影響醫院不同職類異常事件通報之障礙與動機

Barriers and Motivators of Reporting Adverse Events for Medical Professionals

目的：找出影響異常事件通報的重要因素，更進一步探討，在醫師、護理、醫技、行政等不同工作型態間，影響異常事件通報意願的因素是否不同。方法：本研究為橫斷面研究，樣本來自北部某醫學中心。抽樣方式為分層隨機抽樣，測量工具參考國外研究自行發展問卷。統計方式以描述性統計及Forward logistic regression models為主，並使用SPSS 26進行分析。結果：對醫師而言，會提升醫師通報意願的因素為，「知道如何使用異常事件通報系統」（OR, 95% confidence interval（C.I.）: 9.7,1.7-54.2）、「通報系統操作的方便性」（OR,95% confidence interval（C.I.）:8.3,1.2-56.9）。會降低醫師通報意願的因素為，「通報耗時導致延遲下班」（OR, 95% confidence interval（C.I.）:0.1,0.0-0.6）、「目前異常事件通報不是匿名的」（OR, 95% confidence interval（C.I.）:0.3,0.1-0.6）。對護理師而言，會提升護理師通報意願的因素為，「主管／院內支持我通報異常」（OR, 95% confidence interval（C.I.）:4.4,1.9-10.1）。會降低護理師通報的因素為，「擔心被責難」（OR, 95% confidence interval（C.I.）:0.4,0.2-0.8）、「通報後要寫檢討報告」（OR, 95% confidence interval（C.I.）:0.2,0.1-0.5）。對醫技人員而言，會提升其通報意願的因素為，「通報系統操作的方便性」（OR,95% confidence interval（C.I.）:4.4,1.1-16.6）、「有明確的獎勵制度支持通報異常事件」（OR, 95% confidence interval（C.I.）:4.3,1.3-14.0）。會降低其通報的因素為，「打斷工作」（OR, 95% confidence interval（C.I.）:0.1,0.0-0.5）。對行政人員而言，會提升其通報意願的因素為，「應通報之異常事件認知正確率」（OR, 95% confidence interval（C.I.）:27.2,2.8-263.2）。會降低其通報的因素為，「通報系統介面需輸入太多資料」（OR, 95% confidence interval（C.I.）:0.2,0.0-0.7）。結論：在不同職類間，影響異常事件通報的因素不同，此發現對於醫療機構的管理及未來改善措施的介入，提供了更明確的改善方向。

Purpose: This study sought to identify the determinants of affecting adverse events (AEs) reporting among different occupations. Methods: This study was a cross-sectional study with samples stratified randomly from a medical center in northern Taiwan. The total sample size was 423 with 80.3% response rate. The measurement instrument was a self-developed questionnaire with Content Validity Index (CVI) of 0.92. Descriptive statistics and forward logistic regression models were used as the main statistical methods. All statistical analyses were performed using SPSS version 26. Results: ＂Knowing how to use the AE reporting system＂ (OR, 95% confidence interval (C.I.): 9.7,1.7-54.2) and ＂the accessibility of the reporting system＂ (OR, 95% confidence interval (C.I.): 8.3,1.2-56.9) were the factors that would enhance physicians' willingness to report AEs. The factors that would attenuate the willingness of physicians to report were the ＂time consuming of reporting AE resulting in overtime work＂ (OR, 95% confidence interval (C.I.): 0.1,0.0-0.6) and how ＂the reporting system is non-anonymous＂ (OR, 95% confidence interval (C.I.): 0.3,0.1-0.6). ＂When supervisors support them to report AEs＂ (OR, 95% confidence interval (C.I.): 4.4,1.9-10.1), nurses' willingness to report would increase. Being ＂scared to be blamed＂ (OR, 95% confidence interval (C.I.): 0.4,0.2-0.8) and being ＂asked to write a report after reporting AEs＂ (OR, 95% confidence interval (C.I.): 0.2,0.1-0.5) were reasons that would lower nurses' intention to report AEs. ＂Accessibility of the reporting system＂ (OR, 95% confidence interval (C.I.): 4.4,1.1-16.6) and ＂a concrete reward system to support AEs reporting＂ (OR, 95% confidence interval (C.I.): 4.3,1.3-14.0) were causes that would encourage medical personnel to report AEs. Conversely, ＂interruption in work＂ (OR, 95% confidence interval (C.I.): 0.1,0.0-0.5) would decrease the willingness to report. The administration staff would be more willing to report with greater ＂understanding of reportable AEs＂ (OR, 95% confidence interval (C.I.): 27.2,2.8-263.2). Additionally, the ＂need to key in too much information in this reporting system＂ (OR, 95% confidence interval (C.I.): 0.2,0.0-0.7) decreased their willingness to report. Conclusions: This study revealed that the factors affecting willingness of AEs report differed among occupations at hospital. These findings will provide us a direction for future improvement.