 (0.472). 1.292 (0.613). 1.601. reference. 0.149. reference. reference. 1.117 (0.116) < 0.001. 4.563. 0.038. -16. 0.999. 1.783 (0.171) < 0.001. -16. 10 (0.131). 1.117 (0.304) < 0.001. 3.029. 10 (0.344). 0.999. 1.783 (0.447) < 0.001. 1.783 (0.437) < 0.001. 1.089. 10-15 (0.494). 0.999. 1.783 (0.642). 0.007. 69.8% 4. 60.5% 2). 65.1% 22.1%. 4). 7%. 58.1% (. 2. Vincen's 3). 13 7. 9%. 1). 2). 4). Vincen's. SOP. 5. 20. 16%. 1). 2). 1) 2). 3). ) 77. 49%. 1). 2). 12.8%. 26%. SOP. 3. 5.8%. 37. (. 3) 4). ). 77. 5). 59 14. 76.6% 29 ). ( 17. (. 4. 1). Demerol. 4). 3) ). 11 ). ( 2. (. Morphine ). 1) 3). 18. 23.4%. 2).
(6) S42. (N = 86). 1.000 0.540*. 1.000. 0.934*. 0.698*. 1.000. *p < 0.01. (p < 0.05) (. ) Gilkey. (p < 0.01) (r = 0.934) [4]. 60.1% Reason. [9] 0.66. 0.93 84.9% Kaveh. [10] (adverse event) [7]. 2.30. 1.76 [12]. [5,10] [13]. Schaaf [14]. Connolly. Battles. 58.1%. [11] 3. Webb. 4. 90% [16] 62.5% 32% [17]. [15].
(7) S43. 4.. (incident report). 2003;36:48-51 5. 2003 Available at: http://www.tjcha.org.tw/newsletter/main05.asp 6. 2003;36:69-75 7. James R. Managing the risks of organizational. Accent 1997. (Ashgate Publishing Limited) 8. Surgeons AC. Data sources and coordination. Patient Safety Manual. Rockville, MD: Bader & Associates, 1985.. [12]. 9.. -. 2003 10.Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ) 2001;43:1-668. 11.. 1. Joint Commission on the Accreditation of Healthcare Organizations 2003. Available at: http://JCAHO.org. 2.. 1997; 44:83-9. 3.. 17. 2002;7:6-7. Safety Management. 2004 & Risk Management 12. Frankel A, Graydon-Baker E, Neppl C, et al. Patient Safety Leadership WalkRounds. Jt Comm J Qual Saf 2003;29:16-26. 13.Connolly CK. Reducing error, improving safety. Relation between reported mishaps and safety is unclear. BMJ 2000;321:505-6. 14.Van der Schaaf TW. Near miss reporting in the Chemical Process Industry [Doctoral Thesis]. The Netherlands: Eindhoven University of Technology, Eindhoven, 1992. 15. Battles JB, Kaplan HS, Van der Schaaf TW, et al. The attributes of medical event-reporting systems: experience with a prototype medical event-reporting system for transfusion medicine. Arch Pathol Lab Med 1998;122:231-8. 16. Webb RK, Currie M, Morgan CA, et al. The Australian Incident Monitoring Study: an analysis of 2000 incident reports. Anaesth Intensive Care 1993;21:520-8. Health Care Risk Management 2001.
(8) S44. Patient Safety Walk-Around: An Analysis of Hospital Staff's Perception, Attitude and Behavior Toward Patient Concerns 1. 2. Shu-Ting Chuang , Kuo-Min Hsu , Chia-Hui Fan, Hsiu-Chu Tsai, 3. Ling-Nu Hsu, Nan-Yung Hsu 1. Department of Nursing, Consultant to the Director of China Medical University Hospital, 2. 3. Healthcare Quality Committee, Department of Thoracic Surgery, China Medical University Hospital, Taichung, Taiwan.. Purpose. To analyze staff members' perception, attitude, and behavior toward patient safety concerns in the hospital, through a Walk-Around mechanism. Methods. The study was conducted from April to December 2003. A total of 86 staff members in 33 hospital departments were interviewed. Semi-structured questionnaires with interviews were employed in the study. Results. Staff perception is a moderate factor affecting patients' safety. According to our results, we believe that patient safety could be improved by high participation of the supervisors (97.7%). Negative attitude affects staff's intention to report misconduct even when it occurs (84.9%). Staff's behavior is negative to the consequences. Even though the staff is willing to participate in improving patient safety, they are still reluctant to report the incident because of uncertainty of the consequences (41.9%). Perception, attitude and behavior are significantly corelated with each other. The misconduct events were categorized into operation procedure (49%), human error (26%), administration (16%), and equipment (9%) using Vincen's model. Conclusions. Through the Walk-Around approach, the staff's perception, attitude and behavior were better understood and the patient safety problems have been identified for future improvement. ( Mid Taiwan J Med 2005;10 Supplement:S37-44 ). Key words patients' safety, patient safety incident report, Walk-Around. Received : 17 December 2004.. Revised : 4 March 2005.. Accepted : 21 March 2005. Address reprint requests to : Kuo-Min Hsu, Consultant to the Director of China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan..
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