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研究生:吳麗蘭
研究生(外文):Li Lan Wu
論文名稱:醫院員工對『非懲罰性醫療異常事件通報系統』之認知、態度、行為調查及其實用意含-以臺北市某區域醫院為例
論文名稱(外文):The Cognition, Attitude and Behavior of the Hospital Employees to the Non-punished Medical Incident Event Reporting System - a Case Study of a Regional Public Hospital in Taipei
指導教授:蔡維河蔡維河引用關係
指導教授(外文):Wei-Her Tsai , Ph D.
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:130
中文關鍵詞:醫療品質病人安全醫療異常事件通報制度
外文關鍵詞:medical qualitypatient safetymedical incident eventsreporting system
相關次數:
  • 被引用被引用:6
  • 點閱點閱:712
  • 評分評分:
  • 下載下載:212
  • 收藏至我的研究室書目清單書目收藏:0
摘 要
本研究目的主要針對不同職務別的醫院員工(醫療、護理、醫療技術、行政)在病人安全業務之認知、態度、通報流程進行普查,希望運用調查結果最為未來擬定臨床病人安全推動策略之依據及執行計畫之指導方針。
本研究採橫斷式相關性之研究設計,以台北市某公立區域醫院的員工為研究對象
。調查期間為九十四年十月一日至二十三月,共發放721份問卷,回收有效問卷520份,有效回收率72.1%。在此次受訪職務部門員工中以護理人員居多;其次為醫療部門、醫療技術部門、行政部門。
調查結果顯示:在不同職務部門與個人特性、工作資歷及通報特性變項與病人安全認知、態度、通報行為等確實存在著統計上的顯著相關。且其結果足可作為未來臨床實務推動之依據,及實務意含並建議如下:
一、病人安全認知方面:(1)定期舉辦全院性共通性病人安全教育訓練(明確完整名詞、操作定義)(2)加強醫師人員個別性教育訓練(3)定期舉辦服務禮儀之訓練,重視病人抱怨事件(4)增強醫療糾紛及危機應變之課程。
二、病人安全態度方面:(1)建構資淺員工病人安全觀念(2)設置專責單位加重通報系統的宣導與執行面之落實(3)營造不處罰、隱私、保密的原則之安全文化,鼓勵醫師通報。三、通報流程方面:(1)加強醫師、醫療技術人員實務操作訓練(2)建構線上學習系統,重視系統技術操作及推動執行面(3)成立品質管理中心定期檢討分析
因本研究之取向偏重於實務應用目的,本研究之發現及建議主要針對機構決策管理者,期其首先藉由完整訓練計畫建構病人安全文化,其次訂定說明病人安全制度,以降低系統中不安全的設計、操作及行為,落實通報體制,以期共同確實努力以減少醫療傷害
,提昇安全的醫療品質。
ABSTRACT
The purpose of the study is to investigate the cognition, attitude and reporting behavior of the hospital employees to patient safety for different categories of jobs (such as medical treatment, nursing, medical technique and administration). The inquisitional results were hoped to be the basis and the guiding of policies and plans for implementing clinical patient safety activities in the future.
The study was conducted by cross-sectional study design in a regional public hospital in Taipei form October 1 to October 23, 2005. We interviewed the hospital employees by using the questionnaire developed in the study. A total of 721 questionnaires were delivered, and 520 (72.1%) were returned. Most of the respondents were nurses, followed by the staff of medical treatment, medical technique and administration.
Results indicated that there were significant relationships among the departments of the organization, the characteristics and years of work of the employees, the substance of the reporting system, and the cognition, attitude and reporting behavior of the employees. These results could be the guiding of the actual implementation on patient safety activities in the future, and they gave the following suggestions.
1. From the cognition of patient safety standpoint: (1) Holding the educational training periodically and wholly organizationally to identify the definition of patient safety. (2) Enhancing the individually educational training for doctors. (3) Holding the training courses of service etiquette and take complaint affairs seriously. (4) Increasing the courses focus on medical disputes and crisis handling.
2. From the attitude of patient safety standpoint: (1) Helping the junior staff to construct the notion toward patient safety. (2) Setting up the units responsible for publicizing and executing the reporting. (3) Encouraging the doctors to report medical incident events and constructing the fashion of non-punishment, privacy
and keeping secrete.
3. From the reporting procedure standpoint: (1) Enhancing the training of actual operation for doctors and technical staff. (2) Constructing the on-line learning system and emphasizing on the technical operation and implementation. (3) Establishing the quality management center to examine and analyze the medical incident events periodically.
Since the orientation of the study, it was more focused on the purpose of practical implications. Firstly, this study contributed to suggest police makers to construct the culture of patient safety. Secondly, to build up and explain the patient safety system, we hope to reduce the unsafe design of systems, operation and behavior by completely training programs, so that we can do more effort to reduce medical harm and improve quality of care by implementing the reporting system.

