醫療專業人員對醫療異常事件通報系統之認知及態度與其相關因素分析

Abstract

本研究主要在探討醫護人員對於通報制度認知、態度與行為的相關因素，分析影響醫護人員對異常事件通報的關鍵因子。以台灣北部某醫學中心之醫療專業人員進行問卷普查，回收有效問卷為899份，回收率29.7%。主要結果如下： 醫療專業人員對內部通報系統抱持著正面肯定的態度，知道有院內通報系統的受訪者佔全體受訪者之85.9%，又以工作年資十年以上之護理人員為主。而通報比例隨著不良事件情節嚴重度提高。科別中的『其他醫療專科』，執業生涯過去一年遭遇或處理過不良事件，與同意受訪者本身工作安全環境的描述者，會影響醫療專業人員對於內部醫療通報系統之認知。通報意願方面，碩士以上教育程度與科別中的『其他醫療專科』之受訪者意願較為低落。此外，過去一年遭遇或處理過醫療不良事件者與對受訪者本身工作安全環境同意者，對全國性醫療通報系統之通報意願較高。 根據以上結果，本研究提出以下建議：衛生主管機關可加強醫療專業人員對於醫療通報系統之認知與宣導。全國性醫療通報系統除應交由中立第三人執行並應建立有效之監督機制；建議立法機關立法保障通報者與通報機制的安全性。對醫院主管單位，建議提供適當的通報環境與機會，鼓勵同仁對於不良事件提出具體建議。對後續研究者，建議在問卷結構與題目次序方面，如條件題形式，可做些許調整；此外，未來可兼採深度質性訪談方式俾使深入瞭解醫療專業人員真正意向，深入研究探討安全文化與醫療專業人員之通報態度、意願間之關係。

This research aims to examine the knowledge and attitude of medical professionals toward medical incident reporting system and their associated factors. All the medical professionals of a medical center located in northern Taiwan were issued a structured questionnaire. The research collected 899 valid questionnaires, and the response rate is 29.7%. Significant results are as follow: Medical professionals hold positive attitude toward in-house reporting system. Among the respondents, 85.9% were aware of in-house reporting system, especially nursing staff with over ten years of working experience. In addition, reporting rate became higher as damage level rose. With regard to factors influencing medical professionals’ knowledge toward in-house reporting system, those who “were in the departments other than internal or surgery”,” dealt with incident this year”, and “agreed with the description of the safety of their working units” have positive association. As for the attitude toward reporting system, respondents who “had master or PhD degree”, “were in the departments other than internal or surgery” were less willing to report. Moreover, respondents who “dealt with incident this year”, and “agreed with the description of the safety of their working units” were more willing to report to the national reporting system. According to these results, this study provides following suggestions: First, health authority can strengthen the knowledge of medical professionals toward reporting system. The National reporting system should be executed by the third party and the government should set up an efficient monitoring system. Besides, legislative yuan can enact bills to protect the confidentiality of person who file reports. Second, hospital management department should provide appropriate reporting environment to medical professionals, and encourage them to give opinions to incidents. Third, future researcher may modify the sequence of conditional questions; combine in-depth interview to understand the relation between safety culture and the knowledge and attitude of medical professionals.