환자안전 향상을 위한 우선순위

김수경(Sukyeong Kim) 대한약학회 2020 약학회지 Vol.64 No.3

Priority means precedence in right or rank and is set for resource allocation in patient safety targeting efforts to obtain the maximum benefit for the patients and the public. This research aims to understand Korean patient safety priorities in researches and activities supporting better social efforts for patient safety improvement. When Korean priority of patient safety research has been done using WHO’s global patient safety research priorities with patient safety experts, the result shows the mixed priorities of developed country type and developing country type. ‘Lack of communication and coordination’, ‘poor patient safety culture’ etc were similar to developed countries high ranks. But ‘health care associated infections’ and ‘extent and nature of the problem of patient safety’ were get high ranks similar to developing countries. ‘Effect of work pressure on safety’ ranks the highest in Korea compare to any other country types. This priority results were similar to another priority research for patient safety standards and indicators development which showed high ranks for ‘manpower levels’ and ‘patient identification and communication supporting technologies’. ‘Adverse drug events’ related incidents showed commonly high in priorities, incident rates, and reporting rates through studies and Korean Patient Safety reporting and learning system. But there was discrepancy between the patient safety priorities and governmental support. Therefore, it will be needed for patient safety improvement not only investment from hospitals and government focusing on high priority areas including manpower shortage & workload, communication technologies, and adverse drug events but also priority information sharing and periodic priority re-setting.

환자안전과 보건의료기술평가

이상일 한국보건의료기술평가학회 2016 보건의료기술평가 Vol.4 No.1

Patient safety becomes a major health policy issue since the Institute of Medicine report, To Err is Hu- man. Patient Safety Act shall come into operation on the 29th of July 2016 in Korea. This law empha- sizes the importance of shared learning based on voluntary, confidential, and non-punitive reporting of patient safety incidents at the national level. In addition patient safety indicators and standards will be introduced after enforcing this law. Recently several policies around patient safety issues (for exam- ple, limiting resident duty hour and expanding the coverage of telemedicine) are under debate. With this change in healthcare policy environment, more technology assessment activities in the field of pa- tient safety will be needed. In this context producing and synthesizing evidence for patient safety prac- tices will be one of very important areas for health technology assessment (HTA) in Korea. Patient safety issues come not only from traditional clinical areas (e.g., adverse drug events, surgical complica- tions) and emerging clinical areas (e.g., provider fatigue, information transfer), but also from non- medical approach (e.g., information technology, human factors research). But little is known about many patient safety technologies. This may be attributed to several factors; the relatively weak infra- structure for patient safety HTA; the rapid introduction of patient safety technologies; differences in HTA methodology between typical biomedical technologies and patient safety technologies. Increased government funding for supporting patient safety research in Korea will contribute to more patient safety HTA, leading to evidence-based policy making for patient safety.

Patient Participation in Patient Safety and Its Relationships with Nurses' Patient-Centered Care Competency, Teamwork, and Safety Climate

황지인,김성완,진호준 한국간호과학회 2019 Asian Nursing Research Vol.13 No.2

Purpose: This study's aim was to examine degrees of patient participation in patient safety activities in hospitals and to investigate their relationships with nurses' patient-centered care competency (PCC), teamwork, and safety climate. Methods: A cross-sectional study designwas used. Data were collected with 479 nurses from two general hospitals in Seoul, Korea, using a questionnaire designed to collect data on patient participation in patient safety activities, PCC, teamwork perceptions, and safety climate. The response rate was 74.1% (N = 355). Data were analyzed using descriptive statistics and multiple logistic regression analysis. Results: The mean score for patient participation was 2.76 ± 0.46 of 4.0. The mean scores for PCC, teamwork, and safety climate were 3.61 ± 0.46, 3.64 ± 0.41, and 3.35 ± 0.57 of 5.0, respectively. Nurses who experienced high patient participation in patient safety activities ( 3.0) had higher scores for PCC, teamwork, and safety climate. Multiple logistic regression analysis revealed that PCC (OR = 2.31, 95% CI = 1.14e4.70) and safety climate (OR = 2.51, 95% CI = 1.09e5.78) scores were the significant factors associated with patient participation. Conclusion: The degree of patient participation in patient safety activities was not high. Nurses' PCC, teamwork, and safety climate were positively related with patient participation. In particular, the findings indicate that enhancing nurses' competency for patient-centered care and creating a strong safety climate are important to promote patient participation for safer health care.