Keyword: medical quality, patient safety, medical incident events, reporting system
目錄
致謝………………………………………………………………………..………………….…Ⅰ
中文摘要………………………………………………………………………..…………….…Ⅱ
英文摘要………………………………………………………………………..…………….…Ⅲ
目錄……………………………………………………………………………………………..…1
圖目次……………………………………………………………………………………………..2
表目次……………………………………………………………………………………………..3
第一章 緒論………………………………………………………………………………………1
第一節 研究背景與動機……………………………………………………………………1
第二節 問題陳述……………………………………………………………………………3
第三節 研究目的……………………………………………………………………………3
第二章 文獻探討…………………………………………………………………………………4
第一節 病人安全……………………………………………………………………..…….4
第二節 醫療異常事件通報………………………………………………………………..22
第三節 國際醫療通報系統的推動實務………….……………………………………….26
第四節 介紹醫療異常事件通報的認知、態度、行為之實證研究……………………..42
第五節 綜合討論……………………………………………………………………..……50
第三章 研究設計與方法………………………………………………………………………..52
第一節 研究設計架構………………………………………………………………..……52
第二節 研究變項與操作定義………………………………………………… .………..54
第三節 研究假說…………………………………………………………………………..56
第四節 研究對象與工具…………………………………………………………………..57
第五節 資料處理與分析………..………..………………………………………………..59
第四章研究結果…………………………………………………………………………………61
第一節 樣本取樣及資料處理與分析………………….………………………………….61
第二節 相關因素與分析………………………….……………………………………….65
第五章 結論……………………………………………………………………………………..89
第一節 本研究之重要研究成果…………………………………………………………..89
第二節 研究限制…………………………………………………………………………..94
第三節 本研究對推動實務之建議……………………………………………………..95
參考文獻 中文部份…………….……………………………………………………………….96
英文部份………………….………………………………………………………….98
附錄 問卷表………………………………………………………………….……..……….…118

圖目次
圖3-1-1 研究架構圖…………………………………………………….………………………53








































表目次
表2-1-1 病人安全定義彙整表…………………………………………………………………6
表2-1-2 病人安全相關名詞得中英議與解釋…………………………………………………10
表2-1-3 醫療疏失的彙整表……………………………………………………………………11
表2-1-4 不良事件定義的彙整表………………………………………………………………12
表2-1-5 醫療過失定義的彙整表……………………………………………………………….12
表2-1-6 醫療不良事件的國際研究及發展…………………………………………………….13
表2-1-7 病人安全的國際發展………………………………………………………………….16
表2-3-1 各國意外事件通報系統執行比較…………………………………………………….31
表2-4-1 影響醫師通報意願的可能因素……………………………………………………….48
表2-4-2 影響護理人員通報意願的可能因素………………………………………………….48
表3-2-1 各研究變項之定義及測量方式說明………………………………………………….55
表4-2-1-1病人安全調查得分比較表……………………………………………………………67
表4-2-2-5 個人屬性與病人安全認知調查得分及重要事項相關關係彙整表…………………69
表4-2-3-5 個人屬性與病人安全態度調查得分及重要事項相關關係彙整表…………………72
表4-2-4-5 個人屬性與通報流程得分及重要事項相關關係彙整表………………………….…74
表4-3-1 個人屬性與病人安全認知態度通報行為調查得分交互相關表…………………..102
表4-1-1 各類別屬性統計百分比…………………………………….………………………..103
表4-1-2 調查樣本概述……………………………………………….…………………….…..104
表4-2-1 病人安全現況調查結果…………………………..…………………………………105
表4-2-2-1 病人安全認知得分與個人特性的交叉分析表……………………………….…….106
表4-2-2-2 病人安全認知得分與工作經歷的交叉分析表…………………………….……….107
表4-2-2-3 病人安全認知得分與通報經歷的交叉分析表……………………………….…….108
表4-2-2-4 病人安全認知得分與部門別的交叉分析表………………………………….…….109
表4-2-3-1 病人安全態度得分與個人特性的交叉分析表……………………………….…….110
表4-2-3-2 病人安全態度得分與工作經歷的交叉分析表……………………………….…….111
表4-2-3-3 病人安全態度得分與通報經歷的交叉分析表…………………………………….112
表4-2-3-4 病人安全態度得分與部門別的交叉分析表……………………………………….113
表4-2-4-1 病人安全通報特性得分與個人特性的交叉分析表……………………………….114
表4-2-4-2 病人安全通報特性得分與工作經歷的交叉分析表……………………………….115
表4-2-4-3 病人安全通報特性得分與通報經歷的交叉分析表……………………………….116
表4-2-4-4 病人安全通報特性得分與部門別的交叉分析表………………………………….117
表5-1 實務推動具體意含表表………………………………..…………………………….…101
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