杭州市医务人员医疗差错报告的阻碍与促进因素分析

Analysis of the Barriers and Facilitators of Medical Staff's Medical Error Reporting in Hangzhou

目的:调查杭州市医务人员医疗差错报告的现状,分析医务人员医疗差错报告的阻碍与促进因素,为提高医务人员报告医疗差错事件的积极性和主动性提供参考。方法:采用分层抽样法,利用修订后的药物错误报告量表对杭州市一家三级医院、一家二级医院和两家社区卫生服务中心的415名医务人员进行问卷调查,并采用分层线性回归分析医疗差错报告的决定因素。结果:不同年龄、教育程度、职称、医院级别、工作年限的医务人员在医疗差错报告的差异有统计学意义;分层线性回归分析结果显示:促进因素中医务人员医疗差错报告随知识与技能、反馈与支持、行动与影响、努力的得分增加而增加(β=0.070,P<0.05;β=0.160,P<0.001;β=0.110,P<0.001;β=0.265,P<0.001);阻碍因素中医务人员医疗差错报告随焦虑与担心、社会压力的得分降低而增加(β=-0.175,P<0.001;β=-0.248,P<0.001)。结论:杭州市医务人员医疗差错报告水平仍处于较低水平,主要受反馈与支持、努力、焦虑与担心、社会压力的影响。应从建立反馈机制、创造组织无责备文化、构建匿名上报系统等方面提高医务人员医疗差错报告的积极性。

Objective: To investigate the current situation of medical staff’s medical error reporting in Hangzhou, and analyze the barriers and facilitators of medical staff’s medical error reporting, so as to provide references for increasing the enthusiasm and initiative of medical staff in reporting medical errors. Methods: Using stratified sampling method, the revised drug error reporting scale was used to survey 415 medical staff in a third-level hospital, a second-level hospital and two community health service centers in Hangzhou, and the decision factors of medical error reporting were analyzed by stratified linear regression. Results: There were statistically significant differences in medical error reporting among different age, education levels, professional titles, hospital levels and working years. Hierarchical linear regression analysis showed that the medical staff’s medical error reporting was promoted by the increase of knowledge and skills, feedback and support, action and influence, and effort in facilitators(β=0.070,P<0.05;β=0.160,P <0.001. β=0.110,P <0.001;β=0.265,P <0.001). The medical staff’s medical error reporting increased with the decrease of worry and anxiety, social pressure in barriers(β=-0.175, P <0.001;β=-0.248,P <0.001). Conclusion: The level of medical error reporting by medical staff in Hangzhou is still at a low level, mainly affected by feedback and support, effort, anxiety and worry, and social pressure. It is necessary to increase the enthusiasm of medical staff in reporting medical errors in terms of establishing a feedback mechanism, creating an organization’s non-blame culture, and building an anonymous reporting system.