의사와 간호사의 환자안전교육 경험에 관한 포커스 그룹 연구

박정윤,이유라,이의선,이재호,Park, Jeong-Yun,Lee, Yu-Ra,Lee, Eu-Sun,Lee, Jae-Ho 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.2

Purpose:This study aims to understand and explore the subjective experiences of patient safety education among health care professionals in developing a patient safety curriculum in South Korea. Methods: A qualitative descriptive study was conducted through two focus group interviews in the period October-December 2018. Eleven participants who underwent patient safety education participated in each session. All interviews were recorded and transcribed as spoken, and qualitative content analysis was used to identify categories of discussion depicting participants' subjective experience with patient safety education. Results: A total of three categories and seven themes were identified out of 77 units of analysis. Topics were identified in the dimensions of a patient safety curriculum, as follows: (1) activities for patient safety; (2) principle of patient safety (five rights, ethics, patient participation) and patient participation; (3) leadership, teamwork, and communication; and (4) reporting and learning system for patient safety events. In the dimension of methods, (5) case and evidence-based education and (6) multidisciplinary and small group teaching were identified. Finally, in the dimension of the system, (7) policies for patient safety education were identified. Conclusion: Our findings indicate that patient safety education is a significant area for health care professionals. Health care professionals suggested that a systematic patient safety curriculum would improve their knowledge and attitude toward patient safety. Moreover, it enables them to better construct a safety environment in a hospital.

