基层医院患者安全文化现状及其影响因素调查分析

摘要

目的 调研基层医院患者安全文化现状及其影响因素,为促进基层医院患者安全文化提升提供进一步证据支持.方法 2014年7—12月选取北京大学第三医院延庆医院所有医务人员,采用一般资料调查表及医院患者安全文化测评量表(HSOPSC)对医务人员进行调查,采用单因素及多元线性回归分析HSOPSC总分及各维度得分的影响因素.结果 发放问卷932份,回收有效问卷661份,有效回收率为70.9%.HSOPSC结果显示,仅有1个维度,"科室之间协作"的积极反应率>75.00%,为优势区域,积极反应率<50.00%的维度有5个,分别为"对错误的非惩罚性反应""人员配置""沟通的开放性""不良事件上报频率""对患者安全的总体感知",为待改进区域.有90.8%(600人)的医务人员对患者安全的总体评价进行了应答,其中192人(32.0%)评价为"极好"或"好",353人(58.8%)评价为"可接受",55人(9.2%)评价为"不好"或"极不好".有94.9%(627人)医务人员对过去12个月上报的不良事件数目进行了应答,397人(63.3%)过去12个月没有上报任何不良事件,136人(21.7%)过去12个月上报1~2起不良事件,51人(8.1%)过去12个月上报3~5起不良事件,25人(4.0%)过去12个月上报6~10起不良事件,6人(1.0%)过去12个月上报11~20起不良事件,12人(1.9%)过去12个月上报≥21起不良事件.多元线性回归分析结果显示,岗位与医务人员HSOPSC总分有回归关系;工作年限与医务人员HSOPSC沟通的开放性维度得分有回归关系;性别、岗位与医务人员HSOPSC不良事件上报频率维度得分有回归关系;学历、岗位与医务人员HSOPSC交接班及转科维度得分有回归关系;岗位、周工作时长与医务人员HSOPSC对患者安全的管理支持维度得分有回归关系;岗位、工作年限与医务人员HSOPSC对错误的非惩罚性反应维度得分有回归关系;性别、岗位与医务人员HSOPSC对患者安全的总体感知维度得分有回归关系;年龄、岗位、工作年限、周工作时长与医务人员HSOPSC人员配置维度得分有回归关系;性别与医务人员HSOPSC管理者促进患者安全的期望与措施维度得分有回归关系;性别与医务人员HSOPSC科室之间协作维度得分有回归关系;学历、岗位与医务人员HSOPSC科室内团队合作维度得分有回归关系(P<0.05).结论 基层医院患者安全文化状况欠佳,需要改进,尤其是在对错误的非惩罚性反应、人员配置、沟通的开放性、不良事件上报频率、对患者安全的总体感知等维度上提升空间较大.%Objective To investigate the patient safety culture in primary hospitals in order to provide an evidence for formulating strategies to improve the patient safety culture in these settings. Methods This cross-sectional study was carried out between July and December 2014. All the health care providers in Peking University Third Hospital Yanqing Hospital were selected as the participants and surveyed by Demographic Questionnaire and the Chinese version of Hospital Survey on Patient Safety Culture (HSOPSC). Univariate and multiple linear regression analyses were performed to investigate the associated factors for the total scores of HSOPSC and scores of its dimensions. Results Totaled 661 questionnaires were responded validly with a response rate of 70. 9% (661 / 932). The results of the survey showed that,only the assessment of " Teamwork across hospital departments" obtained a response rate higher than 75. 00%,indicating this dimension was superior;5 dimensions including "Nonpunitive response to error" " Staffing" " Communication openness" " Frequency of events reported" " Overall perceptions of safety" with a response rate less than 50. 00% needed improvement. There were 90. 8% (600 / 661)of the participants assessing the " Patient safety grade" . Of them,32. 0% (192 / 600)rated it as " Excellent" or " Very good",58. 8%(353 / 600)rated it as " Acceptable",9. 2% (55 / 600)rated it as " Poor" or " Failing" . Totaled 94. 9% (627 / 661)of the participants answered the question of the number of events reported in the past 12 months. Among them,63. 3% (397 / 627)had not reported any events,21. 7% (136 / 627)had reported 1-2 events,8. 1% (51 / 627)had reported 3-5 events,4. 0%(25 / 627)had reported 6-10 events,1. 0% (6 / 627)had reported 11-20 events,and 1. 9% (12 / 627)had reported 21 or more events. Multiple linear regression analysis found that,position was the associated factor for the total scores of HSOPSC (P <0. 05);years of working was the associated factor for the scores of " Communication openness" (P < 0. 05);sex and position were significantly associated with the scores of " Frequency of events reported" (P < 0. 05);educational attainment and position were notably associated with the scores of " Hospital handoffs & transitions" (P < 0. 05);position and working hours per week were substantially associated with the scores of " Hospital management support for patient safety" (P < 0. 05);position and years of working were the associated factors for the scores of " Nonpunitive response to error" (P < 0. 05);sex,position were the associated factors for the scores of " Overall perceptions of safety" (P < 0. 05);age,position,years of working and working hours per week were the associated factors for the scores of " Staffing" (P < 0. 05);sex was the associated factor for the scores of " Supervisor/ manager expectations & actions promoting patient safety" (P < 0. 05);sex was the associated factor for the scores of " Teamwork across hospital departments" (P < 0. 05);educational attainment and position were the associated factors for the scores of " Teamwork within departments" (P < 0. 05). Conclusion The patient safety culture in Peking University Third Hospital Yanqing Hospital is unsatisfactory,which needs further improvement especially in such dimensions as "Nonpunitive response to error" " Staffing" " Communication openness" " Frequency of events reported" " Overall perceptions of safety" .