مقایسه‌ی فرهنگ ایمنی بیمار در پرستاران بیمارستان واسعی سبزوار بین سال‌های 1395 و 1398

زمینه و هدف: یکی از اصول مراقبت سلامت، حفظ ایمنی بیمار می‌باشد. ارزیابی فرهنگ ایمنی بیمار می تواند اطلاعاتی در مورد چگونگی تاثیر ساختارها و فرآیندهای درون سیستم بر نتایج بیمار ارائه نماید. مطالعه حاضر با هدف مقایسه‌ی فرهنگ ایمنی بیمار در پرستاران بیمارستان واسعی سبزوار بین سال‌های 1395 و 1398 انجام شد.روش بررسی: مطالعه‌ی حاضر یک مطالعه توصیفی از نوع تحلیلی است که در دو سال 1395 و 1398 انجام گرفت. 123 نفر از پرستاران بیمارستان واسعی در سال 1395 و 124 نفر از آنان در سال 1398 به روش نمونه‌گیری در دسترس انتخاب شدند. جهت جمع آوری داده‌ها، از پرسشنامه دو قسمتی اطلاعات دموگرافیک و پرسشنامه بررسی فرهنگ ایمنی بیمار (hsopsc) استفاده گردید. تحلیل داده‌ها با نرم افزار spss نسخه 16 و آمار توصیفی، آزمون آماری کای دو، آزمون دقیق فیشر و t مستقل انجام گرفت.یافته‌ها: نمره کلی فرهنگ ایمنی بیمار در سال 1395، 6.9 ± 41.9 و در سطح پایین گزارش شد. همچنین نمره‌ی کلی فرهنگ ایمنی بیمار در سال 1398، 7.7 ± 51.2 و در سطح متوسط بود. در سال 1395، انتظارات و اقدامات مدیریتی بالاترین امتیاز (29.3 ± 63.1) و برخورد غیرتنبیهی کمترین امتیاز (15.6 ± 11.3) را به خود اختصاص دادند. در سال 1398 ابعاد ارتباطات و ارائه بازخورد (23.4 ± 70.6) و برخورد غیرتنبیهی پایین‌ترین امتیاز (24.3 ± 31.8) را در میان ابعاد مختلف فرهنگ ایمنی بیمار به خود اختصاص دادند.نتیجه‌گیری کلی: اگر چه در نمره‌ی کلی فرهنگ ایمنی و برخی از ابعاد آن پیشرفت‌های محسوسی مشاهده می‌شود، هنوز مواردی از ابعاد فرهنگ ایمنی بیمار وجود دارند که مدیران و مسئولین باید در راستای ارتقاء و تقویت آن تلاش نمایند. در این زمینه باید راهبردهای کلی برای بهبود روش‌های ایمنی بیمار و سرمایه گذاری بیشتر در تعیین کننده‌های فرهنگ ایمنی بیمار، مخصوصاً در زمینه‌های یادگیری سازمانی و کار تیمی درون‌سازمانی راهنمایی و اطلاع رسانی شود.

Comparison of the Patient Safety Culture in the Nurses of Vasei Hospital in Sabzevar, Iran (2016-2020)

