病人安全環境之建構─建立醫院病人安全指標系統
Building Patient Safety Environment─The Hospital Patient Safety Indicator System
中文摘要
病人安全是世界衛生組織及先進國家近年來最受重視的議題，我國行政院衛生署近年來亦一直致 力於促進醫療品質，在民國92 年 2 月成立病人安全委員會，而財團法人醫院評鑑暨醫療品質策 進會（簡稱醫策會）亦將病人安全列為醫院評鑑重點，而台灣醫院協會於九十二年接受衛生署補 助，曾邀請各領域之專家學者及各層級醫院代表，共同研議撰寫病人安全作業指引，在在顯示病 人安全為各界關注的焦點。本研究希望藉由病人安全指標系統之建立，做為國內各醫療院所預防 及監測病人安全之參考指標；期能降低國內醫療疏失率，提供國人更安全之就醫環境。
本研究指標資料之選取是先彙整國內、外病人安全相關指標，透過專家小組討論從339 項病人
安全相關指標中篩選，最後決定問卷指標清單共67 項，再運用修正型德菲法建立專家對病人安
全指標之適用性與指標資料取得難易度之共識，選出適用於台灣之病人安全指標。
研究結果顯示有九成以上的專家認為初步選定之指標是適用的。經德菲法專家問卷後，決定刪除 19 項指標，主要是因指標資料取得難度較高，其中 4 項為專家看法有顯著差異；最後共選定 48 項指標作為病人安全指標系統。其中 20 項指標採用台灣醫療品質指標系列（Taiwan Healthcare Indicator Series, THIS）系統、10 項採用美國醫院協會（American Hospital Association, AHA）系統、7 項採用健康照護研究與品質機構（Agency for Healthcare Quality and Research , AHRQ)系統、另 11 項從 THIS 及台灣醫療品質指標計畫（Taiwan Quality Indicator Project, TQIP）系統中衍生而出。
本研究專家所選定之48 項指標中，焦點皆放在處方簽錯誤(包含醫師開立錯誤與藥師調劑錯 誤)、輸血錯誤、給藥錯誤、感染控制、醫療疏失等方面，顯示專家群非常重視用藥安全與醫療 安全，與美國的醫療照護機構評鑑聯合委員會 (Joint Commission on Accreditation of Healthcare Organization, JCAHO)、行政院衛生署之病人安全目標皆吻合。
而國內醫療界TQIP、THIS 等品質指標之推行已臻純熟，可遵循品質指標之推行與監測模式，
推展至各醫療院所。病人安全指標系統亦可與健保制度結合，以加強各醫療院所重視病人安全，
確保病人擁有安全的就醫環境。
英文摘要
Patient safety has recently become a very important issue in the World Health Organization and also in both developed and developing countries. The Department of Health (DOH) of Taiwan is also dedicated to improving healthcare quality and thus, established its Patient Safety Committee in 2003. Taiwan Joint Commission on Hospital Accreditation (TJCHA) also lists patient safety as its first priority in hospital accreditation. In the same year, Taiwan Hospital Association and DOH invited
professionals from various fields and representatives from hospitals to put together patient safety clinical practice guidelines. The importance of patient safety cannot be overemphasized judging from all these efforts. In this study, we try to establish a patient safety indicator series, which can help Taiwan’s hospitals monitor patient safety, meanwhile, reduce medical errors and ensure a safer healthcare
environment.
We first sort out the related patient safety indicators in this country and
internationally. The next step was to form an expert panel that selected 339 items form our initial listing. Finally, we designed a questionnaire consisting of 67
indicators. We then applied the modified Delphi Technique to build up consensus among experts in terms of validity and reliability so as to come up with the most suitable indicators for Taiwan.
The results demonstrated the experts feel that 90% of the indicators in the questionnaire are applicable. Nineteen indicators were deleted after the modified Delphi round. In the end, we selected 48 items in the final set of patient safety indicators. Of them, 20 indicators were adopted from the Taiwan Healthcare Indicator Series (THIS), 10 indicators from American Hospital Association, 7 indicators from Agency for Healthcare Quality and Research, and 11 indicators were modified from THIS and the Taiwan Quality Indicator Project (TQIP).
Our indicators focus not only on prescription, blood transfusion and medication, but also on infection control and medical malpractice. The results indicated that the expert panel in this study paid great attention to medication safety and medical safety, which coincide with the patient safety objectives of DOH and the Joint Commission on Accreditation of Healthcare Organization of USA.
