| PrefaceWorld Health Organization(WHO)defines patient safety as "reducing the unnecessary injury related to health care to an acceptable minimum risk control process".Singer put forward the "hospital safety culture" and it can be understood that making the Hippocrates maxim “first do no harm” integrated into every unit of the organization,injected into each of the operational norms,that is,putting “security” to the highest priority of a behavior.This kind of safety culture can make public commitment to society and put into practice every day.The American Institute of Medicine(IOM,Institute of Medicine)defines adverse events as the result of injuries caused to patients by medical errors,which ultimately result in prolonged hospitalization,disability and even death,and are divided into preventable and unpreventable adverse events.Preventable adverse events include the accidents caused by the human factors of medical personnel and the equipment accidents caused by the failure of the repair and the maintenance,unpreventable events include the inevitable injury events caused by the correct operations of medical personnel and the normal running of equipments.In 1999,the Institute of Medicine reported that 44,000-98,000 people in the United States died from preventable medical errors each year.In 2000 a British study showed that the incidence of injuries to hospitalized patients caused by adverse events was 10%,resulting in an economic loss of 3.2 billion pounds.At present,there are different reports on the incidence of adverse events in the world,studies in the United States,Australia and the United Kingdom and other studies have shown that the incidence of adverse events in hospitalized patients were between 3.5% to 16.6%,on average,among 10 hospitalized patients,there was 1 person suffering from some preventable adverse events;each year,due to preventable adverse events,as many as 6 billion to 29 billion dollars are required for hospitalization once again,litigation compensation,hospital-acquired infection,loss of family or personal income,physical disability,etc..The medical safety problem not only causes the patient to suffer greatly,but also brings the unnecessary huge economic burden to the governments.According to the reports from the World Health Organization,the problem of patient safety in developing countries is more acute and severe due to the lack of medical infrastructure,the relative scarcity of resources,poor management capacity,limited personal skills and lack of funds.In our country,at least 2.5 million of the more than 50 million hospitalized patients had adverse drug reactions,and the unreasonable drug users accounted for 12% to 32% of all the drug users,while the suffering and the attendant additional medical costs were disastrous.As a result,medical risks not only cause serious harm to the patients,but also increase the unnecessary financial burden to the governments and patients.At present,the common method of evaluating safety culture is the questionnaire survey.The questionnaires for evaluating safety culture include: Hospital Survey on Patient Safety Culture(HSOPSC),Safety Attitudes Questionnaire(SAQ),Patient Safety Climate in Healthcare Organizations(PSCHO),etc.In this study,we adopted the Chinese version of the Safety Attitudes Questionnaire(SAQ),which was translated and revised by Xi Xiuming.The scale,developed by Sexton JB,includes 6 dimensions and 36 items,32 items are in the 6 dimensions,4 items are outside the dimensions,each item was scored by the Likert 5-level scoring method.This study added another two items from the Taiwan version,they are "Administrators encourage the reporting of medical adverse events in this clinical area” and “Managers prioritize safety training programs in this clinical area”,respectively.The scale is widely used in many countries around the world,and it is proved to have good reliability and validity when used in the medical staffs of our country,and it is a good measuring tool to study safety attitude.The scales evaluating adverse events mainly include: the dimension of adverse event reporting frequency in the Hospital Survey on Patient Safety Culture(HSOPSC),adverse events report habit questionnaire,developed by Vincent and revised by Evans,adverse event report intent questionnaire,developed by Terry,adverse events report obstacle questionnaire,developed by Vincent and revised by Evans,adverse events report cognitive questionnaire,developed by Vincent and revised by Evans,adverse events report cognitive questionnaire,developed by Liang Huiyu and adapted by Lu Xiuwen,nursing staff adverse events report cognitive and attitude questionnaire,developed by Wilson and translated and revised by Lian Min,etc.In this study,we used the frequency of adverse event reporting in the Hospital Survey on Patient Safety Culture(HSOPSC)and it was translated and revised by Tian Huanhuan.Adverse events report habit questionnaire,developed by Vincent and revised by Evans,adverse event report intent questionnaire,developed by Terry,adverse events report obstacle questionnaire,developed by Vincent and revised by Evans,adverse events report cognitive questionnaire,developed by Vincent and revised by Evans.Adverse event report