Background Aims: One of the basic principles of health care is to maintain patient safety. Today, patient safety is a priority for any healthcare system that seeks to ensure and improve the quality of care. Being safe from dangers and injuries when receiving healthcare services is one of the most obvious and fundamental human rights. Despite advances in healthcare, patient safety, and patientcenteredness are still worrying issues around the world. According to the World Health Organization, tens of millions of people die or become disabled annually due to clinical errors or unsafe treatment processes, which is one of the five leading causes of death in the world. Recent reports also show that approximately, 13.5% of hospitalized patients experience at least one adverse event during their hospitalization each year, 44% of which is preventable. The biggest challenge to make the healthcare system safer is changing the culture. Assessing the patient safety culture can provide information on how structures and processes within the system affect patient outcomes. However, the question remains that, given the structure of the existing healthcare system and the fact that in recent years, patient safety has been at the forefront of accreditation of medical centers, has the safety culture been able to find and establish its place in these centers and has the staff of medical centers (especially nurses) paid attention to patient safety culture due to the changes that have taken place in the past years. Therefore, this study was conducted to compare patient safety culture in nurses of Sabzevar Vasei Hospital between 2016 and 2020.Materials Methods: The present study is a descriptiveanalytical crosssectional study that was conducted between 2016 and 2020. 123 nurses of Vasei Hospital were selected in 2016 and 124 were selected in 2020 via convenience sampling. Inclusion criteria were having at least 6 months of work experience and consent to participate in the present study, applied in both 2016 and 2020. A twopart questionnaire was used to collect data. In the first part, the demographic information of the samples including age, gender, field and degree, occupation, type of employment, work experience in the hospital, work experience in the recent ward, working hours per week were examined. The second part of the questionnaire included the Persian version of the Patient Safety Culture Survey (HSOPSC). The questionnaire was designed by American Agency for Healthcare Research and Quality in 2004. In the present study, the questionnaire was given to 10 experts to confirm the validity, and their opinions were applied. The reliability of the questionnaire was investigated in 2016 using Cronbach #39;s alpha coefficient which was between 0.740.81 for safety culture and its various dimensions. This questionnaire has 42 questions designed on a 5point Likert scale ranging from strongly disagree to strongly agree. Therefore, each question was assigned a score of 1 to 5. This questionnaire has 12 dimensions including the frequency of reporting events, the overall perception of safety, managerial expectations and actions, organizational learning, teamwork within the organization, open communication channels, communication and feedback, nonpunitive response to errors, staffrelated work issues, safety management support, teamwork out of the organization, transmission and exchange of information. In this study, after calculating the percentage of positive responses in each dimension (sum of completely agree and disagree options), and based on the questionnaire guide and examining the 12 dimensions, an average positive response of at least 70 indicated optimal safety culture, between 5069 showed a moderate level of safety culture, and below 50 indicated a low level of safety culture. Data analysis was performed using descriptive statistics, chisquare, Fisher #39;s exact test, and independent ttest in SPSS version 16, and the significance level was set at P<0.05.Results: The obtained results regarding the individual characteristics of the study units showed most subjects were women and married. There was no significant difference in terms of demographic characteristics of nurses in 2016 and 2020 (P>0.05). The overall score of patient safety culture in 2016 was 41.9 ± 6.9% which was low, also the overall score of patient safety culture in 2020 was 51.2 ± 7.7% which was moderate. In 2016, expectations and managerial actions had the highest score (63.1 ± 29.3%) and nonpunitive response to errors had the lowest score (11.3 ± 15.6%). In 2020, the dimensions of communication and feedback and nonpunitive response to errors had the highest scores (70.6 ± 23.4% and 31.8 ± 24.3% respectively) among the various dimensions of patient safety culture. The comparison of the mean scores of some dimensions in 2016 and 2020 was also statistically significant (P<0.001). The results showed better performance of some dimensions such as the frequency of reporting, open communication channels, communication and feedback, nonpunitive response to errors, staffrelated work issues, and transmission and exchange of information in 2020 compared to the initial survey in 2016. Regarding the dimensions of organizational learning and teamwork within the organization, the average score was higher in 2016, which was also statistically significant. Comparison of mean changes in other dimensions of the overall perception of safety, management expectations and actions, safety management support, and teamwork outside the organization in 2016 and 2020 were not statistically significant (P>0.05). In 2016, 61% of nursing staff made no errors, which was equal to 47.6% in 2020and is not statistically significant. Also in 2016, 12.2% of patients reported the safety of the ward to be very good or excellent, which was 26.6% in 2020, and is statistically significant (P<0.05).Conclusion: The findings of the study indicate that while there are significant improvements in the overall score of safety culture and some of its dimensions, there are still dimensions of patient safety culture that managers and officials should strive to improve and strengthen. In this regard, general strategies for further improvement of patient safety practices and more investment in determinants of patient safety culture, especially in the areas of organizational learning and teamwork within the organization, should be guided and informed. Also, regular management and assessment of patient safety can enable hospitals to better understand and perform more efficiently.