臺灣博碩士論文加值系統

1999年「To Err Is Human」出版，引發世界各國及我國病人安全之改革。病人安全通報制度旨在鼓勵醫護人員共同參與，發掘醫療環境中跡近錯誤及意外事件之通報，並透過資料分析及管理，提昇病人之安全。但現有文獻鮮少探討病人安全事件通報內容及處理方式，因此本研究分析病人安全通報事件類型與處理方式，並探究醫學中心與區域醫院間可能差異及原因。
本研究以隸屬同一管理系統之四家醫院於九十四年一月至九十五年十一月間，病人安全通報內容之一級資料做為研究主體。以量性與質性分析法進行資料分析。
研究結果發現：(1)醫學中心通報發生地點以公共區居高，區域醫院則以病房居多；因此醫學中心通報案件有較高比例無法歸責所屬人員。通報發生地點及事件歸責人員，皆達統計上顯著差異。(2) 醫學中心立案比率較區域醫院高，達統計上顯著差異。(3)院區專責病人安全通報人員對跌倒、通報內容重複及未陳述事由經過等通報事件，判定不立案一致性較高。(4) 同性質原因類別通報案件在同一院區及跨院區判定不一致者，可能與院內有其他通報系統，以及專責人員對事件定義不瞭解影響判斷有關。
建議醫院內部或全國性的病人安全通報系統，建立單一通報途徑；明確通報定義及處理原則，以降低通報案件立案與處理之差異。通報資料應定期分析以回饋管理者與通報者，修正制度之設計及執行的缺失，以落實病人安全通報制度之功能。

關鍵字：病人安全、病人安全通報制度、醫療品質

The publication of "To Err Is Human" in 1999 spawns patient safety reforms in many countries. Patient safety reporting system is set to encourage medical care professionals in excavating and reporting near-misses and adverse events of patient safety concerns, and through data analyses and management, further enhance the safety of the patients. But the existing literature rarely informs the contents and management of reported data. Therefore, this research aims to analyze the types and processing of reported patient safety events, and explore the possible existence of and reasons for difference in reporting between medical centers and regional hospitals.
Patient safety events reported during Jan.1, 2005 and Nov.30, 2006 of four hospitals under the same management scheme constituted the source of analyses. Both quantitative and qualitative techniques were employed.
The findings are: (1) Patient safety events reported in medical centers are mostly located in public areas without identifiable personnel involved, while the majority reported in regional hospitals are located in wards involving healthcare professionals. Both differences reach statistical significance. (2) Patient safety events reported in medical centers are more likely to be established as official records than are in regional hospitals, which also bears statistical difference. (3)Reports of falls, same events or incomplete information are consistently dismissed by hospitals of either types. (4)Events of the same nature, but processed differently across hospitals or within hospitals at various times, may be ascribed to the availability of other venues of reporting, or inconsistent definition or judgment by the administrative staff.
It is advised that an unified venue for reporting patient safety events be established within an institution or nationwide, as well as better defined meaning and process of the events. Reported events should be regularly analyzed and results conveyed to managers and the reporter, so as to identify the possible flaws in the design or execution of the system and fulfill the functions of patient safety reporting.

Key Word：patient safety, patient safety reporting system, healthcare quality

第一章 緒論…………………………………………………… 1
第一節 研究動機及背景……………………………………… 1
第二節 研究目的……………………………………………… 3
第三節 預期貢獻……………………………………………… 3
第二章 文獻探討……………………………………………… 5
第一節 通報制度……………………………………………. 5
第二節 各國病人安全通報制度……………………………. 9
第三節 病人安全通報制度成功要素及面臨之挑戰………. 15
第四節 文獻小結……………………………………………. 20
第三章 研究方法……………………………………………… 21
第一節 研究架構……………………………………………. 21
第二節 研究資料來源及收集方法…………………………. 22
第三節 資料處理與研究變項定義…………………………. 25
第四節 資料分析方法………………………………………. 27
第五節 研究限制……………………………………………. 28
第四章 研究結果……………………………………………… 29
第一節 通報案件分布………………………………………. 29
第二節 通報案件立案與否分布……………………………. 31
第三節 醫院層級通報案件分布差異………………………. 33
第四節 醫院層級別已立案通報案件差異…………………. 36
第五節 醫院層級別未立案通報案件差異…………………. 39
第六節 通報案件處理差異分析……………………………. 41
第五章 討論…………………………………………………… 43
第一節 個案醫院通報狀況概述……………………………. 43
第二節 個案醫院通報案件分布……………………………. 46
第三節 不同類型組織通報差異…………………………… 50
第四節 不同評鑑層級通報內容處理差異………………… 51
第六章 結論與建議…………………………………………… 54
第一節 結論…………………………………………………. 54
第二節 建議……………………………………………………55
參考文獻………………………………………………………….58