Near Miss 사고 예방 활동과 환자안전관리 문화형성이 환자안전에 미치는 영향

장호석,이귀원,Chang, Ho-Suk,Lee, Gui-Won 대한핵의학기술학회 2010 핵의학 기술 Vol.14 No.2

급변하는 의료환경 속에서도 변함없이 의료기관들은 환자 안전관리 부분의 중요성을 인식하여 관리하고 있다. 하지만 현재 환자안전관리는 사후관리와 처벌이 강조된 프로세스들로 조직원들의 참여성이 결여된 문제를 보이고 있다. 본원 핵의학과 에서는 참여형 니어미스 사고예방 활동을 시행하여 환자안전사고에 사전관리를 시작하고 사고보고에 따른 불이익이 없는 시스템을 구축하여 니어미스 감소 와 환자안전사고 제로화를 목적으로 본 연구을 시작하였다. 또한 핵의학과만의 차별화된 환자안전관리System구축도 그 목적으로 하고 있다. 1. 팀원들의 과거 니어미스 및 현재 발생되고 있는 니어미스와 사고 사례수집(1차 자료수집). 2. 설문을 통해 중요도, 긴급도를 파악하고 니어미스 및 사고사례를 정량화(2차 자료수집). 3. 자료 분석을 통한 중요 접점 파악과 사고 사례 정량화. 4. 중요 접점 부분에 대한 매뉴얼 제작과 표준화, 오류방지를 위한 참여형 개선활동 시행. 5. 니어미스 보고체계 구축을 위한 웹 기반 커뮤니티 활동. 6. 설문과 FGI를 통해 활동 전후 평가 시행. 1) 비계량적이었던 핵의학과 내 안전사고 및 니어미스를 계량화(월 50여 회의 니어미스와 년 1건의 안전사고발생) 2) 계량화된 데이터를 통해 개선방안을 수립(0여건의 참여형 개선활동, 프로세스 개선, 표준화를 위한 약속 매뉴얼 제작) 3) 안전문화 시스템을 형성하고 팀원들의 높은 관여도를 형성.(보고체계구축, 체크리스트 제작, 안전문화 슬로건 제작, 평가 인덱스 구축) 4) 니어미스 및 사고 사례를 공유하고 반면교사로 삼기 위한 커뮤니티 개설. 5) 활동 전후 니어미스 발생률은 50% 감소 하였고 안전사고 제로. 핵의학과의 최고의 서비스는 환자안전이 보장된 양질의 검사와 치료를 제공하는 것이다. 참여형 개선활동으로 니어미스사고를 예방하고 안전문화를 형성하여 시스템을 구축함으로써 니어미스 발생 사례는 50% 줄었으며 안전사고는 발생하지 않았다. 이는 환자안전사고의 사전관리란 측면에서도 시사하는 바가 있다. 또한 불이익이 없는 사고보고체계도 마련하여 솔직하게 보고하고 인정하는 문화도 만든 계기가 되었다. 기본에 충실한 뛰어난 시스템은 환자에게 제공되는 최고의 서비스이며 형성된 안전문화 시스템은 결국 고객만족으로 이어질 것이다. 따라서 본원 핵의학과 에서는 마련된 시스템을 정착하고 안정시켜 차별화된 환자안전문화를 형성해 나가고자 한다. Purpose: Despite the rapidly changing healthcare environment, healthcare organizations have recognized the importance of patient safety management. But patient safety management has the problem of the lack of participation of members due to the process of focusing on the follow-up service and punishment. The department of nuclear medicine in Uijeongbu St. Mary's Hospital started this research to reduce the near miss and prevent patient safety accidents by both initiating the participatory near-miss-proof activities as an advance management and constructing a system without disadvantages of reporting. In addition, this research aims to establish a differentiated patient safety management system in the department of nuclear medicine. Materials and Methods: 1. Colleting cases of team members' past and present near miss and accidents(First data collection). 2. Quantifying the cases of near miss and accidents after identifying the degree of importance and urgency through surveys(Second data collection). 3. Quantifying cases and indentifying important points of contact through data analysis. 4. Making and standardizing a manual for important points of contact, and initiating participatory activities to prevent errors. 5. Activating web-based community for establishing the report system of near miss. 6. Estimating the result of before and after activities through surveys and focus group interviews. Results: 1) Quantified safety accidents and near miss in the department of nuclear medicine. About 50 near misses a month and one safety accident a year. 2) Establishing improvement measurements based on quantified data. About 11 participatory activities, the improvement of process, a manual for standardization. 3) Creating a system of safety culture and high participation rate of team members. Constructing a report system, making a check list and a slogan for safety culture, and establishing assessment index. 4) Activating communities for sharing the information of cases of near misses and accidents. 5) As the result of activities, the rate of near miss occurrence declined by 50% and the safety accident did not happen. Conclusion: The best service in the department of nuclear medicine is to provide patients with safety-guaranteed high-quality examination and cure. This research started from the question, 'what is the most faithful-to-the-basics way to provide the best service for patients?' and team members' common answer for this question was building a system with participation of all members. Building a system through the participatory improvement activities for preventing near miss and creating safety culture resulted in the 50% decline of near miss occurrence and no accident. This is a meaningful result from the perspective of advance management for patient safety. Moreover, this research paved the way for creating a culture to report and admit near miss or accidents by establishing a report system with no disadvantage of reporting. The system which sticks to the basics is the best service for patients and will form a patient safety culture system, which will lead to the customer satisfaction. Therefore, all members of the department of nuclear medicine will develop a differentiated patient safety culture with stabilizing the established system.

환자안전 관련 법의 구조와 현황

옥민수 ( Min Su Ock ),김장한 ( Jang Han Kim ),이상일 ( Sang Il Lee ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.3

This paper reviewed structure and current status of laws related to patient safety using patient safety law matrix to promote system-atic approach in legal system of patient safety. Laws related to patient safety can be divided into three areas: laws for preventing; laws for knowing about; and laws for responding. In the case of Korea, gaps are especially prominent in the areas of laws for know-ing about and responding. Patient safety law which will be enacted in July 2016 will fill the gap in the area of laws for knowing about. This law will be comprehensive law, covering the full spectrum of laws related to patient safety. However, after reviewing cur-rent patient safety law in Korea, the following drawbacks were identified: absence of code for grasping the current patient safety level; absence of code for mandatory reporting in patient safety reporting system; and absence of code for privilege about patient safety work product. Furthermore we need wider discussions about covering issues of open disclosure, apology law, coroners sys-tem, and complaint management system in patient safety law.