frequency questionnaire has 4 items and they were scored by the Likert 5 scoring method.Adverse event reporting habit Questionnaire has 4 items and they were scored by the Likert 5 scoring method.Adverse event report intention questionnaire has 15 items,option 1 was scored by 1,2 and 3 are scored by 0.The adverse events report habit questionnaire has 22 items and they were scored by the Likert 5 method.The adverse events report cognition questionnaire has 8 items,option 1 was scored by 1,2 and 3 are scored by 0.The higher the overall scales scores,the better the report condition of adverse events.At present,the research on patient safety in our country started late,in the existing cross-sectional study the sample size was small,so the sample can not represent a region's safety culture,and the intervention research on safety culture in other places except Beijing was blank.Therefore,the sample in this study included the medical staffs of 10 departments of 9 tertiary hospitals located in 5 representative cities in Liaoning province.In this study the safety attitudes questionnaire,the adverse event reporting frequency,reporting habit,reporting intention,reporting obstacle and report cognition questionnaire were used as tools,at first we described the safety attitudes of the medical staffs in nine tertiary hospitals.Then we took one of the hospitals as an example,the intervention work of safety culture was carried out in that hospital in 2017,and the effect of the interventions was evaluated by the safety attitudes questionnaire and the adverse event report frequency questionnaire,etc.The research results are valuable for improving the safety attitude of medical staff and improving the quality of safety culture intervention work.ObjectiveTo know about the safety attitudes of medical staffs in the tertiary hospitals in Liaoning province,to evaluate the effect of the safety culture interventions carried out in Shengjing Hospital,and to know about the frequency,habit,intention,obstacle and cognition of the adverse event report in Shengjing hospital.Methods 1 Research Objects 1 Objects in the cross-sectional research: from July to September in 2017,we chose nine tertiary hospitals in five representative cities in Liaoning Province(Shenyang,Dalian,Anshan,Fushun and Jinzhou),we chose the medical staffs who have formally worked in their organizations for at least one month for the study,at last 2,584 medical staffs conducted a cross-sectional survey on the safety attitudes.2 The objects in the safety attitudes intervention research: we chose the medical staffs who have officially worked or studied for more than 1 months in Shengjing Hospital of China Medical University,we chose 607 medical staffs in March,310 medical staffs in June and 300 medical staffs in December,2017,then we used the safety attitudes questionnaire to investigate.3 Adverse Events Report Intervention Research objects: we chose the medical staffs who have officially worked or studied for more than 1 months in Shengjing Hospital of China Medical University,we chose 310 medical staffs in June,300 medical staffs in December,then used adverse events report questionnaires to survey.2 Methods Methods: Cross sectional survey and comprehensive safety culture interventions were used in this study.The research indices were the scores of the questionnaires.1 Safety Attitudes: we used the SAQ to measure.The dimensions include teamwork climate,safety climate,job satisfaction,stress recognition,perception of management and working environment,there were 32 items,and 6 items were outside the six dimensions.Each item was scored by the five point Likert rating method.The higher the scores were,the better the safety attitudes were.2 Adverse event reporting frequency: we used the frequency of adverse events report dimension in the questionnaire HSOPSC to measure.There were four items,the first three items were scored by the five point Likert rating method.Higher scores indicated higher frequency of adverse event reports.3 Adverse event reporting habit: we used the adverse event report habit questionnaire to measure.There were four items,all of them were scored by the five point Likert rating method.Higher scores mean better adverse event report habit.4 Adverse event reporting intention: we used the adverse events report intention questionnaire to measure.There were fifteen items,option 1 means 1 point,options 2 and 3 mean 0 point.Higher scores mean better adverse event reporting intention.5 Adverse event reporting obstacle: we used the adverse events report obstacle questionnaire to measure.There were twenty two items,all of them were scored by the five point Likert rating method.Higher scores mean less adverse event report obstacle.6 Adverse event reporting cognition: we used the adverse event report cognition questionnaire to measure.There were eight items,option 1 means 1 point and options 2 and 3 mean 0 point.Higher score mean better adverse event report cognition.7 Demographic characteristicsSex,age,education degree,type of position,function,technical title,working hours in this hospital,working hours in this department,average working hours per week,and whether or not received the patient safety training course.3 