中文部分
石崇良、侯勝茂(2004)‧病人安全之現況與建議‧台灣醫學，8(4)，521-527。
石崇良、侯勝茂、薛亞聖、鍾國彪、蘇喜、廖熏香(2005)‧異常事件通報系統與通報障礙‧台灣醫學，9(1)，63-70。
何蘊芳、吳如琇、林慧玲、楊蕙圓、孫美寶、陳文慧、謝玲玲、黃甄彥、陳燕惠(2005)‧住院處方失誤網路通報系統之建置‧台灣醫學，9(4)，439-447。
邱文達、朱子斌、林曉蕾、林靖瑛、李友專、黃崇謙(2004) ‧病人安全指標之建置，8(4)，535-541。
林恆慶、陳楚杰、許銘恭(2003)病人安全相關議題之探討‧醫院，36(5)，69-77。
侯勝茂、陳欣欣、石崇良(2005)病人安全通報系統之國際趨勢‧台灣醫學，9(1)，48-53。
高純琇、回德仁、陳本源、李炳鈺、謝維清、陳燕惠、王惠珀(2005)‧全國藥物不良反應通報系統‧台灣醫學，9(1)，54-62。
曾慧萍、石崇良、廖熏香、李素華、侯勝茂(2005)‧全國性通報系統之先期測試‧台灣醫學，9(1)，71-78。
財團法人醫院評鑑暨醫療品質策進會http://www.tjcha.org.tw
戴慶吉、侯勝茂(2003)‧建立病患之安全醫療照護環境‧台灣醫學，7(31)，768-773。

英文部分
Agency for healthcare research and quality http://www.ahrq.gov/
Anonymous. (2005). Concern over mandatory reporting, Australian Nursing Journal, 12(10),26.
Anonymous. (2005). New patient safety law to facilitate sharing of medical error data, Health care strategic management, 23(10),8.
Anonymous. (2006). Medical errors, Health management technology, 27(3) ,7.
Aviation safety reporting system http://www.arsa.arc.nasa.gov
Boen, J. L. (2006). Making hospitals safer for Hoosiers：State’s efforts include patient-safety center, error reporting, Knight Ridder Tribune Business News. Washington：May 31,1-3.
Brehm, J., Ruddick, P., Lundquist, T. (2003).The culture of safety, Health Management Technology,24 (7), 41-44.
Cobb, D. (2004) Improving Patient Safety-How Can Information Technology Help?, AORN Journal. 80(2), 295-299.
Coile, R.C. (2001). Quality pays: A case for improving clinical are and reducing medical errors, Journal of Healthcare Management, 46(3), 156-160.
Conn, J. (2005). It’s one step toward quality, Modern Healthcare, 35(32),6-8.
Finkelstein, J. B.(2005). Congress once again debates legislation on patient safety, American Medical News,48(12),5-6.
Gatty, B. (2004). Legislation will create system for voluntary medical error reporting; offers docs safe learning environment, Dermatology Times, 25(9),8-10.
Gillespie, G.. (2004).Identifying Patient Safety Priorities, Health Data Management,12(8),40-45.
Guthrie, P. (2006). US creates blame-free adverse event reporting, Canadian Medical Association Journal,174(1),19-20.
Johnson, K., Hudson, M.A.(2004). Keeping patients safe: an analysis of organizational culture and caregiver training, Journal of Healthcare Management,49(3),171-179.
Kondro, W. (2006). Independent federal safety board needed to prevent adverse events, Canadian Medical Association. Journal, 174(12),1699-1700.
Makeham, M. A., Kidd, M. R., Saltman, D. C. Mira, M., et al. (2006). The Threats to Australian Patient Safety (TAPS) study: incidence of reported errors in general practice, Medical Journal of Australia, 185 (2),95-99.
Mayfield, S. (2006). Improving organizational performance, Hospitals & Health Networks, 80(6).30-31.
Meaney, M.E.,(2004). Error Reduction, Patient Safety and Institutional Ethics Committees, The Journal of Law, Medicine & Ethics, 32(2).358-372.
Morrissey, J. (2004).Patient safety proves elusive, Modern Healthcare, 34 (44), 6-10.
National Aeronautics and Space Administration http://www.nasa.gov/
National Patient Safety Agency http://www.npsa.nhs.nk/
Patient safety reporting system http://www.psrs.ars.nasa.gov/
Pronovost, P. J., Weast, B., Holzmueller, C. G., Rosenstein, B. J. , et al.(2003). Evaluation of the culture of safety：survey of clinicians and managers in an academic medical center, Qual Saf Health,12,405-410.
Runy, L. A.(2004). Quest for quality prize, Hospitals & Health Networks, 78(9), 75-82.
Saracino, S.(2006). Patient Safety: The Changing Face of Error Reporting, Rehabilitation Nursing, 31(2), 52-53.
Stow, J. (2006). Using medical-error reporting to drive patient safety efforts, Association of Operating Room Nurses, AORN Journal, 84(3), 406-421.
Weinstein, R.A., Siegel, J.D., Brennan, P.J. (2005). Infection-Control Report Cards – Securing Patient Safety, The New England Journal of Medicine, 353(3), 225-227.
Weissman, J.S., Annas, C. L., Epstein A. M., Schneider E. C., et al. (2005). Error Reporting and Disclosure Systems: Views From Hospital Leaders, JAMA, 293(11).1359-1366.
Williams,S. K., Osborn, S. S.(2006). The development of the National Reporting and Learning System in England and Wales, 2001-2005. Medical Journal of Australia,184(10),65-68.
World