Effects of Fatigue, Nursing Information Competency, Job Control, job demand and Patient Safety Culture on Patient Safety Management Activities of Longterm-care Hospital Nurses

Mi Sun Lee,Hee Kyung Kim 한국성인간호학회 2021 성인간호학회 학술대회 Vol.2021 No.8

Aim(s): Most of the inpatients in longterm-care hospitals are patients with chronic diseases elderly people who have difficulties in daily life due to cognitive impairment, high demands for nursing and care, and patients with high safety accidents. Longterm-care hospitals nurses, who play an important role in patient safety, have a high risk of safety accidents as the number of patients is set at 6, which is lower than the 2.5 patients per nurse, the legal workforce of general hospitals. Therefore, patient safety management activities that identify, improve, and prevent problems that occur or may occur during the patient's treatment process are important. It is necessary to understand the factors affecting the patient safety management activities of Longterm-care hospitals nurses. Method(s): This study is a descriptive correlation study. The study subjects were 217 nurses from 19 longterm-care hospitals in C-city. Data analysis was performed by descriptive statistics, t-test, ANOVA, Scheffe test, Pearson’s correlational coefficients, and stepwise multiple regression. Result(s): The average age of nursing home nurses is 47.59±10.44 years. The average of fatigue was 4.40 out of 7, nursing information competency 3.36 out of 5, job control 3.63 out of 5, job demand 2.80 out of 5, patient safety culture 3.64 out of 5 Point, patient safety management activity was 4.38 out of 5 points. Patient safety management activities were positively related to nursing information competency (r=.28, p<.001), job control (r=.47, p<.001), patient safety culture (r=.57, p<.001) and there was a negative correlation with fatigue (r=.-.13, p=.050). The Subject of Job control (β=.43, p=.008), job demands (β=-.19, p=.006), and patient safety culture (β=.45, p<.001) are important for patient safety management activities. It is an influencing variable and 48.4% explained patient safety management activities. Conclusion(s): In order to promote patient safety management activities of nursing hospital nurses, it is necessary to develop nursing intervention programs that control their duties, reduce job demands, and promote patient safety culture.

환자안전사고 정보매체가 간호대학생의 환자안전에 대한 지식, 인식, 수행자신감에 미치는 영향

천의영(Eui Young Cheon),유장학(Jang Hak Yoo),김해진(Haejin Kim) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.12

본 연구는 간호대학생을 대상으로 정보매체를 통한 환자안전사고 노출 정도와 학생들의 환자안전관련 지식, 인식, 수행자신감의 관계를 알아보기 위해 시행되었다. 연구의 대상자는 일개 여대의 간호학과에 재학 중인 대학생으로 서면동의 서를 작성한 학생 348명 중 불충분한 설문지를 제외하고 337부를 자료 분석에 활용하였다. 자료수집은 2018년 6월 4일에서 12일까지 이루어졌으며 수집된 자료는 SPSS 21.0프로그램을 활용하여 기술 통계, t-test, one-way ANOVA, Pearson"s correlation coefficient 방법으로 분석되었다. 연구결과 대상자의 환자안전에 대한 지식은 평균 6.43점, 인식은 평균 41.02점, 수행자신감은 평균 39.61점이었으며 TV와 인터넷 매체를 통해 환자안전사고에 노출된 정도는 각 1.25점과 1.35점으로 나타났다. 환자안전 지식은 연령, 학년, 환자안전 교육 경험에 따라 통계적으로 유의한 차이를 보였으며, 환자안전 인식은 전공만족도에 따라, 환자안전 수행자신감은 학년, 환자안전 교육 경험, 전공만족도에 따라 통계적으로 유의한 차이를 보였다. TV를 통한 환자안전사고 정보매체의 노출 정도는 지식(r=.32, p<.000), 수행자신감(r=.21, p<.000)과, 인터넷을 통한 정보매체의 노출 정도는 지식(r=.34, p<.000), 인식(r=.12, p=.028), 수행자신감(r=.24, p<.000)과 유의한 순상관관계를 보였다. 본 연구 결과를 바탕으로 임상실습 전부터 학생들에게 환자안전에 대한 체계적인 교육을 제공할 뿐 아니라 정보매체를 통해 전달되는 환자안전사고와 같은 이슈에 비판적 사고를 가지고 접근할 수 있는 환자안전 교육프로그램을 개발, 적용하고 그 효과를 평가하는 추후 연구를 제언하는 바이다. The aim of this study was to identify how information media about patient safety incidents influences nursing students" knowledge, perception, and confidence in performance toward patient safety. A total of 337 nursing students agreed to participate in this study. Data were collected from the participants between June 4 and June 12, 2018. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, and Pearson"s correlation coefficient with SPSS 21.0. Participants" scores for knowledge, perception, and performance confidence toward patient safety were 6.43±1.92, 41.02±4.35, and 39.61±5.89, respectively. Patient safety knowledge was significantly different according to age, grade, and patient safety education experience. Patient safety perception was significantly different according to satisfaction with the major, patient safety performance confidence showed statistically significant differences according to grade, patient safety education experience, and major satisfaction. Information media exposure to patient safety incidents on TV and knowledge (r=.32, p<.000) and performance confidence (r=.21, p<.000) toward patient safety had positive correlations. Information media exposure to patient safety incidents on the internet and knowledge (r=.34, p<.000), perception (r=.12, p=.028), and performance confidence (r=.24, p<.000) toward patient safety also had positive correlations. This study provides basic data for nursing education and program development for patient safety management.