Statistical analysisSPSS16.0 software and Amos17.0 software were used to analyze the data.1 Evaluation of the reliability and validity of the SAQWe used the SPSS16.0 software to analyze the internal consistency to evaluate the reliability of the SAQ.The Amos17.0 software was used to evaluate the structure validity of single factor and multiple factors in the 6 dimensions of the SAQ by confirmatory factor analysis.2 Analysis on the demographic factors affecting the safety attitudes of caregivers:SPSS16.0 software was used to describe the demographic characteristics of the caregivers and to analyze the influence of demographic characteristics on safety attitudes.Taking the safety attitudes scores as the dependent variable and taking the demographic characteristic as the independent variable,the multivariate linear regression was used to study the influencing factors of the safety attitudes.3 Differences of the safety attitude scores and the positive response percentages in different hospitalsWe used SPSS16.0 software to analyze the data,the differences of the safety attitude scores and the differences of the positive response percentages in different hospitals were compared by Kruscal-wallis H test and Chi-square test.4 Comparison results of the scores of SAQ and the scores of the adverse event reporting frequency questionnaires before and after the safety culture interventions.Mann-Whitney U test,Kruskal-Wallis H test and Chi-square test were used to compare the differences between the scores of the SAQ and the adverse event reporting frequency scales before and after the implementation of safety culture interventions and to evaluate the effect of the interventions.Results 1 Evaluation of the reliability and the validity of the SAQThe values of the Cronbach ' alpha of the different dimensions and the total scale ranged from 0.751 to 0.938,these results indicated that the SAQ had good reliability.Through the confirmatory factor analysis the model fitting effect indices were: the values of the GFI ranged from 0.882 to 0.997,the values of the TLI ranged from 0.879 to 0.995,the values of the CFI ranged from 0.923 to 0.997,the values of the RMSEA ranged from 0.051 to 0.191.The results showed that the structure validity of the SAQ were good.2 The influence of demographic factors on the safety attitude scoresThe standard regression coefficients of the factor gender ranged from 0.056 to 0.079,the standard regression coefficients of the factor age ranged from-0.101 to 0.045,the standard regression coefficients of the factor education degree ranged from-0.101 to 0.045,the standard regression coefficients of the factor type of positions ranged from 0.061 to 0.105,the standard regression coefficient of the factor function was 0.079,the standard regression coefficients of the factor years in this hospital ranged from-0.084 to-0.078,the standard regression coefficients of the factor whether participated in patient safety training ranged from-0.189 to-0.078.3 Differences existed in the safety attitude scores and the positive response percentages in different hospitals There were statistically significant differences between the scale scores and between the positive response percentages in the 9 hospitals,p<0.05.4 The scores of the SAQ were significantly different before and after the patient safety interventions.In the different demographic factors,the SAQ scores and the positive response percentages in different departments were significantly different in March,June and December.For the total scale,the SAQ scores in June were significantly higher than those in March,the SAQ scores in December were significantly lower than those in June,but significantly higher than those in March.For the positive response percentages,the comparison results showed that only for the teamwork climate dimension,the percentages in June were significantly higher than those in December.5 The scores of the adverse events report frequency,etc.showed significantly different before and after the safety culture interventions.There were increases in the scores of the reporting frequency and reporting habit in the ten departments,for the scales reporting intentions,reporting barriers and reporting cognition,the scores in December were significantly higher than those in June.Conclusion 1 The safety attitudes of the caregivers in the tertiary hospitals in Liaoning province were good,but the caregivers needed to reduce work pressure.2 After the safety culture interventions,the safety attitudes of the most caregivers in Shengjing hospital were significantly improved,but few departments needed long time interventions to accomplish the significant improvement of the safety attitudes,and the intervention measures achieved simple success.3 After the safety culture interventions,adverse event reporting frequencies,adverse event reporting habits turned to be better than before,adverse event reporting intention improved significantly,adverse event reporting obstacles reduced significantly,adverse events report cognition turned to be significantly better than before,the safety culture was better than before,the intervention measures achieved initial success. |
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