Clinical Nurses’ Patient Safety Competency, Systems Thinking, and Missed Nursing Care: A Cross-Sectional Survey

Hyoung Eun Chang,Milisa Manojlovich 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aims: Patient safety competency of nurses, along with systems thinking, are important nurse attributes. Missed nursing care is known to negatively impact patient safety. However, how nurses" patient safety competency and systems thinking relate to missed nursing care is unknown. The aims of this study were to examine the relationships among patient safety competency, systems thinking and missed nursing care. Methods: A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals from two different regions in South Korea. A total of 480 clinical nurses (240 from each hospital) were recruited. Questionnaires were distributed to nurses participating in direct nursing care in general and special units. Patient safety competency, systems thinking, and missed nursing care were measured using reliable and valid instruments. Data from 432 nurses were analyzed. Multiple linear regression was used to analyze associations among patient safety competency, systems thinking, and missed nursing care. Results: Higher patient safety competency of nurses was associated with lower missed nursing care. The patient safety competency skills sub-scale had a significant negative association with missed nursing care. Systems thinking mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care. Conclusions: The knowledge, skills, and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.

임상실습 경험이 있는 간호대학생의 환자안전관리 행위에 영향을 미치는 요인

박진경(Park Jin Kyoung),서임선(Seo Im Sun) 학습자중심교과교육학회 2020 학습자중심교과교육연구 Vol.20 No.20

본 연구는 임상실습 경험이 있는 간호대학생의 비판적사고 성향, 환자안전에 대한 지식, 환자안전에 대한 태도, 환자안전에 대한 자신감 및 환자안전관리 행위 수준을 조사하고 환자안전관리 행위에 영향을 미치는 요인을 규명하고자 실시되었다. 연구 수행을 위한 자료는 2018년 3월부터 6월까지 I지역과 G지역의 2개 대학 간호학과 3학년과 4학년 학생 227명으로부터 자가 보고식 설문조사를 통해 수집되었다. 조사결과 대상자의 비판적사고 성향은 3.64점, 환자안전에 대한 지식은 4.95점, 환자안전에 대한 태도는 3.49점, 환자안전에 대한 수행자신감은 4.09점, 환자안전관리 행위 점수는 4.29점이었다. 임상실습 경험이 있는 간호대학생의 환자안전관리 행위에 영향을 미치는 요인은 성별, 환자안전에 대한 태도 및 환자안전에 대한 수행자신감 이었으며, 이러한 요인들은 환자안전관리 행위를 33.3%(p<.001) 예측하였다. 환자안전관리 행위는 임상 실무에서 지속적으로 강조되고 있으므로 학부과정에서도 간호대학생의 환자안전에 대한 지식과 태도 및 수행 자신감을 향상 시킬 수 있는 체계적인 교육과정 개발이 필요하다. This study is to examine the level of critical thinking disposition, knowledge of patient safety, attitude of patient safety, confidence of patient safety and patient safety management activity(PSMA), and identify influencing factors on PSMA of nursing students. Data were collected by self-report questionnaires from 227 nursing students in third and fourth year at nursing colleges located in Incheon and Gangwon province from March to Jun in 2018. The level of critical thinking disposition was 3.64, knowledge of patient safety was 4.95, attitude of patient safety was 3.49, confidence of patient safety was 4.09 and PSMA was 4.29. Influencing factors on PSMA of nursing students were gender, attitude of patient safety and confidence of patient safety. The factors predicted PSMA as 33.3%(p<.001). Patient safety management activities are increasingly emphasized in clinical practice, so it is necessary to develop a systematic curriculum that can increase knowledge, attitude and self-confidence.